Title text here How Does the IOM Future of Nursing Report Affect Nurses in Long-Term Services and Supports Susan C. Reinhard, RN, PhD, FAAN Senior Vice.

Slides:



Advertisements
Similar presentations
Making Payment Reforms Work for Patients and Families Lee Partridge Senior Health Policy Advisor National Partnership for Women and Families January 28,
Advertisements

THE COMMONWEALTH FUND Developing Innovative Payment Approaches: Finding the Path to High Performance Stuart Guterman Vice President, Payment and System.
Overview of the Workforce Provisions in the Affordable Care Act The Health Workforce Dream Team: Who Will Provide the Care? Alliance for Health Reform.
Update on Recent Health Reform Activities in Minnesota.
Institute of Medicine Report:
The Future of Nursing: Leading Change, Advancing Health
Overview of the RWJF Initiative on the Future of Nursing, at the IOM
Nurse Delegation in LTCSS Overview Prepared for Pennsylvania Long Term Care Commission July 2014.
AARP Long Term Care LTSS Erica Dhar, Senior Advisor AARP Office of International Affairs.
11 Opportunities to Improve Care for Persons with Disabilities: The Community Living Initiative IMPLEMENTING NATIONAL HEALTH REFORM IN A DIFFICULT ECONOMIC.
The Future of Nursing in Indiana
The Evolving Role of Nursing in ACOs and Medical Homes Carol A. Conroy DNPc RN CNOR Chief Nursing Officer/VP Operations VONL SUMMIT: April 19, 2013.
THE COMMONWEALTH FUND Reforming the Health Care Delivery System – The Role of States Rachel Nuzum Vice President, Federal and State Health Policy The Commonwealth.
Paying for Primary Care: Robert Graham Center Primary Care Forum Washington, DC Two CMS/CMMI payment experiments Jay Crosson March 25, 2014.
The Evercare Model: Using Nurse Practitioners to Achieve Positive Outcomes Pat Kappas-Larson, MPH APRN-BC Professional Relations/Development April 24,
Shaping the future of palliative care leadership: taking the reins Deborah Law Program Manager Workforce Innovation and Reform Health Workforce Australia.
Linking Actions for Unmet Needs in Children’s Health
PCP Capacity Study Regional Findings Commissioned by the Executive Stakeholders’ Council.
It’s All About MME Tasia Sinn September 18, 2014 Understanding Colorado’s New Medicare- Medicaid Enrollee (MME) Program.
SoonerCare and National Health Care Reform Oklahoma Health Care Authority Board Retreat August 26, 2010 Chad Shearer Senior Program Officer Center for.
Kathleen A. Ream Director, Government Affairs October 1, 2010.
Future of Nursing: Campaign for Action Virginia Nurses Association June 16, 2011 Andrea Brassard, DNSc, MPH, FNP.
Susan C. Reinhard, RN, PhD, FAAN Senior Vice President and Director AARP Public Policy Institute Chief Strategist, Center to Champion Nursing in America.
Capacity Task Force Virginia Health Reform Initiative January 14, 2011
Older Americans Act Reauthorization 2011 Julie Jarvis Director, Program Development and Planning Karen Webb Manager of Older Americans Act Programs June.
NC Future of Nursing Action Coalition BSN & Higher Degree Taskforce Champions Foundation for Nursing Excellence NC Area Health Education Centers.
Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy College of Public Health.
Future of Nursing: Campaign for Action Audience to be Addressed Date Presenter’s Name.
Patient Centered Medical Homes Marcia Hamilton SW722 Fall, 2014.
1 NATIONAL ADVISORY COUNCIL ON HEALTHCARE RESEARCH AND QUALITY Subcommittee on Quality Measures for Children's Healthcare in Medicaid and CHIP Overview.
Presented by: Kathleen Reynolds, LMSW, ACSW
Overview Community Care of North Carolina. Our Vision and Key Principles  Develop a better healthcare system for NC starting with public payers  Strong.
Inter-Professional Care Coordination: Looking to the Future Susan C. Reinhard, RN, PhD, FAAN Senior Vice President AARP Public Policy Institute May 24,
Affordable Care Act Aging Network Opportunities Judy Baker Regional Director Health and Human Services October 18, 2010.
Leading Change, Advancing Health in Kansas Through Nursing.
Delaware Health and Social Services NAMI Delaware Conference: January 24, 2013 Rita Landgraf, Secretary, Department of Health and Social Services ACA and.
Health Care Reform and the Future of Health Care in Rural America Presentation to the American Public Health Association Presented by Keith J. Mueller,
