Health care reform

Health Care Reform (The Affordable Care Act)

                                                           

Health Care Reform (The Affordable Care Act)

                                                                                                                                                                          “ANA believes that health care is a basic human right (ANA, 1989, ANA, 1998, ANA 2005). Thus, ANA reaffirms its support for a restructured health care system that assures universal access to a standard package of essential health care services for all citizens and residents.”

  • “ANA believes that the development and implementation of health policies that reflect the six Institute of Medicine (IOM) aims (Safe/Effective/Patient-centered/Timely/Efficient/Equitable) and are based on outcomes research will ultimately save money.”
  • “The system must be reshaped and redirected away from the overuse of expensive, technology-driven, acute, hospital-based services in the model we now have, to one in which a balance is struck between high-tech treatment and community-based and preventive services, with emphasis on the latter. The solution is to invert the pyramid and focus more on primary care, thus ultimately requiring less costly secondary and tertiary care.”

Activity:

Please read the attached Health Policy Brief on Basic Health Program and “Nursing’s Role in healthcare reform” from American Nurse Today. 

Please go to www.rnaction.org, go to the Take Action tab above to access the following information regarding health care reform and the new Affordable Care Act. Scroll down the page to the heading Resources and Supreme Court Challenge to learn more about the health care reform and how it affects you as a nurse and as an individual with a family. Check out all the different information. 

HealthCare.gov 

Keeping health care reform healthy, patients informed

New Animation Explains Changes Coming for Americans Under Obamacare (7/13)

Health Care Transformation: The Affordable Care Act and How it Affects Nurses (3/12)

Health Care Reform Legislation Timeline 

ANA Policy and Provisions of Health Reform Law

National Conference of State Legislatures Health Reform Site

Kaiser Family Foundation Health Reform Page

The Supreme Court Decision Matters for Registered Nurses, their Families, and their Patients  

ANA Analysis: Supreme Court Arguments on the ACA

ANA to Supreme Court: ‘Individual Mandate’ Needed to Make Health Reform Work

 

 Then proceed to the Kaiser Foundation to watch the following: http://kff.org

““Health Care Reform Hits Main Street on the Kaiser Foundation website or Youtube. (2010)

“New Animation Explains Changes Coming to Americans under Obamacare” (2013) Youtube or Kaiser Foundation

Health insurance Explained: YouToons Have it Covered” (2014) Youtube or Kaiser Foundation

If you would like more information regarding the ACA, the Kaiser Foundation is a great source and cover many issues.  http://kff.org

Link:   

http://kff.org/health-reform/press-release/new-animation-explains-changes-coming-for-americans-under-obamacare/

Discussion

After viewing the video and reading the articles, reviewing the information and links provided, discuss your thoughts about the new health care reform.  Some discussion points might be how the ACA is affecting nurses and nursing practice?  How will ACA help control costs and improve quality of care? How will the ACA help eliminate some of the variations that currently exists among states in terms of access, quality, and cost of care? What is your state doing in regards to the Exchange Program and/or expansion of Medicaid? What are the challenges now for health care reform if it is not repealed by the next congress?  Please share your own personal or professional experiences regarding the ACA, along with any new information, websites or videos that you think would add to the discussion. These are just some guidelines, but remember this is a scholarly post and should demonstrate critical reflection of the problem to promote vigorous discussion of the topic among your peers. Your response to a peer should be more than “I agree or disagree”.

 Additionally, your initial post must be posted by midnight Saturday  to allow time for responses by group members.  Failure to do initial post by Saturday at midnight will result in a 2 point deduction from your score for that discussion. You must also respond to at least 2 other postings in your group by midnight Monday to receive the full point assignment. 

 

 

Practice Matters —

Nursing’s role in healthcare reform

By Susan Hassmiller, PhD, RN, FAAN

THE 2010 healthcare re-

form act (Patient Protection

and Affordable Care Act, or

PPACA) gives nurses new

opportunities to deliver care

and play an integral role in

leading change. (See http://championnursing.org/ sites/default/files/nursingandhealthreformlawtable.pdf.) Understanding these opportunities is just the first step. We need to know how we can be part of the solution to achieve better patient outcomes at a more reasonable cost. We need to do more to prevent disease; provide chronic care management to an aging, sicker, and more diverse population; and offer end-of-life care that em- phasizes comfort and compassion. Across all settings— especially geriatrics—we must do more to prepare our- selves for the future.

