Category Archives: Health reform
Has a push for increased efficiency in health care come at the expense of physicians’ happiness? That’s a big question explored recently in a Becker’s Hospital Review article.
Molly Gamble writes:
Physician stress and engagement issues were not born from reform.... But now other factors—such as increased workloads, electronic medical records and physicians’ apprehension to work for hospitals—add another layer of complexity. Healthcare’s pursuit of efficiency seems to be making the adoption of other values it endorses, such as patient-centeredness and continuity of care, more difficult.
Physicians’ interactions with coworkers and patients are changing, according to the article—and the learning curve for electronic medical records and other technological advances has left many physicians looking at screens more and patients less.
This is part of the February 2014 issue of Sharing Nursing’s Knowledge.
“As an ADN-prepared nurse returning to school, I have been confronted with the formidable gap between the current reality of professional nursing and the push to elevate the level and scope of practice in the face of a projected nursing shortage. I have no doubt that higher levels of education, certification, and experience have the potential to create better nurses and in turn safer environments for our patients, but I do have to question whether the infrastructure necessary to support these changes is in place.”
--Eric Deane, RN, Charlottesville, Va., Thoughts on Entry to Practice, Nurse.com, February 10, 2014
“As medical professionals we are recognizing that on a national level, advanced practice nurses [APNs] are part of the solution to the health care access crisis. The only way that patients are going to get the care they need is if all parts of the medical team, including APNs, midwives, physician’s assistants, physicians, and others, come together as partners. It’s not that nurse practitioners are going to replace any other clinicians. That’s not our goal. But advanced practice nurses are extraordinarily well prepared to provide primary care. They are trained in managing multiple types of health problems and in promoting a healthy lifestyle. With the current challenges in patient care, I can only see the role of the nurse practitioner increasing.”
--Ivy Alexander, PhD, APRN, FAAN, clinical professor and director of advanced practice programs, University of Connecticut School of Nursing, An Expanding Role for Nurse Practitioners, Medical Xpress, February 5, 2014
“More needs to be done to help spread awareness [about the Affordable Care Act]. This is one of the things nurses do best. They educate.”
--Mary Wakefield, PhD, RN, FAAN, administrator, Health Resources & Services Administration, Nurses Step Out to Help with ACA Enrollment, Nursezone.com, January 31, 2014
Jay Himmelstein, MD, MPH, is a professor of family medicine and community health and chief health policy strategist at the Center for Health Policy and Research at the University of Massachusetts Medical School (UMMS). He serves as a senior advisor to the UMMS Office of Policy and Technology, and is a senior Fellow in health policy at NORC, University of Chicago. Himmelstein is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program, where he worked on the health staff of Senator Edward Kennedy. This post is part of the “Health Care in 2014” series.
The nation's attention has focused in recent months on the politics and challenges related to the roll-out of state and federal health insurance marketplaces created by the Affordable Care Act (ACA). Despite website technical woes, significant numbers of Americans have already gained access to affordable insurance plans through the marketplaces and other provisions of the ACA, and it appears likely that the ‘marketplace’ concept will be successful over time in connecting consumers to health insurance and significantly decreasing the ranks of uninsured.
The better functioning marketplaces currently allow consumers to: 1) determine eligibility for subsidized health insurance, 2) use basic online shopping tools to compare and purchase health insurance plans based on four different "metallic tiers" (i.e., the platinum, gold, silver, and bronze tiers), and 3) make side-to-side comparisons between these plans on features such as deductibles, out-of-pocket cost limits, and number and proximity of doctors and hospitals. A few marketplaces also offer information about plan quality, the ability to search for health care providers and hospitals associated with specific plans, and rudimentary ‘cost calculators’ which estimate the total cost of plans inclusive of premiums, deductibles, and out-of-pocket costs.
Carli A. Culjat, BSN RN, is a staff nurse in the Emergency Department at Bryan Medical in Lincoln, Neb., and an alumna of the Robert Wood Johnson Foundation New Careers in Nursing program. She graduated with her BSN from the Creighton University School of Nursing. This post is part of the “Health Care in 2014” series.
As a new graduate and a young person, I am very eager to see what will happen to my country, my career, and my own future with the changes taking place in the U.S. health care system. As I walked across the stage receiving my diploma, my emotions developed and they included excitement, relief, and fear of the unknown. I believe our county is facing similar emotional complexity. As a new graduate and new employee – change can bring forth so many emotions, especially on the large scale that is taking place in health care today.
The media covers the controversy of the situation and as a former student, my class still uses social media to reach out and develop opinions on the changes and their possible effects. Fear creates controversy and with this, we see so many different perspectives and reactions. Even still, I believe our country is excited for a change and ready for the health care system to evolve into a system that we can be proud of and utilize.
There are many who are relieved, myself included. I am relieved that employment is an option at this time in this changing system, I am relieved that our country has taken the initiative to address a need, and I am relieved that I have an education and position that I can use to assist, in the best way a single person can, in health care reform—as a frontline person, a staff nurse in an Emergency Department.
Michael Geruso, PhD, is a Robert Wood Johnson Foundation Scholar in Health Policy Research at Harvard University and an assistant professor of economics at the University of Texas at Austin. This post is part of the “Health Care in 2014” series.
2014 marks the start of coverage for those who are newly insured via the health insurance exchanges. In general, healthy behaviors and lifestyle are probably the most important inputs to health, especially for those of us free of serious chronic conditions. But for those of us who are sick, quality health care and access to drugs is crucial for health and happiness. We will soon know to what extent the health insurance exchanges have overcome their implementation problems and have connected previously uninsured Americans to health care.
When markets for health insurance work efficiently, they can deliver access to crucial health services to those who need and want them most. Unfortunately, free, unregulated markets for health insurance rarely function efficiently. The market failures in health care have long been noted by economists, most famously by Nobel Prize winner Kenneth Arrow, MA, PhD. In my view, one the most important changes that the Affordable Care Act (ACA) brings with it is an attempt to address and correct market failures via the exchanges.
Human Capital News Roundup: Racism and aging, the economics of obesity, a culture of fear for health care navigators, and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
Racism may accelerate aging in Black males, according to a study led by David Chae, ScD, MA, Forbes magazine reports. The study found advanced cellular aging in Black men who reported facing more racial discrimination and who had internalized anti-Black bias, according to the Black-White Implicit Association Test. Chae is an RWJF Health & Society Scholars alumnus. His research was also covered by: CBS News, The Baltimore Sun, The Atlanta Black Star, and The Huffington Post, among other outlets.
In an opinion piece for CNN, RWJF Executive Nurse Fellows alumna Cynda Hylton Rushton, PhD, RN, FAAN, discusses the ethical issues involved with end-of-life decisions. Rushton specifically addresses the impact of such situations on medical personnel who are providing treatment that may not be welcomed by patients or their family members.
Bloomberg Businessweek covers a National Bureau of Economics Research Reporter article by John Cawley, PhD, in which he discusses the economics of obesity. Cawley, an RWJF Scholars in Health Policy Research alumnus and member of the program’s National Advisory Committee, addresses health care spending on obesity, the effectiveness of weight-loss products, misuse of body-mass index, and more.
A new guide, Care Coordination: The Game Changer—How Nursing Is Revolutionizing Quality Care, explores how care coordination is positioned in the context of health reform. It was published by the American Nurses Association (ANA).
Care coordination has long been an integral part of nursing practice, the ANA said in a news release, with registered nurses leading the way in designing and delivering successful team-based care coordination programs that improve patient care and reduce costs. In the book, editor Gerri Lamb, PhD, RN, FAAN, and 23 leaders in care coordination explore topics including:
- A historical perspective on nursing and quality care;
- The role of care coordination in quality and safety;
- Models and tools for improving quality and safety;
- The role of nurse leaders in advancing care coordination;
- The care coordinator’s role in reducing avoidable hospital stays;
- Partnering with patients and families for better outcomes; and
- Community-based care transitions.
As many as 900,000 people across the country may leave their jobs now that the Affordable Care Act provides health insurance alternatives, according to Craig Garthwaite, PhD. In an interview with Robert Wood Johnson Foundation Clinical Scholar Chileshe Nkonde-Price, MD, Garthwaite uses an analysis of the Tennessee Public Health Insurance Program to explain why a significant number of American workers may not feel the need to stay with their current employers as subsidized health insurance becomes available through health insurance exchanges.
Garthwaite is assistant professor of management and strategy at the Northwestern University, Kellogg School of Management. The interview is part of a series of RWJF Clinical Scholars Health Policy Podcasts, co-produced with Penn’s Leonard Davis Institute of Health Economics.
The video is republished with permission from the Leonard Davis Institute.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts in 2013. Which were your favorites? Today and tomorrow, as the year comes to an end, we’re taking another look at the posts published on this Blog in 2013 that attracted the most traffic.
A Closer, More Dispassionate Look at Obesity RWJF Scholar in Health Policy Research alumna Abigail Saguy, PhD, discusses how fatness went from being considered a fashion problem to a social problem, a medical problem, and finally the public health crisis we see it as today. She says social perceptions of weight have affected medical interpretations, and shares her concern that some efforts to promote healthy lifestyles will exacerbate weight-based discrimination. Saguy’s interview was also the post most-shared on social media this year, generating more than 2,200 “likes” on Facebook.
A Chief Nursing Officer Who Does Not Have a BSN-Only Hiring Policy in Place In a blog that is both personal and provocative, RWJF Executive Nurse Fellow alumnus Jerry Mansfield, PhD, RN, shares his journey to become a nurse, the setbacks he overcame, and how he has fulfilled his commitment to lifelong learning. He also addresses how he reconciled his support for the Institute of Medicine’s future of nursing education recommendations with the steps he had to take to meet demand for nurses at his institution. Mansfield is chief nursing officer at University Hospital and Richard M. Ross Heart Hospital, and a clinical professor at Ohio State University College of Nursing.
The traditional bedside care team must evolve over the next five years in response to significant changes facing the U.S. health care system, according to the American Hospital Association (AHA), which recently convened a roundtable devoted to the issue.
“Reconfiguring the Bedside Care Team of the Future,” a white paper summarizing the discussion, points to several factors driving changes, including 25 million new patients entering the system as a result of the Affordable Care Act, an aging and increasingly diverse population, and more patients experiencing multiple conditions and acute episodes.