Nurses Note: HEALTHCARE REFORM ACT
The Patient Protection and Affordable Care Act (ACA) passed in March 2010 is aimed at increasing access to health care for the 47 million people who were without health coverage and increasing healthcare quality and cost-effectiveness. 16 million of these people will be covered by ending the practice of insurance companies to place lifetime limits on coverage, will prohibit denial of coverage for preexisting conditions, will allow dependent children up to 26 to stay on parents’ policies and will provide financial assistance to income-eligible individuals and small businesses. The “individual mandate” is one of the most contentious provisions of the law which requires that most U.S. citizens and legal residents have health coverage by 2014 or face penalties.
The quality of care is expected to improve through removal of payment incentives for volume of services to a greater emphasis on value of services, health outcomes and fewer hospitalizations. “The goal is to provide the right patient the right care at the right time in the right place and at the right place.” The ACA expects to make preventive services and screening more accessible so that serious medical conditions may be discovered earlier and then be less costly to care for. Title 3 will require interdisciplinary teamwork focusing on transparency for better safety and quality, reduction of medical errors, preventable admissions and readmissions and healthcare –associated infections through benchmarking progress with special attention to those with chronic conditions and health disparities.
Nurses must be skilled users of health information technology to track how their work leads to quality outcomes and cost efficiencies. This has been at the core of nursing since “Florence Nightingale, during the Crimean War invented the polar-area diagram and pioneered the use of statistics and hospital reporting to improve nursing care.” The American Nurses Association developed the National Database of Nursing Quality indicators collects and evaluates unit-specific nurse-sensitive data from U.S. hospitals.
ACA has reauthorized and modernized Title 8 of the Public Health Service Act to Provide Advanced Nursing Education Grants, reauthorizes forgiveness of loan repayment and scholarship for three years of service in underserved locations and facilities, reauthorized loan programs to support the education of master’s and doctorally prepared nurses in exchange for teaching in accredited schools of nursing. The Nursing student loan program increases the total loan amount from $13,000 to $17,000 as well as expanding several other grant programs that expand the career ladder.
The provisions of ACA will be phased in over the next few years with “nurses participation in the law’s implementation being crucial for nurses to play a leadership role in improving healthcare and implementing healthcare reform.”
(adapted from Nurse.com – May 16, 2011)
Ending supervision of nurse anesthetists by physicians will help patient safety
By: Ali Melillo
David L. Knowlton, President and CEO of the New Jersey Health Care Quality Institute in West Trenton, submitted an Op-Ed to the Asbury Park Press in which he addresses the ongoing debate on supervision of nurse anesthetists by physicians. Describing his position at the institute as “a relatively easy one,” where he mainly focuses on health care and quality patient safety, Knowlton strongly argues against the supervision. He also brings to light the fact that the issue suggests leaving advanced practice nurse (APN) anesthetists the only APNs “required to have the presence of direct supervision of a physician certified in their specialty.”
It is interesting to point out that over 125 years ago, a nurse was, in fact, the first medical professional to provide care to a patient under anesthesia. Knowlton shared this piece of relevant information before the Department of Health and Senior Services Health Care Administration Board, which also supports the elimination of a supervisory statute in APN practice.
Furthermore, Knowlton cites a 2010 study published in Health Affairs, titled “No harm found when nurse anesthetists work without supervision by physicians.” Considered by him to be one of “the most comprehensive and the most compelling” studies on the subject of APN anesthetists, it reviewed almost 500,000 individual cases to conclude that the work of APN anesthetists is indeed of high-quality and safe.
Knowlton concludes his Op-Ed rallying for the state of New Jersey to “do the right thing and take the course that leads to better health care quality outcomes.” He also criticizes that counterarguments on the issue are merely “distracting” and “economically motivated,” calling for the commissioner of health and senior services to ignore them as such.
Knowlton’s position on the topic is clear, as are the opposing arguments, but we’re curious to find out your opinion on the topic. Please share your thoughts and comments!
Read the full article: http://bit.ly/hqanV2
Policy-Making Opportunities Increase for Nurse Practitioner Leaders
By: Ali Melillo
An editorial by Marilyn W. Edmunds, PhD, NP, published in The Journal for Nurse Practitioners brings to light the importance of nurse practitioners (NPs) taking advantage of the increasing opportunities available to them in various policy-making positions. Pursuing these roles would allow NPs to play a vital role in creating policies that are fair to all healthcare providers, including NPs.
Edmunds highlights the work of three NPs that have already become integrated within the policy-making system.
Mary Wakefield, PhD, RN, FAAN, serves as the administrator for the Health Resources & Service Administration (HRSA), where she “is well positioned to keep an eye open for policy that affects NPs and nurse midwives.” Additionally, Wakefield has commented on the White House’s “positive and enlightened support” of APNs. While HRSA continues its search for RNs and APNS with doctorate degrees to fill a number of policy-related positions, Edmunds reminds us that there is a lack of response from nurses for these positions and their input is fundamental to the medical field.
After leaving her faculty position at Washing State University, Louise Kaplan, PhD, NP, took on a new role as a “senior policy fellow for practice and policy in the Department of Nursing Practice and Policy at the American Nurses Association (ANA).” Her expertise as an NP gives her a unique scope of knowledge that should benefit the nursing profession as a whole.
Although not recent, The Robert Wood Johnson Foundation’s (RWJF) appointment of Susan B. Hassimiller, PhD, RN, FAAN, to senior advisor for nursing puts her in an ideal position develop strategies that address the nurse and nurse faculty shortages. “As part of her role, Hassimiller will also provide advice on all Foundation nursing programs and serve as a partner and liaison to the Center to Champion Nursing in America (CCNA).”
As these women continue to strive for more equitable policies and programs within the nursing field, their leadership efforts have already made an impact. Yet, it is essential for NPs and nurses to recognize the need for their input in policy-making to ensure the nursing environment remains progressive and fair in the future. What are your thoughts? Why do you think there is a lack of NP interest in related policies and leadership opportunities? What can be done to stimulate the involvement of NPs within these available roles?
Read the full article: http://tinyurl.com/424r6sb
Suicide factors: UNSAFE or SAFER?
By: Ali Melillo
Suicide risk assessment is an important step in providing psychiatric care for the general population. Primarily, these assessments serve to “identify fixed and modifiable risk factors for suicide and existing or amendable protective factors.”
Rocio Nell, MD, CPE, and Tony Salvatore, MA, have worked in conjunction to develop two mnemonics to aid in the assessment and treatment of at-risk suicide patients, appropriately labeled UNSAFE and SAFER. Both of these mnemonics are used regularly in Salvatore and Nell’s emergency psychiatric facility, posted throughout the office and referred to by the staff during psychiatric evaluations.
UNSAFE Risk Factors:
Unconnected – no support; sense of not belonging or being a burden
Nonadherence – unmanaged mental illness or co-occurring disorders
Stigma/shame related to past attempts or suicidal behavior
Abuse history and/or alcohol misuse; prior attempt
Family history of suicide or suicide attempts
Exacerbations – worsened mental illness, hospitalizations
SAFER Protective Factors:
Self-help skills, personal crisis/suicide prevention plan
Adherence to treatment plan
Family and community support
Education about risk factors, warning signs, and triggers for suicide
Recovery and resilience
The full article can be found in Current Psychiatry, Vol. 10, No. 1.
Do Nurse Practitioners and Physician Assistants Do Things Differently?
By: Ali Melillo
Do Nurse Practitioners (NPs) and Physician Assistants (PAs) do different things within their respective positions? This thought provoking question has arisen from an opinion written by David Mittman, PA, in September 2010 in Clinician 1, an online NP/PA community: “While many of us know that we do very much the same things, we really believe we do it differently. Let me tell you, we don’t… If you watched an NP or a PA practicing from about 20 feet away, you could not tell what their profession was.”
In a short article published in The Journal for Nurse Practitioners, this question is explored and commented on by Mittman and Susan Apold, PhD, RN, ANP-BC, in which Mittman provides rationale against distinguishing between the two positions, and Apold argues in support of recognizing the distinction between NPs and PAs.
Mittman reasons that, “Although we might have taken different educational ladders to get where we are, generally we are standing on the same roof together.” He also goes on to explain that NPs and PAs are used interchangeably within the medical profession, where both utilize the same tools to “come up with the same diagnoses using the same information.”
Contrastingly, Apold calls for NPs and PAs to celebrate the inherent differences within their fields, noting, “Literature is replete with differences in regulation, legislation, and educational preparation.” Additionally, she continues on to indicate the paradigms of care each profession embraces in their work. Apold explains that NPs adopt a nursing paradigm, “with a unique body of knowledge and orientation to patients,” while PAs embrace a medical paradigm, resulting in a notably different approach to patient care.
Though both Apold and Mittman provide reasonable arguments for each position on the topic, the question still remains: do NPs and PAs do things differently? In your professional medical experience, how would you address this question? Please share your thoughts.
Read the full article: http://tinyurl.com/3guoxva
A Doctor is a Doctor is a Nurse
By: Ali Melillo
A blogger for The Daily Caller recently posted a blog commentary in reaction to the Institute of Medicine’s (IOM) new report that calls for expanded authority for nurses within their fields. In short, the IOM reasons that allowing for nurses to have more autonomy in their work will help to solve the lack in primary care physicians.
It seems that with the IOM’s position, nurses will be able to fill the gaps in seeing patients, rather than forcing patients to wait to see a medical doctor. They have the training and education to successfully work with patients for all of their primary care needs.
This comes alongside the newly passed Patient Protection and Affordable Care Act, which requires Medicare’s reimbursements to nurse midwives to equal those given to obstetrician-gynecologists. A positive step in American Nurses Association’s, and other similar organizations, fight for pay parity among advanced practice nurses.