In this article, I outline nine challenges that individual nurses and our profession must address if we are to help lead our country to a healthcare system that is more equitable and provides a higher quality of care. (For a flowchart of these challenges, see Nurse’s role in reforming healthcare.)

1. Use nurse-led innovations. Nurses know how to expand access to care and improve quality at lower cost. We’ve developed innovative care models to prove it, including nurse-managed health clinics, home visiting programs for low-income mothers, and the Transitional Care Model (TCM). By emphasizing the use of master’s-prepared nurses to oversee care from the hospital to within the home, this model has reduced rehospitalizations for elderly patients with multiple chronic conditions. Research shows that us- ing the TCM helps patients achieve better long-term health outcomes and avoid repeat hospitalizations, all at a reduced cost. We need more nurses to devel- op innovations. (For good examples to follow, visit www.aannet.org/i4a/pages/index.cfm?pageid=3303.)

2. Generate evidence and engage in research.

Nurses play important roles as innovators who help shape quality and safety. Successful models aren’t born, implemented, or sustained without solid effec- tiveness data. It’s up to all nurses to collect and track data to improve their own practice as part of broader efforts to improve care. Nursing research

helps build the scientific foundation for clinical prac- tice, prevention, and im- proved patient outcomes. We must support nurse re- searchers through adequate

funding. The Robert Wood Johnson Foundation (RWJF) is doing this by funding the Interdisciplinary Nursing Quality Research Initiative, a program that links evidenced-based nursing care to improved pa- tient outcomes.

3. Redesign nursing education. All nurses need to possess basic competencies to meet the demands of an aging and diverse society, with an emphasis on clinical training in multiple settings across the lifes- pan. The emphasis should be on quality and safety, evidence-based practice, research, and leadership. Several RWJF programs are working to incorporate these concepts into nursing education, including Quality and Safety in Nursing Education, the New Jersey Nursing Initiative, and the Nurse Faculty Scholars program. Therefore, we need to remove barriers to attaining baccalaureate and advanced degrees, such as by strengthening partnership links between community colleges and upper-division de- gree-granting institutions and all academic institu- tions and practice organizations. The RWJF-funded Center to Champion Nursing in America is providing technical assistance to help with academic progres-

Find out about new opportunities for nurses—and the challenges we must address to maximize our contribution to healthcare reform.

Nurse’s role in reforming healthcare

Develop nurse-led innovations

Generate evidence

Redesign education

Embrace technology

Diversify our workforce

Expand scope of practice

Foster interprofessional relationships

Develop leadership at every level

Be at the table

68 American Nurse Today Volume 5, Number 9

www.AmericanNurseToday.com

 

sion. A standardized residency program would give nurses on-the-job learning and would better prepare them for clinical practice. Certification and continu- ous learning opportunities are essential to a profes- sion that’s responsible for others’ lives.

4. Expand the scope of practice. Advanced practice nurses (APNs) must be allowed to practice to the full extent of their education and licensure. Working with physicians, they can provide cost-effective care and help address the primary care shortage. Howev- er, statutory and regulatory barriers prevent them from practicing to the full extent of their licensure. With 32 million Americans about to re-

make the changes necessary to improve ineffectual systems. Physicians and administrators must sup- port nurses in their efforts. Most of all, nurses need to help each other through mentoring, educational and skills development opportunities, and support networks.

9. Be at the table. As the healthcare professionals most actively engaged in direct patient care, nurses are positioned to provide leadership in all healthcare areas, including developing systems to reduce med- ical errors, improving quality, providing better care coordination, increasing access to care, and averting

ceive health insurance under PPACA, it’s crucial that APNs be permitted to provide the primary care they’re trained to give.

Teamwork and collaboration are critical to seamless high-quality care.

5. Diversify our workforce. Approximately

33% of our population belongs to a racial

or ethnic minority group, and by 2042 mi-

norities will account for a majority of the

U.S. population. To reduce health dispari-

ties, greater efforts must be made to ensure that the nursing workforce reflects patients’ diverse back- grounds and cultural values. Furthermore, all nurses should be educated to provide culturally competent care. Finally, we need to bring more men into the profession. The goal of RWJF’s New Careers in Nurs- ing program is to provide scholarships to students from diverse backgrounds to attain baccalaureate and masters degrees.

workforce shortages. Yet clinical experience isn’t enough. To serve as successful and knowledgeable board or committee members, nurses must be famil- iar with governance, strategy, fundraising, financial systems, health law, and policy. Always say “yes” when asked to be at the table. If you believe you’re ready but haven’t been asked, then ask to be in- volved in a board or committee of interest. Nurse Leaders in the Boardroom, another RWJF program, is working to bring more nurses into leadership positions at the local, state, and national levels.

