Impact of Healthcare Reform on Nursing & Nursing Education Clint Child, V.P. Patient Care Services/CNO Saint Alphonsus Medical Center - Nampa

2 Outline  Why Reform is Needed  Patient Protection & Affordable Care Act (PPACA) Overview  Goals for Reform  Policy Shifts with PPACA  Nursing Implications  Summary

3 Herbert Stein’s Law  “If something cannot go on forever, it will stop!”  “Trends that can’t continue, won’t.” Herbert Stein Ben Stein

4 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

5 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

6 Obama’s Reform Goals  Coverage and Insurance Market Reform  Delivery and Payment System Reform  Sustainable Financing Strategies for Reform Source: Avalere Health

7 Policy Shift with PPACA CurrentPPACA Fee-for-ServiceFee-for-Value Episodic / Sick CarePopulation Health Management 50 Million Uninsured<18 Million Uninsured Coverage OptionalCoverage Required Coverage DenialsGuaranteed Acceptance Fragmented / Duplicative Care Coordinated Care

8 Impact to Nursing 1.Increased Primary Care Demand 2.Nursing Shortage 3.Nursing Focus 4.Cost Control

9 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 Gordaon, A. American Academy of Nurse Practitioners

10 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 Gordaon, A. American Academy of Nurse Practitioners

11 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

12 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 world.orgwww.nursing -Buaerhaus, P., Health Affairs 2009 Recent Surge in Nursing Employment -Federal Division of Nursing -Bureau of Labor Statistics Employement Projections

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

14 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

15 3) Impact – Nursing Focus  Susan Hasmiller RN, PhD, 9 Challenges 1.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

16 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! Source: -S. Hasmiller; Nurses Role in Healthcare Reform Americna Nurse Today

17 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!

18 4) Impact – Cost Control  Situation Healthcare Expenditure  32% higher than next comparable country Pace compared to the Economy  Inflation up 29%  Wages up 34%  Healthcare Premiums up 119% Stein’s Law Source: -Kaiser Family Foundation -Legal Eagle Newsletter for the nursing professional -Gold, J. NPR Accountable Care Organizations Explained

19 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 -Legal Eagle Newsletter for the nursing professional -Gold, J. NPR Accountable Care Organizations Explained

20 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 -Legal Eagle Newsletter for the nursing professional -Gold, J. NPR Accountable Care Organizations Explained

21 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 -Legal Eagle Newsletter for the nursing professional -Gold, J. NPR Accountable Care Organizations Explained

22 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

23 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

24 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.”

25 Q&A