INQRI Brief: Non-Physicians Can Address Primary Care Shortage

A pending primary care shortage may be best addressed by implementing promising strategies that fully utilize non-physician health care professionals in new systems of care, according to a new research brief co-authored by INQRI Co-Directors Mary Naylor and Mark Pauly with Janet Weiner.

With approximately 30 million people expected to gain coverage through the Affordable Care Act (ACA), demands on primary care services will no doubt grow. The brief, Primary Care Shortages: It’s More Than Just a Head Count, examines how the ACA will affect the delivery of primary care, and reviews recent research on the primary care shortage and possible strategies to address it.

The brief outlines several strategies that show promise for addressing these demands. Among them is ACA’s investments in health professional education and training to increase the number of primary care providers, including nurse practitioners and physician assistants. Other models, like retail clinics could ensure that more people can access primary care services, particularly in rural areas.

Ultimately, allowing health care providers to practice to the full extent of their education and training is central to increasing access to primary care, the authors write.

An article on the brief from RWJF’s December 2014 Sharing Nursing’s Knowledge is available here.

Hospitals May Get Funds Cut for High Readmission Rates

Hospitals could see their Medicare payments docked as a result of Affordable Care Act (ACA) reforms that aim to reduce patient readmissions. As a result, more hospitals are focusing on patient and caregiver education to reduce re-hospitalizations.

Under ACA, reductions in Medicare payments for inpatient care will be imposed on hospitals that readmit too many patients within a month of discharge. Cuts could range from a few thousand to hundreds of thousands of dollars depending on the circumstances, the article states.

A Medicare Payment Advisory Commission study estimates that approximately 12 percent of Medicare patients readmitted to the hospital may not need to be. The Commission also found that reducing preventable readmissions by 10 percent could save Medicare $1 billion annually.

For 2014 only three types of readmissions will be penalized under ACA: pneumonia; heart attack; and heart failure. Two more types, chronic obstructive pulmonary disorder and hip and joint replacements, will be factored in next year.

INQRI grantees Dr. Marianne Weiss and Dr. Olga Yakusheva have conducted research examining how the hospital discharge process affects readmission rates. Learn more about their work:

Read "Nurse and patient perceptions of discharge readiness in relation to postdischarge utilization."
Read "Age-related differences in perception of quality of discharge teaching and readiness for hospital discharge."
Read "Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization."

The Nursing Profession in 2014

Top nursing leaders make predictions of nursing trends to watch for in 2014, based on what has been happening in the field over the past year, in a recent NurseZone.com article.

Leaders agree that the profession will continue implementation of the Institute of Medicine’s (IOM’s) 2010 landmark report The Future of Nursing: Leading Change, Advancing Health recommendations, which include increasing the presence of nurses on hospital, state, and federal boards.

Without nurse leadership on boards “… our perspective is missing, and it’s an important perspective,” said Karen Daley, PhD, RN, FAAN, president of the American Nurses Association. “We speak for the patients. There’s no one closer to the everyday needs and care that we provide.”

Focus on patient safety, particularly in the areas of alarm management and the prevention of healthcare-acquired infections will also continue to be priorities for the industry, according to Vicki Good, RN, MSN, CENP, president of the American Association of Critical-Care Nurses.

Rollout of the Affordable Care Act (ACA) will continue to have an impact on nurses, including increased use of community-based settings for health care delivery, Daley said. New nurses may begin their careers in such settings, rather than at hospitals. As a result, the educational system may need to recognize and accommodate this trend, Daley said.

The Future for Nurse Practitioners 

The momentum to expand scope of practice for nurse practitioners could continue to build in 2014. In 2013, Nevada became the most recent state to pass a law granting nurse practitioners the freedom to practice independently, bringing the total to 17 states.

“I believe that other states will move slowly but will eventually see the resource that they have in nurse practitioners and be more willing to grant them the ability to practice in accordance with their education,” said Kenneth P. Miller, PhD, RN, CFNP, co-president of the American Association of Nurse Practitioners.

As the ACA seeks to increase medical services for the previously uninsured and underinsured, nurse practitioners must be included. “It is going to take all health care providers working together to achieve that goal,” Miller said.

Opportunities and Challenges Ahead

As the economy improves, many nurses may finally retire, leaving job openings for newer nurses in clinical settings. However, this trend could be a challenge for the academic world as nursing educators and nursing school deans retire and leave gaps that may be difficult to fill, experts said.

The nursing leaders told NurseZone that individuals must remember why they went into nursing and keep their focus, no matter what the future holds.