At the end of her life, Florence Nightingale said, “May we hope that when we are all dead and gone, leaders will arise who have been personally experi- enced in the hard, practical work, the difficulties and the joys of organizing nursing reforms, and who will lead far beyond anything we have done.”

Take her words to heart and prepare yourself to contribute to the reforms that will take place in our lifetime. We have much to contribute. *

Selected references

Nightingale F. Sick nursing and health nursing. In: Billings JS, Hurd HM, eds. Hospitals, Dispensaries and Nursing: Papers and Discussions in the International Congress of Charities, Correction and Philanthropy. Sec- tion III, Chicago, June 12-17, 1893. Baltimore, MD: The Johns Hopkins Press, 1894.

Transitional Care Model. http://transitionalcare.info/ToolQual-1801.html. Accessed August 3, 2010.

U.S. Department of State, Bureau of International Information Programs. U.S. minorities will be the majority by 2042, Census Bureau says. www.america.gov/st/peopleplaceenglish/2008/August/20080815140005x lrennef0.1078106.html. Accessed August 3, 2010.

Susan Hassmiller is Senior Advisor for Nursing at the Robert Wood Johnson Foundation in Princeton, New Jersey.

  1. Embrace technology. We must learn to use the newest medical technology and electronic documen- tation systems to improve quality. Nursing schools should use simulation labs and take advantage of online classes to educate more students. Nurses are frequent technology users; more of us need to be at the table to help make decisions about designing and purchasing the technologies that help patients the most. The RWJF Technology Drill Downs pro- gram provides a process that enables nurses to iden- tify and apply technology solutions to improve pa- tient care.
  2. Foster interprofessional collaboration. Team- work and collaboration are critical to seamless high- quality care. The process begins with understanding the roles and responsibilities of each healthcare dis- cipline. Understanding—and the trust it fosters— must start in joint nursing and medical school train- ing programs, and continue as a cultural norm in practice settings.
  3. Develop leadership at every level. Nurses should have the opportunity to take on leadership activi- ties whether they practice at the bedside or sit in the boardroom. They must believe they are capable and fully empowered to provide excellent care and

www.AmericanNurseToday.com

September 2010 American Nurse Today 69

                                                                                                              “ANA believes that health care is a basic human right (ANA, 1989, ANA, 1998, ANA 2005). Thus, ANA reaffirms its support for a restructured health care system that assures universal access to a standard package of essential health care services for all citizens and residents.”

  • “ANA believes that the development and implementation of health policies that reflect the six Institute of Medicine (IOM) aims (Safe/Effective/Patient-centered/Timely/Efficient/Equitable) and are based on outcomes research will ultimately save money.”
  • “The system must be reshaped and redirected away from the overuse of expensive, technology-driven, acute, hospital-based services in the model we now have, to one in which a balance is struck between high-tech treatment and community-based and preventive services, with emphasis on the latter. The solution is to invert the pyramid and focus more on primary care, thus ultimately requiring less costly secondary and tertiary care.”

Activity:

Please read the attached Health Policy Brief on Basic Health Program and “Nursing’s Role in healthcare reform” from American Nurse Today. 

Please go to www.rnaction.org, go to the Take Action tab above to access the following information regarding health care reform and the new Affordable Care Act. Scroll down the page to the heading Resources and Supreme Court Challenge to learn more about the health care reform and how it affects you as a nurse and as an individual with a family. Check out all the different information. 

HealthCare.gov 

Keeping health care reform healthy, patients informed

New Animation Explains Changes Coming for Americans Under Obamacare (7/13)

Health Care Transformation: The Affordable Care Act and How it Affects Nurses (3/12)

Health Care Reform Legislation Timeline 

ANA Policy and Provisions of Health Reform Law

National Conference of State Legislatures Health Reform Site

Kaiser Family Foundation Health Reform Page

The Supreme Court Decision Matters for Registered Nurses, their Families, and their Patients  

ANA Analysis: Supreme Court Arguments on the ACA

ANA to Supreme Court: ‘Individual Mandate’ Needed to Make Health Reform Work

 

 Then proceed to the Kaiser Foundation to watch the following: http://kff.org

““Health Care Reform Hits Main Street on the Kaiser Foundation website or Youtube. (2010)

“New Animation Explains Changes Coming to Americans under Obamacare” (2013) Youtube or Kaiser Foundation

