THE AFFORDABLE CARE ACT: IMPLICATION FOR NURSES Trula E. Minton, MS, RN, NEA-BC 1 CURRENT HEALTH SYSTEM: 2 1
HOW IS THE CURRENT SYSTEM WORKING FOR US? 3 THE CHANGE COMING 4 2
TRANSFORMED HEALTH SYSTEM 5 2010 AFFORDABLE CARE ACT (ACA) Broadest health care overhaul since 1965 with the creation of Medicare and Medicaid Programs ACA goal to transform health care system to provide care that is: Safe Quality Patient-centered Accessible Affordable Consequence of ACA requires comprehensive rethinking of health care professional roles 6 3
INSTITUTE OF MEDICINE (IOM): KEY MESSAGES Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and an improved information infrastructure. Institute of Medicine 2010, Future of Nursing 7 SOCIAL DETERMINATES OF HEALTH California Institute for Nursing and Health Care 8 4
AFFORDABLE CARE ACT: PREVENTION Former HHS Secretary, Kathleen Sebelius, issued a statement highlighting the roles of nurses in the ACA The emphasis of the ACA on preventing illness and managing chronic conditions opens new opportunities for nurses to shape and lead the future delivery of health care and capitalizes on the expertise of the nursing profession. New England Journal of Medicine, 2013 9 NURSING WORKFORCE 2012 2015 U.S. Department of Health & Human Services, Health Resources & Services Administration, December 2014 10 5
GEORGETOWN UNIVERSITY: SUPPLY AND DEMAND THROUGH 2020 Project 1.6 million openings through 2020 700,000 newly created opportunities 880,000 replacements for retiring baby boomer nurses 1.2 million for RNs 370,000 for LPN/LVNs 11 DIFFERENCES: GEORGETOWN AND HRSA STUDIES Georgetown to 2020, HRSA 2025 Active Supply Those who graduate and work as a nurse One-third licensed nurses do not work Includes APRN s 12 6
VIRGINIA RN WORKFORCE 2012 SUPPLY & DEMAND 69,900 2025 PROJECTED Supply: 106,700 Demand: 87,300 Difference: 19,400 13 ACA: IMPACT ON NURSING EDUCATION Grants, loans and loan repayment programs Nursing education, practice & retention grants Expanding BSN enrollment Increasing use of new technology (including distance learning) Promote nursing practice arrangements in non-institutional settings such as home health care Remedy the shortage of nursing faculty Nurse-Managed Health Centers (NMHC) for underserved populations Georgetown University, Carnevale Smith & Gulish, 2015 14 7
ACUTE CARE NURSING More acutely ill patients Older, more elderly patients Skills required Critical decision-making Increase in sophistication of life-saving technology Information management systems requiring skills in synthesis and analysis 15 COMMUNITY NURSING Coordination of care among various clinicians and community agencies for chronic disease management Focus on preventing episodes of acute care and disease progression Use of technology to improve quality and effectiveness of care The Future of Nursing: Focus on Education, 2011 16 8
PREVENTION THROUGH ACA Improved access to clinical preventive services by removing cost barriers Prevention services for Medicare beneficiaries Annual wellness exams Medicaid beneficiaries No cost sharing for preventive services Wellness in the workplace Health promotion strategies Community partnerships in promoting prevention Partnerships between state, local governments and community groups New England Journal of Medicine, Koh & Sebelius, 2010 17 NURSING ROLES California Institute for Nursing and Health Care Nurse Role Exploration Project Care Coordinator Faculty Team Leader Informatics Specialist Nurse/Family Cooperative Facilitator Primary Care Partner 18 9
PROCESS 19 OPPORTUNITIES 20 10
CHALLENGES 21 SUMMARY ACA creates increase in demand for services Team-based primary care Community-based models Primary care Prevention Management of chronic disease Acute care admissions Demographic Changes Increase in aged population Increase in health care coverage (increase in demand) Nursing Workforce Aging workforce Licensed, not working Discrepancies in demand/supply predictions Educational opportunities, including availability of faculty Decrease in availability of foreign nurses due to immigration laws 22 11