Affordable Care Act:
What It Means and Why It
Matters to Nurses
Susan E. King
MS, RN, CEN, FAAN
ACA Why it Matters
• “America's health care system is neither healthy,
caring, nor a system.” - Walter Cronkite
• “There are more than 9,000 billing codes for
individual procedures and units of care. But there is
not a single billing code for patient adherence or
improvement, or for helping patients stay well.”
- Clayton M. Christensen, The Innovator's
Prescription: A Disruptive Solution for Health Care
ACA Why it Matters
Consumer Reports, July 1992
ACA Why it Matters
• How we practice
• What we practice
• Where we practice
ACA Why it Matters
• Florence Nightingale’s Notes on Nursing:
“I use the word nursing for want of a
better. It has been limited to signify
little more than the administration of
medicines and the application of
poultices. It ought to signify the proper
use of fresh air, light, warmth,
cleanliness, quiet, and the proper
selection and administration of diet -all
at the least expense of vital power to
the patient.”
Where We Practice
Where Will or Should We Practice?
• Primary care homes
• Community based settings
• Schools
• Patient home
• Assisted Living/
Long term care
• Anywhere
How Will We Practice?
• Team based care
• “top of our license”
• Unlicensed workers
• Partnership with patient
• Increased emphasis on cost and quality
outcomes
How Will We Practice?
“Top of our license”
– Carving out vs Full Scope
– Authority for recommendations
– Supervision and oversight of others
– Seat at the table
How Will We Practice?
New Unlicensed Workers
Community Health Workers
Community Health Workers:
An ONA Position Statement
April 2013 by Connie Miyao, RN, BSN; Sue B. Davidson, PhD, RN, CNS
Position
• Oregon Nurses Association supports the development and
utilization of the Community Health Worker (CHW) in Oregon's
evolving health care delivery system.
What Will We Practice?
•
•
•
•
•
•
•
Health Promotion
Prevention
Transitional Care
Care Coordination
Case Management
Health coaching
Direct care
What Will We Practice?
Attending Registered Nurse: An Innovative
Role to Manage Between the Spaces
(Nursing Economics, Vol. 30, No. 5)
• Role: coordinating the work of the
interdisciplinary team in improving relationship
based care and addressing overuse, underuse,
and misuse of services from pre-admission to
post discharge care
How Will We Practice?
• Improving value for patients
• Organize care around the patient’s goals over time
– Needed skills motivational interviewing, supporting
patient self management, education techniques for
patients at all levels of literacy, team communication,
data management and usage
What Will We Practice?
• Transitional care
– Medicare pilot program bundled payment for
acute inpatient, outpatient, physician services
and post acute services for one episode of
care
– BIG ROLE FOR RNs
What Will We Practice?
• Nursing!
– Example:
Sylvia Pishioneri RN
– RN Care Manager
Florence, Oregon
What Will We Practice?
• Pishioneri
– Care Management includes face to face visits
and phone contacts
– First 16 months total savings $1,585,266.89
– ED visits for 16 frequent users dropped 42%
– Top diagnoses: Chronic pain, Diabetes, CHF and
Depression
Where, How and What
• What actions should we take?
– Look beyond hospital practice
– Protect our scope of practice
• Keep it and take it back
– Improve our skill at demonstrating cost and
quality outcomes
– Engage and advocate