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August, September, October 2010 Nevada RNformation • Page 7

Healthcare Reform and Nurses: Challenges and Opportunities By Laura Stokowski, RN, MS

Medscape Ask the Experts Advanced Practice Nurses Reviewed by Denise S. Rowe, MSN, APRN, BC, FNP

Federal healthcare reform, specifically, The Patient Protection and Affordable Care Act (PPACA) was passed into law by Congress in March, 2010. The legislation was passed after a year of intense debate on the pros and cons of the federal government’s role and responsibilities in providing or increasing access to healthcare for its citizens. In this article, Stokowski does not rehash the debate, but offers insights on the implications of PPACA from two nationally known nurse leaders. The article also summarizes key provisions of PPACA that affect nursing.

Stokowski states that the expectation of 32 million people becoming newly insured will significantly affect our healthcare system and that nurses will continue to play a central role in healthcare delivery. To discuss the likely challenges and opportunities, Stokowski interviewed Maureen “Shawn” Kennedy, MA, RN, Editorial Director and Interim Editor in Chief of the American Journal of Nursing, and Susan Hassmiller, PhD, RN, FAAN, senior nursing advisor at the Robert Wood Johnson Foundation.

Both leaders suggested that the new law will be good for nurses. To start, PPACA provides additional funding for baccalaureate and advanced practice nursing education. One exciting area that the law creates is a grant program for health clinics to be managed by nurse practitioners (NP). Kennedy stated this will lead to more NPs going into independent practice. She also pointed out that even though physicians raise the issue of safety when they perceive NPs are treading into their turf and affecting their financial bottom-line, NP delivered care has been shown to be as safe as physician delivered care.

Another question asked was whether there would be enough nurse practitioners to meet the demands of millions more people with health insurance. Hasmiller commented that when the 2006 Massachusetts law offered health insurance to virtually all its residents, there was initially a shortage of primary care providers and emergency room visits went up sharply, initially causing a spike in healthcare costs. Subsequently Massachusetts passed a law requiring recognition and reimbursement for NPs as primary care providers by health insurance plans. Under PPACA, Certified Midwives will receive the same pay as physicians for Medicare Part B, which covers physician fees. The Joint Commission is also working on a medical home designation which expands leadership roles in primary care beyond just physicians to include independent practitioners including NPs.

What about the paradigm shift from a sick care model to a prevention based model which also targets chronic disease management? Hassmiller was emphatic that nursing has always been about prevention and wellness and was excited to see this approach as a significant focus of the new law. She said nursing education curricula while continuing to address acute care, must now include more emphasis on community care and address cultural competencies and training for new multidisciplinary healthcare settings to meet the needs of a more diverse and aging population.

Stokowski asked if healthcare reform would lead to staff reduction among hospital-based nurses. Kennedy suggested that more nurses would be needed due to the expected increase in patient volumes. She stated that nurses are at the center of promoting optimal wellness because they have that close interaction with patients. She added that whether at the emergency room or at doctors’ offices, nurses were on the front lines to assess where patients fit on the health-illness continuum. Hassmiller pointed out that PPACA would also reward the delivery of higher quality of care in hospitals, trauma care, prevention, wellness, safety and disaster preparedness. Therefore, more nurses with better training will be needed. Should nurses be worried about losing their jobs as a result of healthcare reform? Kennedy said while the nurse work force has resulted in some job losses related to the economy, nurses must continue to strongly

advocate for the economic value that nurses bring to the workplace.

