Impact of Healthcare Reform on
Nursing & Nursing Education
Clint Child, V.P. Patient Care Services/CNO
Saint Alphonsus Medical Center - Nampa
Outline
Why Reform is Needed
Patient Protection & Affordable Care Act (PPACA)
Overview
Goals for Reform
Policy Shifts with PPACA
Nursing Implications
Summary
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Herbert Stein’s Law
Ben Stein
 “If something cannot go on
forever, it will stop!”
 “Trends that can’t continue,
won’t.”
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Herbert Stein
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 expenserelated financial issues.
 Historic Time! What we do or what happens to
us WILL make history!
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Source: Kaiser Family Foundation
www.kff.org
PPACA Overview
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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
Obama’s Reform Goals
 Coverage and Insurance Market Reform
 Delivery and Payment System Reform
 Sustainable Financing Strategies for Reform
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Source: Avalere Health
www.avalerehealth.net
Policy Shift with PPACA
Current
PPACA
Fee-for-Service
Fee-for-Value
Episodic / Sick Care
50 Million Uninsured
Population Health
Management
<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
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Source: Mann, D.
Health Day
Dr. Smith, C.
American College of Physicians
Salary Wizard
www.salary.com
Gordaon, A.
American Academy of Nurse Practitioners
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
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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
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 innovations
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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
Summary 2 – Nursing Shortage
 Nursing Profession and Education programs
must:
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•
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Address current supply vs. future demand
Improve training resources
Create more faculty options
Collaborate to facilitate education progression while
quickly and effectively developing nurses
3) Impact – Nursing Focus
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Susan Hasmiller RN, PhD, 9 Challenges
1. Nurse-Led Innovations (Hard Skills)
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Chronic care, home visits, population management, …
2. Evidence and Research (Hard Skills)
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Need for data and clinical knowledge
3. Redesign Nursing Education (Hard Skills)
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Basic competencies, community focus, preventative care,
residencies
4. Expand Scope of Practice (Hard Skills)
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In every setting
5. Diversity of Workforce
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Workforce compared to populations served
Source: -S. Hasmiller; Nurses Role in Healthcare Reform
Americna Nurse Today
HTTP:www.americannursestoday.com
3) Nursing Focus – continued
 Hasmiller 9 Challenges - continued
6. 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!
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Source: -S. Hasmiller; Nurses Role in Healthcare Reform
Americna Nurse Today
HTTP:www.americannursestoday.com
Summary 3 – Nursing Focus
 Nursing Profession and Education programs
must:
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•
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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!
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
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Source: -Kaiser Family Foundation
www.kff.org
-Legal Eagle
Newsletter for the nursing professional
-Gold, J. NPR
Accountable Care Organizations Explained
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!
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Source: -Kaiser Family Foundation
www.kff.org
-Legal Eagle
Newsletter for the nursing professional
-Gold, J. NPR
Accountable Care Organizations Explained
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
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Source: -Kaiser Family Foundation
www.kff.org
-Legal Eagle
Newsletter for the nursing professional
-Gold, J. NPR
Accountable Care Organizations Explained
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
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Source: -Kaiser Family Foundation
www.kff.org
-Legal Eagle
Newsletter for the nursing professional
-Gold, J. NPR
Accountable Care Organizations Explained
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&A
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