Health Care Reform Sandra Gilman
Health Care Reform Outline • Overview of Health Care Reform (HCR) • The Effect of Health Care Reform on Hospitals and Health Care Workers • Nursing and Physician shortage • Increased patient population • Reimbursements based on patient outcomes • Relevant Theories • The Point of View of Patient, Physician, and Nurse • Health Care Environment Now, and Later • Implication of Health Care Reform • Recommendations • Conclusion
Objectives • Describe the many aspects of Health Care Reform • Identify the impact Health Care Reform will have on the General Population • Identify the effects Health Care Reform with have on nursing, physicians, and institutions as a whole. • Describe interventions which will lessen the effects of Health Care Reform on Nursing, Physicians, and institutions • Recognize the differences in Health Care as it is, and Health Care Reform
Terms and Definitions • Patient Protection and Affordable Care Act (PPACA) • Health Care Reform • Accountable Care Organization • Medicaid • Medicare • Bundled Payments • Insurance exchanges • Integrated Care
Introduction to Health Care Reform • Universal Health Coverage for all • 32 million uninsured adults will receive insurance • Reforming Health Care Payment System • Reimbursements based on patient outcomes • Achieving Effective and Efficient Health Care • Accountable Care Organizations • Increasing Access to Quality and Cost information
Faye Abdellah’s Nursing Theory in relation to Health Care Reform Current Nursing: A portals for Nursing Professionals; Nursing Theories Kaiser Family Foundation: Summary of New Health Reform Law Goal of Health Care Reform Reimbursements are tied to quality outcomes Development of new models of care Community heath needs appraisal by not for profit hospitals Affordable Quality care for all Abdellah’s Nursing Responsibilities • Patient Centered Approach • Effective Communication • Relieve pain, and provide continuous security for the patient • Plan for optimum health at local, state and national level • Continuous research and evaluation of nursing practice
The Current Health Care System • Many Working American’s Lack Medical Insurance • Health disparities exist • Poor management of chronic disease • Lack of providers who except Medicaid • Rising health care costs • Fragmented Care • Strict Medicaid eligibility • Life time dollar limit on health plans Musanti, R., et al.(2012) Partners in Caring Kaiser Family Foundation, (2012), Kaiser commission on key facts Medicaid and the uninsured
New Face of Health Care • Affordable insurance for all • Insurance Exchanges • Higher quality care • New regulations on private insurance companies • Increase in physicians accepting Medicaid/Medicare • Bundled Payments • Accountable Care Organizations’ McNeilly, L. 2012, Accountable care, value based purchasing, outcomes measurement Kaiser Family Foundation (2010) Summary of new health reform law Hart, M. (2012) Accountable Care Organizations, the future of care delivery?
Barriers to Change • Increased health care worker shortages • Many physicians threatening to leave practice • Older nurse population close to retirement • Therapy Services • Financial Implications • Deliver more with Less Resources • Cost of Health Reform • Influx in patients seeking care Cabin, W.D. (2011) Doing more with less McNeilly, L. (2012) Accountable care, value based purchasing, outcome measurement
Nursing Shortage • Estimated shortage • Causes of the shortage • What it means for society • How do we fix it? • Nursing contribution Cleary, B.,Wilmoth, P. (2011) The Affordable Care Act Dick et al (2007) Nurse working conditions and patient safety outcomes Lavizzo-Mourey, R., Rother, J. (2009) Addressing the nursing workforce
Nursing Wage by Specialty American Association of Colleges of Nursing (2012)
Physician Shortage • As of 2014 the projected physician shortage is estimated at 62,900. • Shortage projected to increase to nearly 140,000 physicians by 2025 • Lack of providers who accept Medicaid • Simulated Study projected the need of 4,500-12,100 new physicians by 2019 • New physicians choosing specialties to make more money Cleary, B. (2011) The Affordable care act- what it means for the future of nursing. Epstein, A. Et al. (2011), Policy makers should prepare for major uncertainty in Medicaid enrollment, costs, and needs for physicians under Health Reform Sanchez, C. (2010) Health law may worsen family doctor shortage.
Physician Pay Sanchez, C. (2010) Health law may worsen family doctor shortage.