Key PPACA provisions include but are not limited to the following:

• Increases the total loan amount for nurse education from $13,000 to $17,000 (at 5% interest)

• Provides fellowship programs for nursing faculty and advance practice RNs to practice in geriatrics, long term care, or chronic care for 5 years and offers traineeships for advanced practice nursing degrees in geriatric care

• Provides education grants for Nurse Midwives, removing the 10% cap on doctoral education

• Provides nurse retention programs including career ladders and funding for nursing residencies and internships

• Expands scholarships and repayments to nurses working as nursing faculty for 2 years in accredited schools

• Increases the nurse faculty loan repayment program from a maximum of $30,000 to $35,000. Master’s graduates working as nursing faculty at accredited programs for 4 years would be eligible for $40,000 loan repayment, while doctoral graduates would be eligible for $80,000

• Provides stipends for racial and ethnic minorities with diplomas or associate degrees to enter bridge or higher degree programs. Grants would also be available for pre-entry preparation and advanced degree preparation and retention

• Offers grants to train family NPs in primary care in federally qualified facilities or clinics managed by nurses

• Provides grants for the delivery of comprehensive primary care services in schools for underserved children and adolescents

• Offers incentive programs that increase payments to providers including NPs and clinical nurse specialists by 10%

• Optionally covers home visitation services to new mothers among low-income and at-risk families

• Funds patient-centered outcomes research which will compare health outcomes, clinical effectiveness, risks and benefits of medical treatments and services

• Increases payment rates to Nurse Midwives for covered services from 65% to the rate that a physician providing the same service would receive

In summary, I agree with Stokowski that healthcare reform will bring opportunities and challenges. As nurses we need to educate ourselves about the law’s provisions so we can in turn educate our patients. The American Nurses Association President, Rebecca Patton, in discussing how nurses can help people understand the changes that lie ahead in healthcare reiterated that as devoted patient advocates, nurse are uniquely positioned to educate patients on how healthcare reform will directly impact them. I completely agree. By doing so, we have the ability to impact patient outcomes when we educate and advocate for our patients. Many of them will be newly insured, accessing care, and navigating through a healthcare network with the ultimate goal of getting the best care for themselves and their families. While it may initially be challenging as the law is phased in, PPACA provides opportunities for nurses to grow and to lead. As we approach the changes ahead, I believe there is much on the horizon for nurses to be excited about.

Letters to the Editor

Mobile MedWatch April 14, 2010 Dear Editor,

I would like to ask your assistance in notifying your Nevada nurse members of a new and clinically useful medical product safety tool provided free from FDA that we expect can improve the safety of their patients and improve health outcomes.

In 2010, we recognize that nurses, other clinicians and healthcare managers are using smartphones and other mobile text devices as a routine part of their daily work flow. To that end, FDA MedWatch is announcing a MedWatch mobile pilot to evaluate the effectiveness of using text messaging to send our popular MedWatch Safety Alerts, currently disseminated by standard e-mail [www.fda.gov/ Safety/MedWatch/ucm168422.htm]. Clinical care nurses and nurse managers who receive these concise alerts, no more than 2 or 3 messages a week on average, will learn immediately about clinically important safety changes to the drugs they dispense and manage, or the devices they use in diagnosis and therapeutic settings.

Our goal is to inform all medical care organizations and their provider workgroups, whether practicing in inpatient, outpatient clinic, office, or senior/extended care settings, of the opportunity to subscribe to the Safety Alert pilot, described at http://www.fda.gov/ AboutFDA /ContactFDA /StayInformed/ucm193168. htm. On the subscription page, we also have provided you and your IT team with the code for this web graphic, which can be placed on your website to inform website visitors of the opportunity to sign up for MedWatch alerts.

Patient safety is central to our public health mission, and FDA is committed to delivering new safety information to nurses and other clinicians at the point-of-care in order to reduce the risk of drug or device-related harm, improving patient health outcomes. I hope that you will consider using your various communication channels, whether paper-based or electronic, to make your nurse members aware of the Safety Alert pilot and the opportunity to subscribe.

I would be pleased to provide you with further information about this pilot project and with other ongoing patient safety activities that our MedWatch program can offer your nurse members. I would enjoy speaking further with you or your staff about possibilities for collaboration between FDA and Nevada Nurses Association in ways that might impact the health of Nevada’s citizens. You can reach me directly with an email message to the address below.

With kind regards, Norman

Norman S. Marks, MD, MHA Medical Director, MedWatch Program US Food and Drug Administration [email protected] www.fda.gov/medwatch

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