Emerging challenges in the American healthcare delivery system require prompt reaction both from the legislators and nursing professionals. To address pressing issues in the industry, back in 2010, President Obama initiated the Affordable Care Act, also known as the Patient Protection and Affordable Care Act (PPACA). As explained by McIntyre and Song (2019), its critical purpose was to expand health insurance coverage, regulate the industry, and reduce care spending per capita. However, with the change of administration in 2016, the PPACA experienced a series of significant modifications, affecting the health care delivery system, the role of nurses, and nursing practice, in general. This paper discusses the aforementioned criteria through a prism of quality measures and payment, nursing leadership, and emerging trends in the industry.
Initially, the PPACA reformed insurance coverage in the US in the ways, as follows. On the one hand, it introduced competition of health insurance marketplaces in the states, allowing people to choose from the affordable options and taking advantage of the subsidies and federal poverty line (McIntyre & Song, 2019). On the other hand, the law expanded the eligibility criteria, obligating insurance companies to reimburse treatment of pre-existing conditions (McIntyre & Song, 2019). However, in the recent four years, the regulation was limited in its capacity due to a heated debate in Congress. With several states resisting to amplify their Medicaid program, millions of Americans remain uninsured.
The issue of the Affordable Act in 2010 did not only reform the current health delivery system but also had a substantial impact on the nursing practice. As explained by DiNardi, PPACA is associated with nursing shortages and frequently critiqued for putting pressure on healthcare professionals by extending work shifts and shortcutting the staff. For instance, average registered nurses (RN) had to work 30 minutes more, while licensed practical nurses (LPN) experienced a 50-minute increase in shifts. The nursing practice also had specifically adverse effects in a rural setting, wherein the lack of personnel transformed into significantly lower quality of healthcare, higher mortality rates, and patients’ dissatisfaction (DiNardi, 2019). Further outcomes of the PPACA should be assessed under consideration of quality measures and payment.
Together with the Affordable Care Act, three quality measures and payment systems were incorporated. As stated in “The Affordable Care Act”, under the CMS’ Hospital Value-Based Purchasing Program, acute-care hospitals get 2% reduction on all Medicare payments, resulting in the increased safety, clinical care, and enhanced patient-centered experience. Hospital Readmissions Reduction Program obligated hospitals with high readmissions rates after episodes of acute care to a 3% reduction in their Medicare payments. Such measure aims to prevent low-quality care based on socioeconomic discrimination. Finally, the Hospital-Acquired Condition Reduction Program provided 1% reduction for all Medicare payments, associated with conditions acquired during hospitalization, which contributed to an improved patient’s safety (“The Affordable Care Act,” 2015). While all the aforementioned quality and payment measures are beneficial to the primary patients’ care, they noticeably increase the expectations and responsibilities of healthcare professionals.
The passage of the PPACA set high expectations for the nurses in terms of improved quality care, higher patients satisfaction, and reduced spending. Salmond and Echevarria (2017) explained that the paradigm of providers’ responsibilities shifted from treating episodic manifestations of diseases without regard to the repeated medical history, advances in genomics, and preventative methods to holistic health assessment. The major role of nursing professionals now lays in the careful collection and analysis of patients’ symptoms to eliminate uncalled instances of hospitalization, unnecessary utilization of emergency department, repetitive diagnostics, and redundant prescriptions (Salmond & Echevarria, 2017). Consequently, the overall level of nursing responsibility has increased with a response to the emerging need for comprehensive health assessment. In addition to the increased expectations and reformed responsibilities, new leadership and management roles appeared after the issue of PPACA. As followed by Joseph and Huber, the three most demanded positions for nurses are clinical nurse leader, care coordinator, and advanced RN. Assessing the complexity, compensating for the workforce shortages, providing high rates of patients’ safety and quality care, the aforementioned personnel is critical with a response to the emerging trends in the industry.
As mentioned earlier, currently, healthcare professionals have to adjust their knowledge and daily tasks by contemporary healthcare trends. According to Vogenberg and Santilli , modern tendencies for consumerism and integrated healthcare will likely transform the nature of nursing practice into patient-centered within the next five years. The principal focus will shift from medical assistance to education, raising awareness on preventative, and early diagnostic methods. First, in addition to their typical responsibilities, nurses will have to deal with millennials’ dissatisfaction with high insurance and medical costs. Second, providers will need to incorporate advanced technological and communicational strategies in their routine, for instance, 3D printing and genome sequencing (Vogenberg & Santilli, 2018). Ultimately, the researched tendencies provide substantial evidence to argue that the scope of nursing duties will expand, which calls for enhanced educational opportunities and training for healthcare professionals to better prepare them for upcoming challenges.
References
The Affordable Care Act and value-based purchasing: What’s at stake for children with medical complexity. (2015). Catalyst Center, 1-13.
DiNardi, M. (2019). Affordable Care Act Medicaid expansions and the nurse labor market. SSRN Elsevier, 1-40. doi: 10.2139/ssrn.3083464
Joseph, M. L., & Huber, D. L. (2015). Clinical leadership development and education for nurses: Prospects and opportunities. Journal of Healthcare Leadership, 7, 55-64. doi: 10.2147/JHL.S68071
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLOS Medicine, 16(2), 1-3. doi:10.1371/journal.pmed.1002752
Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12-25. doi:10.1097/NOR.0000000000000308
Vogenberg, F. R., & Santilli, J. (2018). Healthcare trends for 2018. American Health & Drug Benefits, 11(1), 48-54.