By Rose O. Sherman, EdD, RN, FAAN
Last month, the United States Supreme Court found that most provisions of the Affordable Care Act (ACA) are constitutional. With a presidential election looming in November, the debate about the future of law will continue. In spite of the political battles, most health care analysts agree that the law’s structural and financial features are likely to remain in place. As systems thinkers, nurse leaders now need to consider the impact of ACA on the work of nursing and future needs in the US nursing workforce. Areas of impact could include the following:
1. Increased Nursing Workforce Needs
Under the Affordable Care Act, more than 32 million uninsured Americans will have increased access to affordable health coverage options. With better coverage, fewer people will delay or avoid seeking care that they need simply because they cannot afford it. This is likely to result in an increased demand for health services. In a recent report issued by the George Washington University Center on Education and Workforce, it was predicted that health care workforce demand will grow by 30% by the end of 2020. Much of this growth will come from the implementation of the Affordable Care Act and the current aging of the US population.
2. An Expansion of Nursing Roles outside of Acute Care
The ACA includes legislation that provides for the development of new models of patient care delivery with a focus of patient management in ambulatory versus acute care settings. Two major demonstration projects that are funded as part of this legislation include the implementation of Accountable Care Organizations (ACO) and Patient-Centered Medical Homes.
Definition of an ACO – A group of health care providers (including physicians and hospitals) who provide coordinated care and chronic disease management, and thereby improve the quality of care their patients get. The organization’s payment is tied to achieving health care quality goals and outcomes that result in cost savings.
Definition of a Medical Home – A comprehensive, team-based primary care practice, which might include physicians, advanced practice nurses, physician assistants, pharmacists, nurses, nutritionists, social workers, educators and care coordinators, that takes care of large majority of each patient’s needs while coordinating any other care patients may need, including specialty, hospital, home and community-based care services. Medical homes partner with patients and families to facilitate shared decision-making and guide patients in managing their own care and conditions, while demonstrating commitment to quality and improving patient experience.
3. A Need for more Nurse Practitioners
The United States is on the verge of a serious physician shortage especially in primary care. The ACA legislation will move many more patients into the primary care system. Nurse practitioners will assume more responsibility for the primary care management of patients in the United States and there are provisions in the legislation to both fund ARNP programs and nurse managed clinics.
4. Increased Accountability for Health Care Quality and Value
At the present time, the United States spends over $8000 per person on health care each year. This trend cannot continue. The Affordable Care Act contains provisions to move the reimbursement system from fee for service to bundled payment for episode-based care. In this type of care different health care providers treat an individual for the same or related conditions over set time period and are reimbursed by overall sum, rather than for individual test, treatment, or procedure. As a result providers are encouraged to coordinate care, prevent errors and complications, and reduce duplicative tests and treatments. All health care providers including nurses will be held to a higher level of accountability to ensure not only quality care but also value-based care.
5. Opportunities for the Development of Innovative Nursing Care Delivery Models
Nurses have a unique opportunity at this time to lead and contribute to the redesign of health care delivery models that focus on wellness and prevention, rather than simply on the acute care management of patients. The traditional nursing care delivery models that we have used focus on the episodic management of patients while they are in the hospital. This will need to change. Nursing will assume more accountablility to manage patients across the continuum of care as part of the change in reimbursement.
In responding to the Affordable Care Act, the American Nurses Association has noted that the legislation represents an enormous step forward in advocating for registered nurses, their families and their patients. What is clear from an analysis of the legislation is that it will change nursing, and nurse leaders need to be proactive in planning for the changes.
Read to Lead
Carnevale, A., Smith, N., Gulish, A. & Beach, B.H. (2012). Healthcare Whitepaper. George Washington University Center on Education and Workforce. Available at http://www9.georgetown.edu/grad/gppi/hpi/cew/pdfs/Healthcare.FullReport.070612.pdf
American Nurses Association (June 29th, 2012). The Supreme Court Decision Mattters for Registered Nurses, their Families and Patients. SupremeCourtDecision-Analysis
© emergingrnleader.com 2012
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