The 2012 election is over. Speeches (victory and conceding) have been made and (hopefully) the many signs along the roadway will be retrieved and recycled. With all of the speeches, debates and advertisements made, the end result looks very much like what this election cycle started with. President Barack Obama retains his position, the Senate is still controlled by the Democrats and the House of Representatives is in the hands of the Republicans. While the political landscape has not changed much, one can only hope that people can learn to work together better over the next few years. So where does this leave the future for health care?
It does give us some semblance of direction since there will be no push to dismantle the Affordable Care Act (ACA). There are many published chronologies that give us a time map showing when new parts of the ACA will take effect.
The push to increase the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores will increase. This is due to the fact that the percentage of Medicare reimbursement subject to Value Based Purchasing (VBP) will increase yearly to a maximum of 2% in 2017. This means hundreds of thousands of dollars in lost reimbursement for many hospitals.
Additionally, the HCAHPS survey has been expanded to include domains that look at how the patient was prepared for discharge. This is a part of the Readmission Reduction Program. To look at the expanded HCAHPS survey, go to www.hcahpsonline.org/surveyinstrument.aspx and click on the “Expanded HCAHPS Survey”. The bottom line on HCAHPS and VBP is the need for vastly improved communication between hospital staff members as well as patients and hospital staff.
Next year, 2013, will usher in some new taxes and a flurry of regulation production in preparation for 2014. Many sections of the ACA are specified as being implemented by rules and regulations implemented by the Secretary of Health and Human Services. The ACA, for all of its many pages, is general in nature and the details are still being worked out.
On January 1, 2014, a veritable tsunami of regulations and programs will take effect.
– Insurers are prohibited from establishing annual spending caps.
– Workers who are not covered by an acceptable insurance policy will pay a penalty.
– Penalties for employers of 50 or more full-time employees who do not offer health insurance.
– Medicaid eligibility will be greatly expanded (except for 5 states that are opting out).
– A $2500 limit on tax-free contributions to flexible spending accounts.
This is just a partial listing of the new regulatory environment that will affect health care. Other items will affect Medicare reimbursement to physicians, stress quality care while minimizing cost, and impose new taxes on most medical devices.
So, what does this mean to nurses? First, we will be tested by our neighbors and patients. Being named the most trusted profession carries the responsibility to have answers when people ask questions. Though most of us don’t specialize in the details of insurance coverage, it will behoove us to do some reading to be prepared for the inevitable inquiries that will arise.
Our nursing communication skills will need to improve. How well we explain the importance of taking medications and keeping follow up appointments in the post-discharge period can mean the difference between a hospital that can thrive and one that has to contemplate reducing services due to reduced reimbursement. Even more important than the financial aspect of better communication is the patient safety aspect. Being able to explain to a patient how, when and why they need to take their medication is extremely important. To do less than our best for those entrusted to our care is not acceptable.
Other impacts of the health care’s future for nursing include an increased need for nurse practitioners. With decreased Medicare payments to physicians, many have expressed their intention to stop taking any new Medicare patients. As more patients become Medicare (think new baby boomers) and Medicaid eligible the health care community will need to seek out providers to see these patients.
Are you a nurse with an entrepreneurial outlook? The many changes to take place beg for someone to pair a new need with a service. Should you talk to your local hospital about providing follow up care coordination or patient teaching? How about starting a phone check-up service where you make periodic calls to follow the transition of service in the patient’s discharge period? Health care is rapidly changing. These changes implore someone to marry the technology available today and tomorrow to our health care needs.