From Beth Zorn, RN, BSN, LNCC
I appreciate Sharon's offer to post on her President's Blog about my recent trip to Washington, DC. On 6/13/12, The White House and Department of Health and Human Services officials hosted a two hour “conversation with nurses” to discuss delivery system transformation, and how the Affordable Care Act can support their efforts to provide high quality care to patients. Their stated goal was to “bring local nurse leaders from around the country to the White House to discuss the challenges and opportunities they are facing in their clinics, hospitals and communities, and facilitate an open dialogue that can enable shared learning from one-another.” In attendance from the White House were Cecilia Munoz (Director, White House Domestic Policy Council), Carole Johnson (Senior Policy Advisor, White House Domestic Policy Council), Mandy Cohen, MD MPH (Director, Stakeholder Engagement Group, Center for Medicare and Medicaid Innovation) and Liz Fowler (Special Assistant to the President for Heathcare & Economic Policy, White House National Economic Policy). Also in attendance were nursing leaders, including those representing more than 80 professional nursing organizations. I attended as AALNC’s representative.
Short panel presentations were made by three doctoral prepared nurses:
Margaret Flinter, APRN, FNP-c, PhD, FAANP - Senior VP & Clinical Director, Community Health Center, Inc; Director, Community Health Center’s Weitzman Center for Innovation in Community Health & Primary Care
Kristi Henderson, DNP, NP-BC, FAEN – Chief Advanced Practice Officer, Director of Telehealth, Associate Professor in the School of Nursing, Univ. of Mississippi
Mary D. Naylor, PhD, RN, FAAN – Professor in Gerontology; Director, New Courtland Center for Transitions and Health University of Pennsylvania School of Nursing.
The major themes addressed by the three panelists included:
- The Transitional Care Model (TCM) which provides comprehensive in-hospital planning and home follow-up for chronically ill high-risk older adults hospitalized for common medical and surgical conditions. The heart of the model is the Transitional Care Nurse (TCN), who follows patients from the hospital into their homes and provides services designed to streamline plans of care, interrupt patterns of frequent acute hospital and emergency department use, and prevent health status decline.
- Use of Advanced Practice Nurses to provide primary care, especially in underserved populations. Dr. Henderson runs a program encompassing 100 telemedicine sites staffed by advanced practice nurses all of whom participate in “mini-residency” programs in which they work with ED doctors during their training. This type of health care model reduces over health care costs by 25% as compared to the traditional health care model.
- The impact of the ACA on increasing access to health care among the underserved – 20 million Americans get their health care via community health centers staffed by NPs. There are also numerous school based health centers staffed by NPs.
- The ACA’s Innovation Center (http://innovations.cms.gov/) which is looking at innovative programs to improve quality health care while reducing costs. The nursing profession is critical to many of these initiatives, which include a Million Hearts (http://millionhearts.hhs.gov/index.html), the Strong Start Program (http://innovations.cms.gov/initiatives/strong-start/index.html) and the Comprehensive Primary Care Initiative. They are also looking at Accountable Care Organizations, groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. One of the panelists talked about bundled payments (and getting away from the fee for service model) and a team approach to care.
Following the panel presentations, the moderator opened up the floor to the attendees to share their concerns about the current state of health care delivery and how it might be improved. There was time for about 22 nurse leaders in the clinical arena to share their thoughts. All comments were captured with note-taking by several aides to the senior White House officials present.
Those who spoke represented diverse nursing organizations, including:
American Psychiatric Nurses Association
National Nursing Centers Consortium
American Academy of Nurse Practitioners
American College of Nurse Midwives
American Association of Nurse Anesthetists
National Association of Nurse Practitioners in Women’s Health
National Association of Clinical Nurse Specialists
American Nephrology Nurses Association
Developmental Disabilities Nurses Association
Oncology Nursing Society
National Alaska Native American Indian Nurses Association
The most common complaint mentioned was barriers to reimbursement for NP care, especially in the mental health arena and with medicaid reimbursement. Also mentioned was the importance of cultural issues in providing effective health care to the ethnically diverse population in our country. I have to say that after listening to the panel presentations and feedback provided by some of the attendees, I couldn’t be more proud of my clinical nursing colleagues who are making such important contributions to the delivery of high quality care!
Following are some patient education resources provided to us, for anyone interested in more information about health care or the ACA: