Impact of Healthcare Reform on Nursing & Nursing Education

Clint Child, V.P. Patient Care Services/CNO

Saint Alphonsus Medical Center - Nampa

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Outline

Why Reform is NeededPatient Protection & Affordable Care Act (PPACA) OverviewGoals for ReformPolicy Shifts with PPACANursing ImplicationsSummary

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Herbert Stein’s Law

“If something cannot go on forever, it will stop!”

“Trends that can’t continue, won’t.” Herbert Stein

Ben Stein

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Why Reform is Needed

50 million Americans uninsured Inadequate access to Primary Care Delays in care leading to poor outcomes Healthcare expenditures outpacing the

economy 20% of U.S. families have medical

expense- related financial issues. Historic Time! What we do or what

happens to us WILL make history!

Source: Kaiser Family Foundation www.kff.org

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PPACA Overview

Guaranteed Issue Shared Responsibility Health Insurance Exchanges Federal Subsidies Minimum Standards Employer Responsibility Small Employer Subsidies Copayments & Deductibles Bundled Payments

Source: Avalere Health www.avalerehealth.net

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Obama’s Reform Goals

Coverage and Insurance Market Reform

Delivery and Payment System Reform

Sustainable Financing Strategies for Reform

Source: Avalere Health www.avalerehealth.net

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Policy Shift with PPACA

Current PPACAFee-for-Service Fee-for-Value

Episodic / Sick Care Population Health Management

50 Million Uninsured <18 Million Uninsured

Coverage Optional Coverage Required

Coverage Denials Guaranteed Acceptance

Fragmented / Duplicative Care

Coordinated Care

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Impact to Nursing

1. Increased Primary Care Demand

2. Nursing Shortage

3. Nursing Focus

4. Cost Control

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1) Impact – Primary Care Demand

50,000 PCP shortage • Without reform• Even greater with reform

32 million more Americans insured• Through Medicaid expansion• Includes over 70,000 Idahoans

Primary Care not as attractive as other specialties

Source: Mann, D. Health Day Dr. Smith, C. American College of Physicians Salary Wizard www.salary.com Gordaon, A. American Academy of Nurse Practitioners

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1) Primary Care Demand – Opportunity

Opportunity for More Nurse Practitioners• NP-led primary care offices

NPs Supplement the PCP shortage Independent with opposition

• Physician-led team offices NPs extend PCP practices Highlights training and education differences

Source: Mann, D. Health Day Dr. Smith, C. American College of Physicians Salary Wizard www.salary.com Gordaon, A. American Academy of Nurse Practitioners

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Summary 1 - PCP Demand

Nursing Profession and Education programs must:• Support increased number of NP students• Prepare NPs for critical role in primary care

settings• Build and sustain a unified advocacy voice for

NP practice standards & scope• Participate and guide policy changes around

scope of practice

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2) Impact – Nursing Shortage

Skilled RNs to NP Opportunities• Positive for Scope of Practice opportunities• Negative for skill and experience at bedside

Aging Population• Baby Boomers are aging• More chronic conditions

Source: -American Nurses Association www.nursing world.org -Buaerhaus, P., Health Affairs 2009 Recent Surge in Nursing Employment -Federal Division of Nursing -Bureau of Labor Statistics Employement Projections 2010-2020

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2) Nursing Shortage – continued

Nursing Workforce Demographics• Economy impact• Gender / social role impact

Aging Nursing Workforce• Average RN 47 • Nearing retirement / personal medical needs

Increased Bachelor’s Nurses• Top of scope• Managing / leading innovationsSource: -American Nurses Association www.nursing world.org -Buaerhaus, P., Health Affairs 2009 Recent Surge in Nursing Employment -Federal Division of Nursing -Bureau of Labor Statistics Employement Projections 2010-2020

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Summary 2 – Nursing Shortage

Nursing Profession and Education programs must:• Address current supply vs. future demand• Improve training resources• Create more faculty options• Collaborate to facilitate education progression

while quickly and effectively developing nurses

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3) Impact – Nursing Focus

Susan Hasmiller RN, PhD, 9 Challenges1. Nurse-Led Innovations (Hard Skills)

Chronic care, home visits, population management, …

2. Evidence and Research (Hard Skills) Need for data and clinical knowledge

3. Redesign Nursing Education (Hard Skills) Basic competencies, community focus, preventative

care, residencies

4. Expand Scope of Practice (Hard Skills) In every setting

5. Diversity of Workforce Workforce compared to populations served

Source: -S. Hasmiller; Nurses Role in Healthcare Reform Americna Nurse Today HTTP:www.americannursestoday.com

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3) Nursing Focus – continued

Hasmiller 9 Challenges - continued6. Embrace Technology (Hard Skills)

Understand and lead use of technology

7. Interpersonal Collaboration (Soft Skills) ACOs = Teamwork and trust

8. Develop Leadership (Hard and Soft Skills) Confidence, empowerment, support, mentoring

9. Be At the Table (Hard Skills) Help lead change, governance, strategy, …

Patient Satisfaction• Quality is what the Patient says it is!

Source: -S. Hasmiller; Nurses Role in Healthcare Reform Americna Nurse Today HTTP:www.americannursestoday.com

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Summary 3 – Nursing Focus

Nursing Profession and Education programs must:• Prepare students for key roles• Focus on increasingly diverse populations• Ensure competence with latest technology• Build Hard and Soft skills• Screen out candidates that can’t develop both!

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4) Impact – Cost Control

Situation• Healthcare Expenditure

32% higher than next comparable country

• Pace compared to the Economy Inflation up 29% 1999-2008 Wages up 34% 1999-2008 Healthcare Premiums up 119% 1999-2008

• Stein’s Law

Source: -Kaiser Family Foundation www.kff.org -Legal Eagle Newsletter for the nursing professional -Gold, J. NPR Accountable Care Organizations Explained

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4) Cost Control – continued

Litigation• Claims down, severity up• Nurses named personally in claims

OR: “Surgical Error Blamed, In Part, On Circulating Nurse’s Negligence”

OB: “Court Finds Evidence of Nursing Negligence” Med Error: “Court Upholds Verdict For Nursing

Negligence”

• Nursing role in preventing outcomes• Nurses must act important!Source: -Kaiser Family Foundation www.kff.org -Legal Eagle Newsletter for the nursing professional -Gold, J. NPR Accountable Care Organizations Explained

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4) Cost Control – continued

Operational Efficiencies• Reduced reimbursement = less payment for

current care = not covering costs = must change process

• Doing more with less = potential poor outcomes

• Must improve resource utilization Lean, Six Sigma, etc… Need ROI or investment = different kind of waste

Source: -Kaiser Family Foundation www.kff.org -Legal Eagle Newsletter for the nursing professional -Gold, J. NPR Accountable Care Organizations Explained

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4) Cost Control – continued

Accountable Care Organization• Incentives for coordinated care and services• Shared responsibilities and shared payments

Throughout patient’s health needs

• Coordination needs facilitators RN Health Coaches

• Estimated cost savings = nearly a billion dollars

Source: -Kaiser Family Foundation www.kff.org -Legal Eagle Newsletter for the nursing professional -Gold, J. NPR Accountable Care Organizations Explained

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Summary 4 - Cost Control

Nursing Profession and Education programs must:• Educate an understanding of legal process• Train and practice patient advocacy (acting

important)• Change culture towards non-punitive reporting• Learn from near misses, not just direct hits• Train nurses to be business CEOs of their

practice• Train nurses to be case managers

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Closing

Now, more than ever, nursing programs need to prepare students to enter the workforce ready to:

participate and lead innovation participate in research care for culturally diverse populations manage social issues be care managers and coaches coordinate care be customer service experts be savvy financial stewards understand the legal process

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Florence Nightingale

“I think one’s feelings waste themselves in words; they ought all to be distilled into actions, and into actions which bring results.”“Unless we are making progress in our nursing every year, every month, every week, take my word for it, we are going back.”“The progressive world is necessarily divided into two classes – those who take the best of what there is and enjoy it – those who wish for something better and try to create it.”

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Q&AQ&A