Health insurance Explained: YouToons Have it Covered” (2014) Youtube or Kaiser Foundation

If you would like more information regarding the ACA, the Kaiser Foundation is a great source and cover many issues.  http://kff.org

Link:   

http://kff.org/health-reform/press-release/new-animation-explains-changes-coming-for-americans-under-obamacare/

Discussion

After viewing the video and reading the articles, reviewing the information and links provided, discuss your thoughts about the new health care reform.  Some discussion points might be how the ACA is affecting nurses and nursing practice?  How will ACA help control costs and improve quality of care? How will the ACA help eliminate some of the variations that currently exists among states in terms of access, quality, and cost of care? What is your state doing in regards to the Exchange Program and/or expansion of Medicaid? What are the challenges now for health care reform if it is not repealed by the next congress?  Please share your own personal or professional experiences regarding the ACA, along with any new information, websites or videos that you think would add to the discussion. These are just some guidelines, but remember this is a scholarly post and should demonstrate critical reflection of the problem to promote vigorous discussion of the topic among your peers. Your response to a peer should be more than “I agree or disagree”.

 Additionally, your initial post must be posted by midnight Saturday  to allow time for responses by group members.  Failure to do initial post by Saturday at midnight will result in a 2 point deduction from your score for that discussion. You must also respond to at least 2 other postings in your group by midnight Monday to receive the full point assignment. 

 

 

Practice Matters —

Nursing’s role in healthcare reform

By Susan Hassmiller, PhD, RN, FAAN

THE 2010 healthcare re-

form act (Patient Protection

and Affordable Care Act, or

PPACA) gives nurses new

opportunities to deliver care

and play an integral role in

leading change. (See http://championnursing.org/ sites/default/files/nursingandhealthreformlawtable.pdf.) Understanding these opportunities is just the first step. We need to know how we can be part of the solution to achieve better patient outcomes at a more reasonable cost. We need to do more to prevent disease; provide chronic care management to an aging, sicker, and more diverse population; and offer end-of-life care that em- phasizes comfort and compassion. Across all settings— especially geriatrics—we must do more to prepare our- selves for the future.

In this article, I outline nine challenges that individual nurses and our profession must address if we are to help lead our country to a healthcare system that is more equitable and provides a higher quality of care. (For a flowchart of these challenges, see Nurse’s role in reforming healthcare.)

1. Use nurse-led innovations. Nurses know how to expand access to care and improve quality at lower cost. We’ve developed innovative care models to prove it, including nurse-managed health clinics, home visiting programs for low-income mothers, and the Transitional Care Model (TCM). By emphasizing the use of master’s-prepared nurses to oversee care from the hospital to within the home, this model has reduced rehospitalizations for elderly patients with multiple chronic conditions. Research shows that us- ing the TCM helps patients achieve better long-term health outcomes and avoid repeat hospitalizations, all at a reduced cost. We need more nurses to devel- op innovations. (For good examples to follow, visit www.aannet.org/i4a/pages/index.cfm?pageid=3303.)

2. Generate evidence and engage in research.

Nurses play important roles as innovators who help shape quality and safety. Successful models aren’t born, implemented, or sustained without solid effec- tiveness data. It’s up to all nurses to collect and track data to improve their own practice as part of broader efforts to improve care. Nursing research

helps build the scientific foundation for clinical prac- tice, prevention, and im- proved patient outcomes. We must support nurse re- searchers through adequate

funding. The Robert Wood Johnson Foundation (RWJF) is doing this by funding the Interdisciplinary Nursing Quality Research Initiative, a program that links evidenced-based nursing care to improved pa- tient outcomes.

3. Redesign nursing education. All nurses need to possess basic competencies to meet the demands of an aging and diverse society, with an emphasis on clinical training in multiple settings across the lifes- pan. The emphasis should be on quality and safety, evidence-based practice, research, and leadership. Several RWJF programs are working to incorporate these concepts into nursing education, including Quality and Safety in Nursing Education, the New Jersey Nursing Initiative, and the Nurse Faculty Scholars program. Therefore, we need to remove barriers to attaining baccalaureate and advanced degrees, such as by strengthening partnership links between community colleges and upper-division de- gree-granting institutions and all academic institu- tions and practice organizations. The RWJF-funded Center to Champion Nursing in America is providing technical assistance to help with academic progres-

Find out about new opportunities for nurses—and the challenges we must address to maximize our contribution to healthcare reform.

