Over the next five to ten years, our nation will experience the steady implementation of President Obama's landmark health care reform legislation, the
The federal government will increasingly invest in Health Information Technology (HIT) and data-driven Comparative Competitive Research (CER) in order to ensure that the care provided will, in fact, be appropriate and based upon the most up-to-date scientific knowledge. An additional 32 million previously uninsured Americans will have access to necessary health insurance, while the Congressional Budget Office (CBO) estimates that the bill will reduce the deficit by $143 billion over the first decade of enactment and effectively bend the ever-escalating cost curve. No longer will the Institute of Medicine (IOM) report: "The lag between the discovery of more efficacious forms of treatment and their incorporation into routine patient care is unnecessarily long, in the range of about 15 to 20 years. Even then, adherence of clinical practice to the evidence is highly uneven." Licensure mobility will become the norm. The public sector with its budgetary resources, and especially the Department of Defense (DoD) and the Veterans Administration (VA), will undoubtedly take the lead in demonstrating the effectiveness of "seamless care" and the unprecedented opportunities for developing individualized gold standard protocols utilizing the unprecedented advances occurring within the communications and technology fields. Virtual realities, 24/7world-wide expert consultations, and home-based care will become what the public (and their elected officials) expect. Over the years we have learned that change is always unsettling, especially for those whose future suddenly seems unpredictable and perhaps out of their control. And yet, unprecedented change is undoubtedly upon us.
This Fall the IOM, in conjunction with the Robert Wood Johnson Foundation, released a truly visionary report: The Future of Nursing: Leading Change, Advancing Health. Nursing is the largest sector of the health professions, with more than 3 million registered nurses in the
The committee urged: "Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Major changes in the
The clinical skill set of professional nursing covers a broad continuum from health promotion, to disease prevention, to coordination of care, to cure – where possible – and to palliative care when cure is not possible. Many members of the nursing profession admittedly require more education and preparation to adopt new roles in response to rapidly changing health care settings and the evolving health care system. Today's restrictions on their scope of practice, policy- and reimbursement-related limitations, and professional tensions have undermined the nursing profession's ability to provide and improve both general and advanced care. Developing a health care system that delivers the right care – quality care that is patient centered, accessible, evidence based, and sustainable – at the right time will require transforming the work environment, scope of practice, education, and numbers of
The IOM committee was truly interdisciplinary in composition, including a former Administrator of HCFA (now CMS). It appreciated that: "Strong leadership is critical if the vision of a transformed health care system is to be realized. To play an active role in achieving this vision, the nursing profession must produce leaders throughout the system, from the bedside to the boardroom. These leaders must act as full partners with physicians and other health professionals, and must be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions. Being a full partner transcends all levels of the nursing profession and requires leadership skills and competencies that must be applied within the profession and in collaboration with other health professionals…. To be effective in reconceptualized roles, nurses must see policy as something they can shape rather than something that happens to them. Nurses should have a voice in health policy decision making and be engaged in implementation efforts related to health care reform. Nurses also should serve actively on advisory committees, commissions, and boards where policy decisions are made to advance health systems to improve patient care." Those colleagues fortunate to have attended the APA Practice Directorate State Leadership conferences will recall that these are the same powerful messages that
Over the years we have learned that substantive change always takes time. In June 2005 Senator Dodd, one of the major architects of PPACA, re-introduced the Information Technology for Health Care Quality Act which is a major component of the President's initiative. "By encouraging health care providers to invest in information technology (IT), this legislation has the potential to bring skyrocketing health care costs under control and improve the overall quality of care in our nation…. (E)xpanding the use of IT in health care is the best tool we have to control costs. Studies have shown that as much as one-third of health care spending is for redundant or inappropriate care…. Most experts in the field of patient safety and health care quality, including the IOM, agree that improving IT is one of the crucial steps towards safer and better health care…. (T)his legislation would provide for the development of a standard set of health care quality measures."
Calling for an increased investment in obtaining reliable data on which to transform our nation's workforce and practitioners' scopes of clinical practice, the IOM made a series of far-reaching policy recommendations including: * Expanding the Medicare program to include coverage of APRNs just as physicians are currently covered; * Authorizing APRNs to perform admission assessments, as well as certification of patients for home health care services and for admission to hospice and skilled nursing facilities under Medicare; * Requiring third-party payers that participate in fee-for-service arrangements to provide direct reimbursement to APRNs; * Amend or clarify the requirements for hospital participation in Medicare to ensure that APRNs are eligible for clinical privileges, admitting privileges, and membership on medical staff; and, Requiring the Federal Trade Commission to review existing and proposed state regulations concerning APRNs to identify those that have anticompetitive effects without contributing to the health and safety of the public. State Boards of Nursing, accrediting bodies, government, and health care organizations were urged to support nurses' completion of a transition-to-practice nurse residency. Schools of nursing should double the number of nurses with a doctorate degree by 2020. And, nurses should be systematically encouraged to engage in lifelong learning by making the necessary resources available to facilitate interprofessional continuing competency (i.e., CE) programs.
"The [IOM] committee recognizes that improved primary care is not a panacea and that acute care services will always be needed. However, the committee sees primary care in community settings as an opportunity to improve health by reaching people where they live, work, and play. Nurses serving in primary care roles could expand access to care, educate people about health risks, promote healthy lifestyles and behaviors to prevent disease, manage chronic diseases, and coordinate care…. Recognizing the importance of primary care… the committee viewed the potential contributions of these nurses to meeting the great need for primary care services if they could practice uniformly to the full extent of their education and training." Education has always been the key to our nation's future. As we enter the 21stcentury, times are definitely changing. Those colleagues who possess degrees in both nursing and psychology – one of whom is APA President Carol Goodheart – must be particularly proud. They instinctively invested in their future long before many of us began to understand the intimate connection between the mind, body, and psychosocial-economic-cultural gradient of health care. Aloha,
