 |
|
 |
 |
| |
|
|
| |
| Harnessing Opportunities through Changing Times |
 |
by Seth Gordon, President & CEO - April 19, 2011
|
The Year is 2025 and predictions of the Institute of Medicine (IOM) Report, The Future of Nursing: Leading Change, Advancing Health written fifteen years prior, are evident in the workplace. Nearly every facet of healthcare delivery now has a digital dimension around it, “mediated increasingly by digital workflow, computerized knowledge management, and decision support. Computer generated patient management programs are moving from infancy to common place where histories and physical examinations, diagnostic tests, medication management and several forms of therapeutic interventions are handled through technology; not face to face encounters with your healthcare provider. Such encounters are now reserved for a much more complex, personal type of care not yet possible through technology requiring specific skills sets in patient education, counseling and support similar to what nurses traditionally were trained and prepared for dating back to the turn of the 20th Century! Sound far-fetched?
The IOM report reminds us that healthcare in the United States is at the crossroads of change and that nursing practice will play a critical role within it! As nurse practitioners, on the cutting edge of healthcare delivery, you know firsthand that the evolution of the profession and your role has evolved ahead of public policy that supports it. As the IOM report points out: “The ability of nurses to better serve the public is hampered by the constraints of outdated policies, particularly those involving nurses’ scope of practice.”
Among its key messages and recommendations presented within the report describe the role of nurses in realizing a transformed healthcare system. Importantly, its states: “Nurses should practice to the full extent of their education and training.” How long have we been saying that! Finally, others have heard the call and the IOM no doubt will be a great partner to have for the NPA and nursing community at large in implementing these recommendations!
New York is one of five demonstration states with a Regional Action Coalition (RAC) established for such purpose. RAC representatives have been named and have invited the NPA to discuss its role in assisting with report implementation activities around this objective! In the meantime, I encourage all members and your nursing colleagues to become familiar with this report if you have not already because it is bellwether and can help shape not only your future, but that of the profession for generations to come (see NPA.org for link to report and brief).
As nurse practitioners, you know that you are already mainstream healthcare providers. The NP I see for my care tells me that all the time. Yet the profession is constantly playing catch-up when it comes to role recognition and public policy support. For instance, long before the NPA gained legal title and scope for the profession…even before the NPA even existed, NPs were out there- practicing and delivering care to a population in need. Long before Medicare would reimburse NPs for services, NPs were providing care to Medicare beneficiaries. Today, several decades later, while many things have changed for the better, there is still much work to be done.
As NPs, some of you are filling out death certificates but are unable to legally sign them. As NPs, many of you counsel patients in end of life decisions but are unable to sign DNR orders. As NPs practicing in the specialty of psychiatry, you can conduct a patient assessment, diagnose an illness and prescribe treatment. You can write a discharge order in a hospital. Yet, you are unable to legally admit a patient on either a voluntary or involuntary basis to a behavioral health unit when called for. And the list goes on from being restricted to writing home care orders under Medicare to signing and documenting the comprehensive care plan you that you developed but under law, had to have the physician sign.
Above all, all of you practice autonomously under your own license as authorized and regulated by the State of New York. Yet your practice is controlled by those outside the profession who claim that quality will suffer without strict adherence to a legal mandate that they would never accept for themselves. They say physicians have far more training and experience through years of education and hours of residency requirements that NPs do not have. In fact, some physicians have far more education, training and experience than other physicians in different specialties. Yet no one is correlating the quality of patient care they deliver with professional standards of collaboration. No one is suggesting that a law is needed to ensure that they collaborate with other healthcare professionals as a substitute for one’s professional judgment within their scope of practice.
Through the Looking Glass?
At the national level, the Affordable Care Act (ACA) health reform package is not secure. Some portions (if not all) could conceivably not survive the Supreme Court; calling into question the right of Congress to impose insurance mandates on the public. The new Republican majority in the House have vowed to go after several provisions through funding strategies and budget mechanisms. At the same time, our national organizations, the ACNP and AANP are monitoring very closely, how these threats could impact those provisions important to the profession; such as funding for wellness and prevention programs; nursing education and the expansion of nurse managed healthcare clinics. Our national organizations will need strong State Association advocacy support to protect your interest as a profession and together, we will provide it in a coordinated fashion with our Congressional delegation. Remember, all politics is local!