Nurse’s role in reforming healthcare

Develop nurse-led innovations

Generate evidence

Redesign education

Embrace technology

Diversify our workforce

Expand scope of practice

Foster interprofessional relationships

Develop leadership at every level

Be at the table

68 American Nurse Today Volume 5, Number 9

www.AmericanNurseToday.com

 

sion. A standardized residency program would give nurses on-the-job learning and would better prepare them for clinical practice. Certification and continu- ous learning opportunities are essential to a profes- sion that’s responsible for others’ lives.

4. Expand the scope of practice. Advanced practice nurses (APNs) must be allowed to practice to the full extent of their education and licensure. Working with physicians, they can provide cost-effective care and help address the primary care shortage. Howev- er, statutory and regulatory barriers prevent them from practicing to the full extent of their licensure. With 32 million Americans about to re-

make the changes necessary to improve ineffectual systems. Physicians and administrators must sup- port nurses in their efforts. Most of all, nurses need to help each other through mentoring, educational and skills development opportunities, and support networks.

9. Be at the table. As the healthcare professionals most actively engaged in direct patient care, nurses are positioned to provide leadership in all healthcare areas, including developing systems to reduce med- ical errors, improving quality, providing better care coordination, increasing access to care, and averting

ceive health insurance under PPACA, it’s crucial that APNs be permitted to provide the primary care they’re trained to give.

Teamwork and collaboration are critical to seamless high-quality care.

5. Diversify our workforce. Approximately

33% of our population belongs to a racial

or ethnic minority group, and by 2042 mi-

norities will account for a majority of the

U.S. population. To reduce health dispari-

ties, greater efforts must be made to ensure that the nursing workforce reflects patients’ diverse back- grounds and cultural values. Furthermore, all nurses should be educated to provide culturally competent care. Finally, we need to bring more men into the profession. The goal of RWJF’s New Careers in Nurs- ing program is to provide scholarships to students from diverse backgrounds to attain baccalaureate and masters degrees.

workforce shortages. Yet clinical experience isn’t enough. To serve as successful and knowledgeable board or committee members, nurses must be famil- iar with governance, strategy, fundraising, financial systems, health law, and policy. Always say “yes” when asked to be at the table. If you believe you’re ready but haven’t been asked, then ask to be in- volved in a board or committee of interest. Nurse Leaders in the Boardroom, another RWJF program, is working to bring more nurses into leadership positions at the local, state, and national levels.

At the end of her life, Florence Nightingale said, “May we hope that when we are all dead and gone, leaders will arise who have been personally experi- enced in the hard, practical work, the difficulties and the joys of organizing nursing reforms, and who will lead far beyond anything we have done.”

Take her words to heart and prepare yourself to contribute to the reforms that will take place in our lifetime. We have much to contribute. *

Selected references

Nightingale F. Sick nursing and health nursing. In: Billings JS, Hurd HM, eds. Hospitals, Dispensaries and Nursing: Papers and Discussions in the International Congress of Charities, Correction and Philanthropy. Sec- tion III, Chicago, June 12-17, 1893. Baltimore, MD: The Johns Hopkins Press, 1894.

Transitional Care Model. http://transitionalcare.info/ToolQual-1801.html. Accessed August 3, 2010.

U.S. Department of State, Bureau of International Information Programs. U.S. minorities will be the majority by 2042, Census Bureau says. www.america.gov/st/peopleplaceenglish/2008/August/20080815140005x lrennef0.1078106.html. Accessed August 3, 2010.

Susan Hassmiller is Senior Advisor for Nursing at the Robert Wood Johnson Foundation in Princeton, New Jersey.

  1. Embrace technology. We must learn to use the newest medical technology and electronic documen- tation systems to improve quality. Nursing schools should use simulation labs and take advantage of online classes to educate more students. Nurses are frequent technology users; more of us need to be at the table to help make decisions about designing and purchasing the technologies that help patients the most. The RWJF Technology Drill Downs pro- gram provides a process that enables nurses to iden- tify and apply technology solutions to improve pa- tient care.
  2. Foster interprofessional collaboration. Team- work and collaboration are critical to seamless high- quality care. The process begins with understanding the roles and responsibilities of each healthcare dis- cipline. Understanding—and the trust it fosters— must start in joint nursing and medical school train- ing programs, and continue as a cultural norm in practice settings.
  3. Develop leadership at every level. Nurses should have the opportunity to take on leadership activi- ties whether they practice at the bedside or sit in the boardroom. They must believe they are capable and fully empowered to provide excellent care and

www.AmericanNurseToday.com

September 2010 American Nurse Today 69

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