Last month, I discussed the first two points made in my March 2013 blog post,  Nurses: Five Ways Health Reform Affects You..  I compared observations about health reform with current developments and implications for nurses.  This post wraps up the discussion with the remaining three points from 2013.

Three: Value-Based Purchasing

The pay-for-performance provisions implemented in 2012 by Medicare per health reform continue to operate as I reported in 2013.  In January 2015, for the first time in the history of Medicare, the US Department of Health and Human Services (HHS) established goals for value-based purchasing.  By 2016, the goal is to tie 85% of all traditional Medicare payments to quality or value, increasing to 90% by 2018.

The growing reliance on performance and performance measures makes high-quality nursing care more important than ever.  Nursing care has always been crucial to the bottom line of the hospital or other health care setting.  Value-based purchasing only intensifies the need for nurses to demonstrate their important contributions to improving patient care quality.

Four:  Emphasis on Care Coordination

In 2013, I mentioned the initiative creating Accountable Care Organizations (ACOs).  As of June 2014 there are an estimated 626 ACOs, including Medicare ACOs and ACOs with commercial contracts.  These ACOs serve more than 20 million covered lives.   Close to 70% of Americans now live in areas served by ACOs.

More and more nurses are or will be working in hospitals or other health settings that are part of an ACO.  Home health agencies and long-term care facilities need nurses who can see “the big picture” of a patient’s entire episode of care, as do hospitals.

Five: Full Scope of Practice 

Although not written into the health reform law, I stated in 2013 that current health policy supports all professional nurses working at their full scope of practice.  Currently, restrictive laws continue for nurse practitioners in 33 states, but nurses continue to advocate for expansions to practice.  As more and more Americans become insured and seek health services, shortages in primary care will likely help turn the tide on unnecessary restrictions to full scope of nursing practice.

Nurses must continue to advocate for full scope of practice.  Professional organizations such as the American Nurses Association (ANA) allow nurses to have a voice in national and state policies.  Political involvement and voting reinforce nurse advocacy at national, state and local levels.


Whether a nurse supports or opposes the Affordable Care Act, the ongoing implementation of health reform has an impact in many health care settings where nurses work.   Nurses can add their voices to advocate for their profession and for their patients as health reform changes health care delivery, and undergoes changes over time.

Susan J. Penner, RN, MN, MPA, DrPH, CNL, is the author of Economics and Financial Management for Nurses and Nurse Leaders, Second Edition (2013) and adjunct faculty at the University of San Francisco School of Nursing and Health Professions.