How the ‘Fiscal Cliff’ Deal, ACA and Other Changes Will Affect Nurses This Year

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By Debra Wood, RN, contributor 

January 18, 2013 - The Affordable Care Act (ACA) moves forward in 2013 toward full implementation, with hospitals and other providers preparing for increased demand for health services and greater opportunities for nurses. The newly-signed American Taxpayer Relief Act of 2012, known as the “fiscal cliff “deal, however, does not hold the same nearly universal positives for the profession.

“It’s an exciting time for nurses, because there’s a lot of opportunity,” said Suzanne Wells, MSN, RN, president of the American Academy of Ambulatory Care Nursing (AAACN) in St. Louis. She added that nurses are taking on more responsibilities as health care delivery changes.

Nurses and the Fiscal Cliff
Phyllis Shanley Hansell, EdD, RN, FAAN, said the ACA offers numerous opportunities focused on the deployment of nurses.

The ACA offers numerous opportunities focused on the deployment of nurses and considers nurses integral to intraprofessional heath care teams, added Phyllis Shanley Hansell, EdD, RN, FAAN, dean and professor of the Seton Hall University College of Nursing in South Orange, N.J.

“This is an exciting time but challenging, too,” added Karen Fuller, RN, BS, BC, PMP, a principal at CSC’s Health Delivery Group in Sarasota, Fla.

Greater numbers of insured patients 

The ACA is good news for nurses and the country, because it empowers nurses to help more patients, said Jemarion Jones, spokesperson for the American Nurses Association (ANA).

ANA health economist Peter McMenamin said, while more patients will be covered in 2014, the planning and arranging for that is happening now.

“The kind of care they will be looking for is the kind that is especially well done by nurses and advanced-practice nurses,” added McMenamin, a senior policy fellow in ANA’s nursing practice and policy department.

Jan Towers, PhD, NP-C, FNP, director of health policy for the American Association of Nurse Practitioners (AANP), cited patient benefits, including preventive services and elimination of pre-existing conditions and caps on coverage. Congress wrote the bill with provider-neutral language, which helps nurse practitioners (NPs), and NPs are recognized as providers in accountable care organizations (ACOs), in which the entity is responsible for the care of a population of patients.

Nurses and the Fiscal Cliff
Karen Fuller, RN, BS, BC, PMP, called this an exciting for nurses.

“With the Patient Protection and Affordable Care Act, a lot of new people will enter the pipeline, and a bunch of baby boomers are turning 65 every day,” Fuller said. “When you think about the sheer numbers of people who will need care, they will need people to take care of them.”

Not enough primary care physicians exist to care for the influx of people, and nurse practitioners will play a greater role and be a primary contact for patients, Fuller suggested.

“Nurse practitioners will be in great demand,” said Margaret Leonard, RN-BC, FNP, MS, senior vice president of clinical services at Hudson Health Plan in Tarrytown, N.Y. “It’s an exciting time for us with all of the different opportunities.”

“The ACA calls for investing in nurse-managed health clinics, as well as the creation and expansion of community health centers,” said Kristyn Kent-Wuillermin, director of strategic alliances, marketing and enrollment at Seton Hall. “Through the National Health Service Corps, nurse practitioners who work in medically underserved areas, as well as primary care physicians, and physician assistants, will have more opportunities for loan forgiveness and scholarships.”

More health care moving to the community 

Patients will receive more care in their communities--at home and in offices or clinics.

“The ambulatory setting is where so much of care will be provided and coordinated,” Fuller said. At the same time, home health is an area that is expected to continue growing at a rapid pace, allowing more employment opportunities for nurses.

Eighteen practices and consortia are participating in the Center for Medicare and Medicaid Innovation’s Independence at Home Demonstration, which will provide primary care home visits by physicians or NPs to patients with chronic conditions and functional limitations.

Greater need for education and care coordination 

The ACA also places a greater emphasis on patient engagement, health promotion and prevention of illness. More transitional services will take place in an attempt to prevent readmissions.

“Our role is going to be as health coaches and educators,” Fuller said. “There is a big opportunity for us.”

Better coordination of care, a key part of ACA, aims to prevent patients from needing hospital-level care. Nurses will likely have roles in ACOs.

Nurses and the Fiscal Cliff
Diane Omdahl, RN, MS, said nurses will play a role in reducing readmissions.

“Accountable care organizations, if it works, will be a wonderful innovation,” said Diane Omdahl, RN, MS, founder and president of 65 Incorporated, which educates people about Medicare. “Reducing the frequency of readmissions, nurses should be happy with that [role].”

Leonard said that nurses working for health plans also will be providing more care coordination for beneficiaries with complex conditions. 

“More opportunities within managed care organizations will open up, because everyone is realizing that if you do care coordination with patients and do outreach, the return on investment is there,” Leonard said.

Wells works in a call center and her practice has changed from dealing primarily with incoming calls to following up on discharged patients.

Positives and challenges ahead as country averts ‘fiscal cliff’ 

The American Taxpayer Relief Act of 2012 maintained lower tax rates for millions of Americans, including nurses, who earn less than $400,000 annually. The so-called “fiscal cliff” legislation also deferred reimbursement cuts associated with the Sustainable Growth Rate (SGR) formula for 2013, so nurse practitioners have been spared 26.5-percent reductions in payments associated with caring for patients covered by Medicare.

The SGR fix saved advanced practice nurses between $750,000-$800,000 in Medicare payments,” McMenamin said.

However, Congress paid for that with reduced payments to hospitals.

“Cuts in payments to hospitals have a non-positive effect on staff nurses,” McMenamin said. “It’s not a good thing, but it may or may not be negative. Hospitals have to make choices…But you cannot bump all reductions to nurses.”

Because nurses contribute to value-based payment measurements, he said, “Hospitals will want to retain and celebrate nurses.”

The Relief Act also postponed sequestration’s 2 percent cuts to Medicare until March 2012. If those reductions take place, hospitals will look to further reduce costs, which could adversely affect nurses.

“Hospitals have to do a balancing act,” McMenamin said. “But it’s hard to bet against health care in this country.”



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