VISIONING SESSION May 29, NWD Planning Grant  One year planning grant, started October 1, 2014; draft plan by September 30, 2015; final plan by.
Stephanie Hull MGA Conference Chief, Long Term Services and Supports June 7, 2012 Maryland Department of Aging.
THE COMMONWEALTH FUND Developing Innovative Payment Approaches: Finding the Path to High Performance Stuart Guterman Assistant Vice President and Director,
Susan Reinhard, PhD, RN, FAAN Senior Vice President & Director, AARP Public Policy Institute; Chief Strategist, Center to Champion Nursing in America.
Innovation and Health System Transformation Chisara N. Asomugha, MD, MSPH, FAAP (Acting) Director, Division of Population Health Incentives & Infrastructure,
The Indiana Family and Social Services Administration Section 2703 Health Homes July 13,2012.
A Federal Update on Title VIII Nursing Workforce Development Programs The Ties That Bind: Creating Partnerships and Collaboratives – Education, Practice,
Improving Care for Medicare-Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 19, 2015.
Getting Connected: Can the ACA Improve Access to Health Care in Rural Communities? Russell Senate Office Building October 13, 2010 Clint MacKinney, MD,
The MARYLAND HEALTH CARE COMMISSION. Telehealth Landscape Telehealth adoption is increasing 2013: ~ 61 percent of acute care hospitals; ~9 percent of.
The Affordable Care Act: Highlights & Updates Presentation for the Iowa State Association of Counties Meeting November 29, 2012.
Kathleen Reynolds, LMSW, ACSW Vice President for Health Integration and Wellness Health Care Reform: Opportunities and Challenges for Behavioral Health.
Presentation 2014 Nurse Leadership Summit Developing Nurse Leaders for a Changing Healthcare Environment September 24, 2014 Nurse Alliance of SEIU Pennsylvania.
An Overview of the Pennsylvania Action Coalition Fall 2014.
Informal Caregivers: Sustaining the Core of Long Term Services and Supports Susan C. Reinhard, PhD, RN, FAAN, Senior Vice President and Director, AARP.
A Journey Together: New Maryland Healthcare Landscape Health Montgomery Maryland Health Services Cost Review Commission March 2015.
A Journey Together: New Maryland Healthcare Landscape Baltimore County Forum Maryland Health Services Cost Review Commission June 2015.
Future of Nursing: Campaign for Action The Wisconsin Action Coalition presents an introduction to the IOM report “The Future of Nursing November, 2011.
Health Reform: Local Safety Net Implications Karen J. Minyard, Ph.D., Executive Director, Georgia Health Policy Center, Georgia State University.
Improving Patient-Centered Care in Maryland—Hospital Global Budgets
Mark Leeds Director of Long Term Care and Community Support Services April 26, 2012 Maryland Medicaid Advisory Committee: Balancing Incentive Program.
A NEW REIMBURSEMENT STRUCTURE FOR AMERICA ADVANCED DISEASE CONCEPTS.
Patient Protection and Affordable Care Act The Greens: Elijah, Amber, Kayla, Patrick.
Presentation Pennsylvania Coalition for the Advancement of Nursing Education October 14, 2014.
Approaches to Slowing Cost Growth in Public Programs State Coverage Initiatives National Meeting August 5, 2010 Nikki Highsmith Center for Health Care.
1. What are Long Term Services and Supports (LTSS)? Who Uses LTSS? What is a No Wrong Door (NWD) System? Why Do We Need a NWD System? What Can We Do in.
Payment and Delivery System Reform in Medicare Alliance for Health Reform April 11, 2016 Cristina Boccuti, MA, MPP Associate Director, Program on Medicare.
Supporting Families Community of Practice Meeting December 14,
PHSKC Health Dialogue: New Opportunities for Public Health, Workforce and Innovative Pilot Projects under Health Care Reform Charissa Fotinos, MD Chief.
Post-Acute Care Healthcare Beyond The Hospital Claire M. Zangerle, RN, MSN, MBA President and Chief Executive Officer.
Care Transitions Intensive. 2 Agenda Open Session (8:00 – 10:30) AoA Introduction/Overview Cross Cultural Strategies for Strengthening the Relationship.
HFMA – Physician Perspective on Key Issues April 5, 2013.
Maryland’s ADRC Evidence Based Transitions Grant Project: the Guided Care Model Ilene Rosenthal Deputy Secretary Maryland Department of Aging.
Presentation transcript:

