THE FUTURE OF NURSING

THE FUTURE OF NURSING

2013 AND BEYOND112In the 1980s Insurance Companies were given the authority to designate fees for Medicare and hospital services by Congress, with the intention of controlling health care costs. The instruments of control were called DRGs: Diagnosis Related Groups, along with ICD codes: International Classification of Diseases by which to bill these diagnoses and procedures according to the use of hospital resources, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used to determine how much Medicare paid for patient care , since patients within each category are similar and expected to use approximately the same amount of hospital resources. DRGs evolved into (MDCs) Major Diagnostic Categories. DRGs became the standard practice for establishing reimbursements from private insurance companies as well as for Medicare related reimbursements. With the insurance industry in charge and barely regulated, health care costs continued to escalate and lobby for control of health care spending. Hospitals, providers and the general public had little power, with regard to controlling health care costs. Providers and hospitals were paid more for frequent hospitalizations and episodes of illness among their patient populations. EFFORTS TO REDUCE HEALTH CARE COSTS STARTED WITH FDR

2NURSING ADVANCEMENTIN THE PAST NURSES DID NOT CONCERN THEMSELVES WITH THE INSUANCE COVERAGE OF THEIR PATIENTSTODAY WE KNOW THAT IF A PATIENT IS NOT INSURED, THE HOSPITAL WILL NOT GET PAIDAND NEITHER DO WE BEDSIDE NURSING ONCE PREVAILEDCLINIC NURSING NEW BORN NURSERIESOBSTETRICSPATIENT CARE ON HOSPITAL UNITSPUBLIC HEALTH VISITING NURSESPEDIATRIC UNITSICU/CCUTODAY NURSING CONTINUES TO GROW BEYOND HOSPTAL WALLSNURSING ADMINISTRATION PATIENT CARE ON MULTIPLE LEVELS RESEARCHONCOLOGY GERIATRICSPOPULATION HEALTH NAVIGATORSHOME CARE/POST OP/HOSPICE

33Population Health is a new term that nursing can embraceNurses are now included in legislative decisionsRecognition of APNs as independent practitionersReimbursement for services of AP nursesACO are adding nurses to their patient assessment teams. RNs are now required to do patient assessments for home care organizations to get reimbursed by Medicare and Medicaid.

4Health Care Reform is Adding more opportunities for nurses:41. Hospitals are bracing for the unexpected2. High cost of hospital operations versus nurse/patient ratios. If the census drops; staffing must also drop.3. New graduates are flooding the market so only the sharpest get hired, while older nurses avoid retirement due to the economy. 4. Lack of diversified skill sets

5THEN WHY ARE SO MANY NURSES UNEMPLOYED TODAY?5Until Hospitals stabilize, the hiring of nurses will remain at a minimum level.Hospitals will stabilize once universal insurance coverage is in place.

6The Affordable Health Care Act is changing the conditions and places where nurses will be needed.We need to expand our expertise beyond the hospital walls.

6AREAS OF GROWTH FOR NURSES NOW AND IN THE FUTUREPUBLIC HEALTHLEGISLATIONINSURANCE INDUSTRYRESEARCHREHAB MEDICINEHEALTH IT / EMR WRITE POPULATION HEALTHDISASTER PREPERATION

JOIN ACCOUNTABLE CARE EFFORTSBECOME AP NURSESBECOME MORE PREVENTION ORIENTEDBECOME EDUCATORSDEVELOP COMMUNITY HEALTH PLANSCARE COORDINATIONPARTNER WITH OEM77WHEN COMMUNITY HEALTH ASSESSMENTS ARE ALL DONE. WHEN THEY HAVE A PLAN TO MEET THE COMMUNITY NEEDS.WHEN THEY START TO REALIZE INCOME THAT SUPPORTS THE PATIENT CASE LOAD ALONG WITH OTHER OPERATING COSTS. WHEN THE PENALTIES OF HEALTH CARE REFORM DO NOT OUTWEIGH THE BENEFITS. 8WHEN WILL HOSPITALS STABILIZE?8TWO OF THE BIGGEST HOSPITAL WORRIES WITH HEALTH CARE REFORM:READMISSION PENALTIEShospitals will face penalties for excess readmissions for heart attack, heart failure and pneumonia, starting in October 2012 (which is the beginning of fiscal year 2013). If patients with these diagnoses come back with the same dx within 30 days, the hospital loses a percentage of the reimbursement.

HOSPITAL ACQUIRED CONDITIONS Hospitals also will face Medicare penalties for hospital-acquired conditions, starting in fiscal year 2015Urinary tract infectionsPneumoniasBlood infections and Infections from I.V. lines

99HOW DO WE PREPARE ?Dont become a dinosaur: up date your knowledge baseListen to the political arguments and develop an educated understanding and opinionBecome a member of your state professional organization and voteGo back to school if you can: you can never have enough education. Always consider what value your nursing education can offer to changes that come in the near and far off future.

1010

11REMEMBER; THESE ARE THE PEOPLE WHO COULDNT AFFORD HEALTH CAREONCE THEY ARE ALL INSURED WERE GONNA GET REAL BUSY!11