THE FUTURE OF NURSING

1. THE FUTURE OF NURSING 2013 AND BEYOND

2. In the 1980’s 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 DRG’s: 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……

3. NURSING ADVANCEMENT BEDSIDE NURSING ONCE PREVAILED • CLINIC NURSING • NEW BORN NURSERIES • OBSTETRICS • PATIENT CARE ON HOSPITAL UNITS • PUBLIC HEALTH VISITING NURSES • PEDIATRIC UNITS • ICU/CCU TODAY NURSING CONTINUES TO GROW BEYOND HOSPTAL WALLS • NURSING ADMINISTRATION • PATIENT CARE ON MULTIPLE LEVELS • RESEARCH • ONCOLOGY • GERIATRICS • POPULATION HEALTH • NAVIGATORS • HOME CARE/POST OP/HOSPICE IN THE PAST NURSES DID NOT CONCERN THEMSELVES WITH THE INSUANCE COVERAGE OF THEIR PATIENTS TODAY WE KNOW THAT IF A PATIENT IS NOT INSURED, THE HOSPITAL WILL NOT GET PAIDAND NEITHER DO WE…

4. Health Care Reform is Adding more opportunities for nurses: • “Population Health” is a new term that nursing can embrace • Nurses are now included in legislative decisions • Recognition of APNs as independent practitioners • Reimbursement for services of AP nurses • ACO 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.

5. THEN WHY ARE SO MANY NURSES UNEMPLOYED TODAY? • 1. Hospitals are bracing for the unexpected • 2. 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

6. The 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. • Until Hospitals stabilize, the hiring of nurses will remain at a minimum level. • Hospitals will stabilize once universal insurance coverage is in place.

7. AREAS OF GROWTH FOR NURSES NOW AND IN THE FUTURE • PUBLIC HEALTH • LEGISLATION • INSURANCE INDUSTRY • RESEARCH • REHAB MEDICINE • HEALTH IT / EMR • WRITE • POPULATION HEALTH • DISASTER PREPERATION • JOIN ACCOUNTABLE CARE EFFORTS • BECOME AP NURSES • BECOME MORE PREVENTION ORIENTED • BECOME EDUCATORS • DEVELOP COMMUNITY HEALTH PLANS • CARE COORDINATION • PARTNER WITH OEM

8. WHEN WILL HOSPITALS STABILIZE? • WHEN 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.

9. TWO OF THE BIGGEST HOSPITAL WORRIES WITH HEALTH CARE REFORM: • READMISSION PENALTIES • hospitals 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 2015 • Urinary tract infections • Pneumonias • Blood infections and • Infections from I.V. lines

10. HOW DO WE PREPARE ? Don’t become a dinosaur: up date your knowledge base Listen to the political arguments and develop an educated understanding and opinion Become a member of your state professional organization and vote Go 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.

11. REMEMBER; THESE ARE THE PEOPLE WHO COULDN’T AFFORD HEALTH CARE…ONCE THEY ARE ALL INSURED WE’RE GONNA GET REAL BUSY!