Title text here How Does the IOM Future of Nursing Report Affect Nurses in Long-Term Services and Supports Susan C. Reinhard, RN, PhD, FAAN Senior Vice President and Director AARP Public Policy Institute Chief Strategist Center to Champion Nursing in America Long-Term Care Conference A Regulatory Perspective and Future Implications August 23-24, 2011

Focus Key issues in LTSS and what the future may bring LTSS State Scorecard in relation to LTSS nurses How the IOM Report on the Future of Nursing will impact this future Your leadership 2

Key Issues in LTSS and what the future may bring Long Term Services and Support rather than Long Term Care Overlap with Chronic Care, Transitional Care— Functional Focus Movement toward accelerating Home and Community Based Care 3

LTSS Nurses need to change language to be in tune with today Consumer focused Not about the care they get from others as passive recipients It is about services and supports they ideally control 4

Key Issues in LTSS and what the future may bring Focus on Family Caregivers Federal innovations that will affect nurses: –Integration with Acute, Primary Care –Managed care –Duals demonstrations –CMS Innovation Center CLASS Act 5

Innovations to Improve Care Transitions and Coordination Medicare Community-Based Care Transitions Program Medicare Independence at Home Demonstration Medicare & Medicaid Center for Innovation Patient-Centered Medical Home Demonstration Community Health Teams for Medical Homes Medicaid Health Homes for Chronic Conditions See Public Policy Institute Fact Sheet: Health Reform Initiatives to Improve Care Coordination and Transitional Care for Chronic Conditions

Payment Reforms that Support Care Transitions and Coordination Hospital Readmission Reduce Incentives (§ 3025) –Penalties for avoidable readmissions Accountable Care Organizations (§ 3022) –Medicare Shared Savings Program –Provider bonuses for saving money and improving quality National Payment Bundling Pilot (§ 3023) –Bundled payment for episodes of care –Physicians, acute hospitals and post-acute care providers

Medicare Payment Reforms that Support Care Transitions and Coordination Avoidable Readmission Penalty (§ 3025) –Incentive to improve care transitions and reduce avoidable readmissions –Reduced Medicare DRG payments by 1%, rising to 3% –For certain avoidable readmissions exceeding a threshold (TBD) –3 Target conditions TBD starting in FY 2012, 7 in 2015 –Readmission window TBD (ie, 30 days post discharge) –Hospital-specific readmission rates will be published on Medicare Hospital Compare website –Expand to skilled nursing homes and HH Agencies

Innovations to Improve Care Transitions and Coordination Independence at Home Demonstration (§ 3024) –Starting in 2012 (or sooner), funding of $5 million/5 years –House Calls to help Medicare beneficiaries remain at home Medical Practices (MDs and Nurse practitioners) must have experience delivering home-based primary care, available 24 x 7 Target Medicare Beneficiaries with Multiple Chronic Illnesses –2 or more chronic conditions; 2 or more functional dependencies (ADLs) –Hospitalized in past 12 months (non-elective) –Rehab therapy in past 12 months –Voluntary enrollment of up to 10,000 beneficiaries –Bonus for savings exceeding 5%

Innovations to Improve All Care Transitions and Coordination Community Health Teams (§ 3502) Interdisciplinary teams contract with Medical Homes –Collaborate with community support services –Teams must be designated by states or Indian tribes –Chronic care coordination, discharge planning, transitional care, medication therapy management (§ 3503), mental health referrals, 24 x 7 availability –HHS grants: ACA does not authorize funding but HHS has indicated funding will be available Teams must become self-sustaining in 3 years Targets patients with chronic conditions regardless of payer type (Medicare, Medicaid, private)

Medicaid Innovations to Improve Care Transitions and Coordination Medicaid Health Homes for Chronic Conditions (§ 2703) –Also known as Medical Homes –State Medicaid Option Targets high-risk Medicaid beneficiaries –2 chronic conditions or –1 existing chronic condition plus risk of 1 or more additional or –Serious mental illness Services –Enhanced integration and coordination of primary care, acute care, behavioral care, and long term care –Care management, transitional care, community support services

Medicaid Innovations to Improve Care Transitions and Coordination Medicaid Health Homes for Chronic Conditions (cont) Funding –Planning grants starting in 2011 –CMS will base approval on Letter to State Medicaid Directors, Nov 16, 2010, and subsequent regulations –Matching funds totaling up to $25 million ($500,000 each?) –Over 20 states have expressed interest in planning grants Conditions During first 2 years, 90% federal matching funds for Health Home services –States must track avoidable readmissions –Estimate savings from care coordination –Report lessons learned

Duals CMS: $1 million per state for 15 states to support design Person-centered models that integrate the full range of acute, behavioral health and long-term supports and services Does not prescribe managed care per se---CMS open to innovative models

Acceleration toward more HCBS Money Follows the Person Balancing grant program Community First Option CLASS

LTSS State Scorecard Concise performance tool to put LTSS policies and programs in context. First attempt to use a multidimensional approach to comprehensively measure state LTSS system performance overall and across diverse areas of performance. Differs from analyses that examine a single aspect of states’ LTSS systems. Developed over two years—to be released September 8th. 15

Partners & Contributors Funded collaboratively by The Commonwealth Fund and The SCAN Foundation. Experts from across the country formed a National Advisory Panel and a Technical Advisory Panel, which were consulted regularly throughout the development of the Scorecard. NCSBN key contributor 16

Our Definition of LTSS* Inability to perform ADLs or IADLs on one’s own for an extended period (typically 90+ days) Includes human assistance, supervision, cueing and standby assistance, assistive technology, health maintenance tasks, information, care coordination Includes services used by family caregivers In a high-performing system, LTSS are coordinated with housing, transportation, health/medical services *Those whose LTSS needs arise from intellectual disability or mental illness are excluded for purposes of the scorecard. 17

Characteristics of a High-Performing LTSS System Support for Family Caregivers Affordability and Access Choice of Setting and Provider Quality of Life and Quality of Care Effective Transitions and Organization of Care –The first four characteristics map to dimensions and indicators 18

Dimension: Support for Family Caregivers In a high-performing LTSS system, the needs of family caregivers are assessed and addressed so that they can continue in their caregiving role without being overburdened. Support for Family Caregivers includes: level of support reported by caregivers; legal and system supports provided by the states; and the extent to which registered nurses are able to delegate health maintenance tasks to non-family members, which can significantly ease burdens on family caregivers. 19

Nurse Delegation Tasks Medication administration i. Oral medication ii. PRN medication iii. Pre-filled insulin/insulin pen iv. Draw up insulin v. Other injectable medication vi. Glucometer testing vii. Medication through tubes viii. Insertion of suppositories ix. Eye/ear drops 20

Nurse Delegation Tasks Tube feedings (Gastrostomy) Administration of enemas Bladder regimen (intermittent catheterization) Ostomy care (skin care, change appliance) Respiratory Care i. Nebulizer treatment ii. Oxygen therapy iii. Ventilator care 21

State Policies on Delegation of 16 Health Maintenance Tasks 22 DATA: National Council of State Boards of Nursing, 2011 Nurse Delegation Survey SOURCE: State Long-Term Services and Supports Scorecard, 2011 NOTE: Data not available for Alabama, Delaware, District of Columbia, North Carolina and Ohio

Future of Nursing: Campaign for Action

Health Care System Challenges Fragmentation Health care disparities Aging and sicker population Primary care shortage High costs

Fragmentation Lack of integration among providers System rewards volume, not value Result: lower-quality care and higher costs

Health Care Disparities Get fewer routine procedures Receive poorer care Die younger Racial and ethnic minorities

Aging and Sicker Population Life expectancy rising Baby boomers aging Chronic diseases increasing