In the meantime, 2014, the year in which ACA insurance reforms will begin at the state level, is closing in on us adding over 2 million Medicaid beneficiaries to the role! Who is going to take care of them when we are already having a shortage of primary care physicians? The Governor’s Medicaid Re-design team is trying to figure this out how to cut nearly $3 billion from Medicaid while policy makers struggle to close an overall $10 billion state budget deficit. Ready access to timely cost-effective primary care can have a positive impact on reducing healthcare costs. Therefore, state and federal governments are looking at ways to build a robust system infrastructure to encourage care coordination throughout the spectrum that ensures efficiency and accountability through various financial incentives, disincentives and bundling arrangements. Where will NPs fit in these models of care?
Another model being tested…Accountable Care Organizations, “groups of providers of services and suppliers meeting criteria specified by the Secretary (HHS) who work together to manage and coordinate care for Medicare fee-for-service beneficiaries.” As NPs, what will be your role in a system that integrates patient care information and delivery within a model that requires healthcare professionals to work closely together to supply the most efficient and economical patient care? Don’t worry, organized medicine has an answer! They run the show and you work for them similar to the model institutionalized under statutory collaboration! However, to demonstrate that they truly value and recognize your role, you will be permitted to pay dues and join their Associations as non-voting affiliate members! No kidding, you will be hearing more about this.
At this writing, proposed legislation is being drafted to implement concepts of Medical Homes in New York which will entail highly coordinated, comprehensive primary care delivery and strong relationships between patients and providers to improve quality outcomes. The NCQA just recently within its medical home standards recognized NPs as qualified to lead medical home teams. This was hard earned and required strong, coordinated advocacy by the NPA, AANP, ACNP and other state/national organizations. Now, we turn to our State Legislature to ensure that NPs will be afforded the opportunity to play a meaningful role in medical homes as this concept evolves over time.
So here we are locked in a fight for professional recognition and public policy support which the NPA started over 30 years ago! Yes we have come a long way thanks to those who supported the cause and the hard work of this Association and its members. And yes, our work is far from over. At both State and Federal levels our healthcare system will be changing before us presenting new opportunities and new challenges. These opportunities must be harnessed; not lost!
So how are we going to meet the challenges currently before us? A call to action! Help us write the next Chapter in healthcare delivery to ensure that public policy not only talks about NPs as mainstream providers, but walks the talk. How?
Rule #1: Do not stay on the sidelines and expect to win in an endeavor that is as important and highly competitive as this! Clearly, it will require a personal commitment from all nurse practitioners so that we can harness our collective strengths in terms of human and financial resources;
Rule #2: Do not settle for less! They need all of you; and,
Rule #3: Be confident in who you are; you earned it.
Together, we have an opportunity to shape the future of the profession and for the better. Public policy must catch up and support the profession because the profession is vital to healthcare. I know we can we count on you and together, we will see this through!
Congratulations to all of you who dedicate yourself to the betterment and who so deservedly have been honored by Governor Cuomo as we celebrate April 2011 as Nurse Practitioner Month in New York!
 A seasoned leader with over 30 years of experience in healthcare in both the private and public sectors, Seth has held several senior level positions in healthcare policy and management. He brings extensive Association experience to the position including that with the Healthcare Association New York State (HANYS). His accomplishments are numerous including a White House meeting to discuss healthcare reform with then, First Lady Hillary Rodham Clinton. Seth holds a B.S. degree in healthcare administration, as well as M.P.A. in healthcare policy from Syracuse University’s Maxwell School of Citizenship and Public Affairs. He has received several advocacy awards including Honorary Nurse Practitioner Alumnus from the State University at Buffalo, School of Nursing, and is the recipient of the ACNP’s 2005 Koehler Legislative Advocacy Award for outstanding political and legislative leadership. This year will mark the 12th year of service to the NPA as its Chief Executive.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
RECOMMEND THIS ARTICLE
You must be logged in
to recommend articles
|
|
|
|
| |
|
|
 |
 |
|
 |
 |
 |
|