Financial Implications • Financial impact is unknown • Medicare and Medicaid Service payment reductions • Changing payer mix • Budget cuts • Lost revenue if outcomes aren't met Schmidt, R. (2010) Reshaping the healthcare delivery network
Theory of Microeconomics as it Relates to Health Reform Aspects of Micro Economics Economic Changes in the face of Health Reform Value Based Purchasing Bundled Payments Increase in Baby Boomer population Accountable Care Organizations • Evaluates Supply and demand • Studies individual purchasing • Flow of economic resources • Helps determine costs Hart, M.A. (2012) Accountable Care Organizations Hussain, A., Rivers, H. (2009) Confronting the challenge of Long Term Health Care Crisis in the United States MBA Knowledge Base, Micro Economics and Macro Economics 2012
What happens with out Health Care Reform • Amount of Americans without insurance will increase • Rising healthcare costs • Rapid increase in Federal debt • Bankrupt Medicare Hussain, Et al. (2009) Confronting the challenges
Critical Steps to Ensure Success • Transform the workplace to focus on Quality • Support Nursing School Advancement • Implementation of innovative models of care
Quality of Practice • Ethics • Collaboration • Environmental Health ANA Standards American Nurses Association (2010)
QSEN Standards • Patient-Centered Care: • Teamwork and Collaboration • Safety • Evidence Based Practice • Quality Care Quality and Safety Education for Nursing (2012)
Conclusion • American’s deserve equal treatment • Will produce good quality outcomes • May worsen nursing and physician shortage • Financial burden on organizations • Once reform complete will likely have more positive than negative
References American Association of Colleges of Nursing (2012) Nursing Faculty Shortage retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage American Nurses Association (2010) Scope and Standards of Practice Nursing (2nd ed.) Silver Springs: MD Cabin, W.D. (2011) Doing more with less. Home Health Care Management and Practice 23(4) 266-270 Cleary, B., Wilmoth, P. (2011) The Affordable Care Act- what it means for the future of nursing. Tar Heel Nurse 8-12. Current Nursing: A portals for Nursing Professionals; Nursing Theories: A companion to nursing theories and models(2011). Retrieved October 11, 2012, from http://currentnursing.com/nursing_theory/Abdellah.htm Dick, A. W., Glance, L.G., Horan, T., Larson, E. L., Mooney-Kane, C., Stone, P.W., Zwanziger, J. (2007) Nursing working conditions and patient safety outcomes. Med Care 45(6) 571-578. Epstein, A., Sommers, B.D., Swartz, K. (2011). Policy makers should prepare for major uncertainties in Medicaid enrollment, costs, and needs for physicians under health reform. Health Affairs 30(11) 2186-2193 Hart, M.A. (2012) Accountable care organizations: the future of care delivery? American Journal of Nursing 112(2) 23-26 Hussain, A., Rivers, P.A. (2009) Confronting the challenges of long-term health care crisis in the united states. Journal of Health Care Finance 36(2) 71-82 Kaiser Family Foundation (2010). Summary of New Health Reform Law. Focus on Health Reform . Retrieved October 11, 2012 from http://www.kff.org/healthreform/8061.cfm Kaiser Family Foundation (2012, July). Kaiser Commission on Key Facts Medicaid and the uninsured. Retrieved from http://www.kff.org/medicaid/upload/8338.pdf Lavizzo-Mourey, R., Rother, J. (2009) Addressing the nursing workforce: a critical element for health reform. Health Affairs 28(4) 620-624 MBA Knowledge Base (2012). The micro economics and macro economics. Retrieved from http://www.mbaknol.com/managerial-economics/the-micro-economics-and-macro economics
References Mcneilly, L., Sutherland-Cornett, B. (2012) Accountable care, value based purchasing outcomes measurement. American Speech Language Hearing Association Leader 10-13. Musanti, R., O’Keefe, T., Silverstein, W. (2012) Partners in caring, an innovative nursing model of care delivery. Nursing Administration 36(3) 217-224 Sanchez, C. (2010). Health law may worsen family doctor shortage. The Tennessean a Gannett Company Schmidt, R., Altus, G. (2010) Reshaping the healthcare delivery network. Health Care Financial Management 64(1) 100-104 Quality and Safety Education for Nurses (2012) Quality and Safety Competencies. Retrieved from http://www.qsen.org/