Yet, Jason Fodeman, the author and M.D., argues otherwise, reasoning that giving nurses more autonomy within primary care will exacerbate the shortage of physicians.
Fodeman describes the IOM’s suggestions as “misguided” and “shortsighted,” claiming that the IOM’s recommendations will in fact limit patient access to physicians, something all patients want and need.
There is no doubt that with any piece of legislature, or any argument in any capacity, there will always be opposition. However, is this blogger making assumptions well beyond his knowledge? Does he fully grasp the extent of the training and competence of APNs and their unique and valuable role in the changing healthcare system? Or, is he valid in his arguments against the IOM report? Has the IOM overlooked the possibility of creating an even larger gap in primary care physicians?
What Fodeman has neglected to address is whether or not advanced practice nurses are actively seeking to take on the role of physicians? Or are APNs simply wanting to practice fully within the scope of their training and ability without costly undue restrictions to their practice?
Read the full article: http://tinyurl.com/28n9ehm
Congress Passes Bill Protecting Medicare Practitioners from Imminent Fee Cut
April 15, 2010, President Obama signed into law the “Continuing Extension Act of 2010.” The new law extends through May 31, 2010 the zero percent update to the Medicare “Physician” Fee Schedule (MPFS) which was in effect for claims with dates of service from Jan. 1, 2010, through March 31, 2010. The new law is retroactive to April 1, 2010 and will remain in force until the end of May. Without this new stopgap measure, physicians, clinical social workers and other health professionals that bill Medicare Part B independently faced a scheduled rate cut of 21 percent on claims for service delivered after April 1.
The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare contractors to immediately resume processing claims under the new law for services provided by physicians, and non-physician practitioners (NPPs) such as clinical social workers, who are paid under the MPFS. Most claims with dates of service April 1 and later were held by Medicare in anticipation of yesterday’s congressional action. If Congress had not acted, payment rates for claims occurring after April 1, by practitioners who are paid under the MPFS would have been reduced by 21 percent, as required by a formula specified in the Medicare law.
The Medicare MPFS cut was originally scheduled to go into effect for claims paid on or after Jan. 1, 2010, but it was first postponed until March 1 by a provision in the Defense Appropriations Act of 2009, and again until April 1, in the Temporary Extenders Act of 2010. This latest Act extends last year’s payment levels until the end of next month, May 31, at which time Congress plans to again have reached agreement on a longer-term formula solution. For background information on this matter, please see NASW’s website here.
NPR: Should Nurse Practitioners Be Given Greater Authority?
The nation is facing a shortage of primary care doctors, and to fill that gap many states are proposing to expand the role of nurse practitioners to allow them to prescribe medication, practice without a doctor’s supervision, and even be called doctors if they
have a doctorate. NPR’s The Takeaway addresses access and physician shortage in this interview featuring:
Dr. Mario Motta is president of the Massachusetts Medical Society and is also a practicing cardiologist. He believes that nurse practitioners don’t have the qualifications to be independent primary care practitioners. But some disagree.Linda Upmeyer, a nurse practitioner and the minority whip in the Iowa state House of Representatives believes in expanding roles for nurse practitioners. We’ll also hear from Micah Weinberg, senior research fellow at the New America Foundation, on why there is such a shortage of primary care doctors in the first place.
Health Insurance Reform Law Q&A
There has been a lot of confusion and misinformation about the new health insurance reform legislation. Rep. Rush Holt from the 12th Congressional District of NJ answers questions about Health Insurance Reform in this informative memo.
Healthcare Law at a Glance
In a conference call with Rep. Rush Holt on Thursday, I, along with Carolyn Torre and a number of other NJ providers, were briefed as to what the new Healthcare Bill will entail.
But first, two minor provisions that violate Congress’s budget rules dealing with Pell Grants for low-income students have to be formally removed from the bill before it can be enacted. The revisions are minor and not expected to derail the legislation.
Effective immediately in 2010 assuming the passage, there will be immediate access to health care for the uninsured. There will be small business tax credits up to 35% toward reimbursing employers for providing health care coverage for employees, and up to 25% tax credit for nonprofit organizations. The new bill will eliminate pre-existing conditions and it will end lifetime limits as well has annual limits for new plans. It will remove charges for preventive services for seniors and for all new plan enrollees. It strengthens community health centers and adds temporary coverage for early retirees over 55. Scholarships and educational loans have increased to promote entrance into primary care.
Adult children up to age 26 can remain on their parents’ plan and the bill provides for a better insurance appeals process. Greater effort in identifying Medicare and Medicaid fraud along with increased taxation of pharmaceutical and medical device companies, as well as high priced health insurance plans to help defray the cost. It adds resources to HSS to develop quality strategies, closes the Medicare prescription drug doughnut hole, and expands Medicaid. It also increases savings from the Medicare Advantage plans by eliminating large giveaways to insurance companies for managing the plans which has been shown to be inefficient use of that money. There will be fewer uninsured patients which is expected to help keep hospitals more solvent.
Here are the key points at a glance:
Let the insurance games begin..