Primary Care Shortage Rural and low-income areas particularly affected Fewer physicians entering primary care 32 million more people to get health insurance in 2014

High Costs Health care costs unsustainable Federal budget deficits affected Wages stagnating

IOM Report High-quality, patient- centered health care for all will require transformation of the health care delivery system

Health Care Reform and the Nursing Workforce: Matching Nursing Practice and Skills to Future Needs, Not Past Demands Julie Sochalski & Jonathan Weiner A reorganized health care delivery system will have a significant effect on the future roles and responsibilities of RNs and APRNs Appendix F

32 Innovative Solutions: Nursing education funding, emphasis on graduate level Medicare GNE Demo Prevention and Public Health Fund Title VIII of the PHSA NHSC Problem: Chronic and cyclical nursing workforce shortage. Innovative Solution: Transitional care pilot program Problem: Unnecessary re-hospitalizations decrease quality of life for the older adult and drive up Medicare costs. Opportunities in Affordable Care Act

33 Innovative Solution: Medicare’s Independence at Home Demo Problem: Too many people in nursing homes and hospitals when they want to be home. Innovative Solution: Residency Demo Problem: Need for nurse practitioners skilled in community-based health centers. Innovative Solutions: Accountable Care Organizations Nurse Managed Health Centers Medicare Medical Homes Medicaid Health Homes Problem: Uncoordinated care, lack of communication, too many medications lead to poor outcomes. Opportunities in Affordable Care Act

Campaign Vision All Americans have access to high-quality, patient- centered care in a health care system where nurses contribute as essential partners in achieving success

Campaign for Action EducationPractice Collaboration LeadershipData Campaign for Action

Education Increase to 80 percent the proportion of nurses with BSN by 2020 Double number of nurses with doctorate by 2020 Implement nurse residency programsPromote lifelong learning

Education Evidence Significant association between educational level and patient outcomes 6 percent of AD grads get advanced degree, enabling them to teach and serve as PCPs, compared to 20 percent of BSN grads

Appendix I Recommendation 2: Convene expert panels to develop a model pre-licensure curriculum which: can be used as a framework by faculty in community college-university partnerships for development of their local curriculum; is based on emerging health care needs and widely accepted nursing competencies as interpreted for new care delivery models incorporates best practices in teaching and learning

Practice All practitioners should practice to full extent of their education and training Optimal care –Physicians, nurses and other health professionals work in team-based model of care delivery –Models of care maximize time that providers can spend on their respective roles and responsibilities to patients

Practice Evidence: More than 10 studies show equivalent patient outcomes when care is provided by APRN or MD for certain services –Includes two Cochrane reviews –Randomized clinical trial published in JAMA –Office of Technology Assessment No studies show care is better in states that do not allow APRNs to practice to full extent of education and training

Practice

Leadership Nurses bring important viewpoint to management and policy discussions Prepare more nurses to help lead improvements in health care quality, safety, access and value

Data Improve health care workforce data collection to better assess and project workforce requirements Research on health care workforce is fragmented Need data on all health professions

Diversity Nurses should reflect patient population in terms of gender, race and ethnicity All nurses should provide culturally competent care Increase workforce diversity

Transforming Health Care cost quality access Education Leadership Access to Care Workforce Data Interprofessional Collaboration 45

RWJF AARP Advisory Committee Diverse Stakeholders Policy-makersAction CoalitionsCommunicationsGrantmaking Research, Monitoring, Evaluation Campaign Strategies

Campaign for Action RWJF/AARP seeking support from: health professions payers consumers business policy-makers philanthropies educators hospitals and health systems public health agencies Nursing must be considered societal issue!

Campaign for Action Long-term alliances Field strategy to move key nursing issues forward at local, state and national levels Expect to be in all states in 2012 Capture best practices, networking Action Coalitions To become part of a coalition, go to:

UPDATED:

Your Leadership New models of care require change, including us Action Coalitions –80/20 competencies –Scope of Practice (including delegation) –Leadership on boards and commissions –Interprofessional education and collaboration 50

Campaign Resources Visit us on the Web at: Follow us on twitter at: Join us on Facebook at: Visit us on the Web at: Follow us on twitter at: Join us on Facebook at: