Category Archives: Health reform
More than half of recently graduated physician assistants (PAs) had three or more job offers upon completion of their training, according to a report from the National Commission on Certification of Physician Assistants. The commission, which gathered data on 80 percent of the nearly 96,000 PAs working in the United States, calls the report—its first statistical profile of certified PAs—“the most comprehensive workforce data available anywhere about the PA profession.”
The 76,000 PAs surveyed are predominantly female (66%) and white (86%), with a median age of 38 in 2013. Three-quarters of the PAs practice in an office-based private practice or a hospital setting.
“It is not surprising to see that demand is high for certified PAs in the era of health care reform,” Dawn Morton-Rias, EdD, PA-C, the commission’s president and CEO, said in a news release. “The PAs who responded cumulatively see over 5 million patients a week and are well entrenched in the delivery of health care to patients across the nation. As newly insured patients increase and more baby boomers enter the Medicare system, demand for PAs will continue to surge as proven providers of quality care.”
Healthy enrollment figures from state and federal marketplaces—topping 8 million sign-ups—during the Affordable Care Act’s (ACA) first open enrollment period got a significant helping hand from 28,000 full-time staff and volunteers in 4,400 assister programs, according to a Kaiser Family Foundation survey.
The survey, which is the first nationwide assessment of these programs and their impact, found that navigators and assisters provided in-person help to an estimated 10.6 million people. Programs in states running their own marketplaces helped people at twice the rate of programs in states that relied on the federal marketplace.
Around one in eight assister programs reported that consumer demand exceeded capacity, and that share grew to one in four during a surge in March as open enrollment neared its deadline. Among the most difficult challenges programs faced were helping consumers with online technical problems, helping consumers understand plan choices, and helping consumers who had a limited understanding of the ACA.
The survey was designed to capture issues that came up with consumers, assisters’ experiences with the enrollment process, and suggestions for improvements during open enrollment next year.
This is part of the July 2014 issue of Sharing Nursing’s Knowledge.
“We can’t just sit back and wait for things to get created, to be made for a bigger market, to be made just for a patient like that, so we have to make and create what we need ...”
--Roxana Reyna, BSN, RNC-NIC, WCC, skin and wound care prevention specialist, Driscoll Children’s Hospital, MacGyver Nurse and Maker Nurse Program, KRISTV (Corpus Christi, TX), June 30, 2014
“Nurses make up the single largest segment of the health care workforce and spend more time delivering patient care than any other health care profession. Nursing’s unique ability to meet patient needs at the bedside and beyond puts us in a critical position to transform health care.”
--Michelle Taylor-Smith, RN, BSN, MSN, chief nursing officer, Greenville Health System, GHS to Require B.S. Degrees for Nurses, Greenville Online, June 28, 2014
“This country won’t succeed in its implementation of health care reform without more of these types of [nurse-led] clinics in underserved communities.”
--Tine Hansen-Turton, MGA, JD, FAAN, CEO, National Nursing Centers Consortium, At Paul’s Place, Partnership with Nursing School Promotes Good Health, Baltimore Sun, June 22, 2014
This is part of the June 2014 issue of Sharing Nursing’s Knowledge.
“A registered professional school nurse is the only person [who] has the education, the training, and the skill level to meet the needs of kids in the schools. It’s all about what the kids need and how can they attend schools, be healthy, and learn. Health and education go together: If a child is not healthy, he can’t learn.”
--Sue Buswell, RN, director, Montana Association of School Nurses, Philadelphia Tragedy Highlights Role of School Nurses, Education Week, June 2, 2014
“I quite frankly don’t understand how a school can function without a school nurse. They really are one of the most cost-effective, unrecognized resources in our country.”
--Anne Sheetz, MPH, RN, NEA-BC, director, school health services, Massachusetts Department of Public Health, School Nurses Save, Not Cost Money, New Study Says, Philadelphia Inquirer, May 29, 2014
“And lest we forget: a heartfelt thanks to all nurses, present and past, who are or have served in the military in any capacity, in some cases losing their lives as they tried to save other lives and heal the wounded. And to their families.”
--Jacob Molyneux, BA, MFA, senior editor and blog editor, American Journal of Nursing, Memorial Day Weekend: Thanks to the Nurses Who Served, May 23, 2014
Expanded health care coverage under the Affordable Care Act (ACA) has led to a rise in emergency room (ER) visits this year, according to a survey by the American College of Emergency Physicians (ACEP). Nearly half of the 1,845 ACEP members who responded to an online poll conducted in April report higher ER patient loads since January 1. Additionally, 86 percent anticipate more increases over the next three years, and 77 percent say their ERs are not adequately prepared for significant increases.
“Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care,” ACEP President Alex Rosenau, DO, FACEP, said in a news release. “But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low. When people can't get appointments with physicians, they will seek care in emergency departments. In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care.”
U.S. Department of Health and Human Services spokesperson Erin Shields Britt told the Wall Street Journal that broad conclusions can’t be drawn from the study: “This survey, looking at only the first three months of coverage, cannot speak to the long-term effects of expanded coverage, which will be shaped by our continuing efforts to help people use their new primary care and preventive care benefits and to invest in innovative approaches aimed at improving our nation’s system of primary care.”
This is part of the May 2014 issue of Sharing Nursing’s Knowledge.
“It is only fitting that the theme for this year’s National Nurses Week is ‘Nurses: Leading the Way.’ After all, nurses lead the way in showing an elderly patient how to manage his or her diabetes. They lead the way in making sure their patients—children and adults—get the vaccinations they need. They lead the way in helping our young moms learn how to care for their infants. And they lead the way in conducting research to promote high-quality life for those with chronic illnesses, and to help all of us stay healthy across the lifespan.”
--Kathleen Sebelius, U.S. Secretary of Health and Human Services, Statement on National Nurses Week, May 6, 2014
“As our global population starts to age, health care as a business is growing rapidly. The rise of local clinics offering ambulatory services and new models of care, such as medical homes, is an outcome of greater demand for services by an aging population. Already the shortage of primary care physicians is being felt. To help fill that gap, the role of the nurse practitioner will continue to expand. Recruiting, training and then retaining enough nurses will be crucial.”
--Olivier Dumon, managing director, Elsevier Academic and Government Research Markets Group, RX for Health Care: Nursing as a Force for Change, Huffington Post, May 6, 2014
Katherine Grace Carman, PhD, is an economist at the nonprofit, nonpartisan RAND Corporation and an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program.
Since September 2013, the RAND Health Reform Opinion Study (HROS) has been collecting data about both public opinion regarding the Affordable Care Act (ACA) and insurance enrollment among respondents of the RAND American Life Panel.
The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage. We survey the same respondents each month. This allows us to observe not only aggregate changes, but also individual respondents changing their opinion or insurance coverage over time. Respondents are split into four groups and one group is surveyed each week. This allows us to present updated information on a weekly basis, while not burdening survey respondents.
One of the most notable findings of our study has been the increase in insurance coverage between September 2013 and March 2014, with an estimated net gain of 9.3 million in the number insured. The margin of error for this estimate is 3.5 million. The newly insured have gained access to insurance through a variety of insurance types, with the largest gains through employer-sponsored insurance (ESI). One might expect larger gains through Medicaid or the exchanges than through ESI. While our data do not allow us to tease out the causes of this gain in ESI, some possible explanations include: greater take-up of previously offered benefits, an improved economy leading more people to hold jobs (or have family members with jobs) that offer ESI, or an increase in employers offering ESI. These results on insurance coverage transitions have been discussed widely in the media, so here we want to bring your attention to some of the other findings of the HROS.
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.