On June 28, 2012, the U.S. Supreme Court upheld President Barack Obama's Affordable Care Act (ACA). This historic Supreme Court ruling will extend health care coverage to millions of uninsured Americans. This ruling also has implications for the providers of this health care-at all levels, especially advanced practice registered nurses (APRNs).
WHAT DOES THE ACA MEAN FOR APRN PRACTICE?
It is anticipated that the ACA will strengthen the health care system and make it more efficient and cost-effective through (1) expanded coverage, (2) care cost reductions, (3) fair and equitable treatment of patients, (4) Medicare preservation, (5) health promotion and prevention, and (6) the establishment of new models of care (U.S. Department of Health and Human Services, 2012). Advanced practice registered nurses will be intimately involved in all facets of the ACA.
Expanded Coverage
Millions of uninsured Americans will soon have increased access to affordable, quality health care coverage via Health Insurance Exchanges. The goal is for patients to be proactive by accessing the care they need in a timely manner to avoid delays in treatment, and 8,000-9,000 APRNs are being trained annually to help meet this increased demand (American Association of Colleges of Nursing, 2012).
Care Cost Reductions
Through health care electronic medical record mandates set forth for provider offices and hospitals in the ACA, new rules and regulations are designed to streamline current administrative and documentation requirements. This will allow providers, including APRNs, to spend more time on patient care and less time completing paperwork.
Fair and Equitable Treatment of Patients
Also included in the ACA are stipulations that insurers not be allowed to set limits on patients' benefits and that these insurers be required to spend a minimum amount on patients' health care annually. Patients will be able to file appeals for denied claims. In addition, patients will be given the opportunity to choose the provider of their choice. This means expanded opportunities for APRNs.
Medicare Preservation
The ACA preserves Medicare benefits. The Medicare Part D prescription drug program is also under revision. Furthermore, under the ACA, an annual "well visit" will be covered under Medicare. Advanced practice registered nurses are poised and ready to see these patients. In the near future, the plan provides for bonuses to be paid to providers who see underserved Medicare patients.
Health Promotion and Prevention
Under the ACA, local clinics and state programs will have the ability to expand health promotion and prevention services. There will also be a greater focus on caring for patients with chronic diseases and conditions linked to increased morbidity and mortality such as cardiovascular disease and diabetes secondary to obesity.
Establishment of New Models of Care
As a result of the ACA, new models of care are being enacted (e.g., medical homes) and other advanced care coordination and disease management models will help ensure that patients receive seamless, efficient care. Providers who provide high-quality services will be rewarded on the basis of standards that they help develop, based on solid evidence.
WHAT CAN YOU DO
As APRNs, we need to take up the gauntlet by (1) growing the workforce, (2) establishing nurse-managed clinics, (3) supporting student programs, and (4) educating patients about the ACA.
Growing the Workforce
Training and development is underway for more than 16,000 new primary care providers within the next 5 years. We need highly educated APRN faculty and leaders at all levels, in practice and in academia, to join in these efforts.
Establishing Nurse-Managed Clinics
Under the ACA, new nurse-managed clinics to train APRNs (i.e., nurse practitioners) to work in underserved communities have been approved. There are also plans to build new clinics and to renovate and expand the services of existing community clinics all over the United States.
Supporting Student Loan Programs
The National Health Service Corps will be expanded to include more APRNs who want to repay their school loans. These individuals will work with vulnerable populations in underserved areas of the country following graduation to repay part or all of their student loans.
Educate Patients About the ACA
Part of our responsibility is to educate our patients-not just about their diseases but also about the health care system. We need to explain the changes in simple terms and, when possible, refer them to the appropriate websites such as http://www.healthcare.gov/law/index.html.
There are now more than 155,000 nurse practitioners in the United States (American Academy of Nurse Practitioners, 2012). The intended outcome of the ACA is access to health care through affordable insurance and quality health care for all patients. Strategies to accomplish these aims include facilitating training of additional primary care providers, both APRNs and physicians, and offering incentives to providers, including APRNs, to enhance care coordination.
-K. Sue Hoyt, PhD, RN, FNP-BC, CEN,
FAEN, FAANP, FAAN
Emergency Nurse Practitioner
St. Mary Medical Center
Long Beach, CA
-Jean A. Proehl, RN, MN, CEN,
CPEN, FAEN
Emergency Clinical Nurse Specialist
Proehl PRN, LLC
Cornish, NH
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