Medicaid expansion


How it affects nursing practice: Nurses always have advocated for pa- tients tohave access tohealthcare, said EdwardBriggs,DNP,ARNP, a family nurse practitioner and president of the Florida Nurses Association, which is working toconvinceFlorida legislators to expandMedicaid. Evidence shows Medicaid expansion is reducing the number of uninsured people and pro- vidingmoremoney forhospitals. States that have expandedMedicaid report decreases inamounts spent on charity care and increases in Medicaid reve- nues.Other reports indicateMedicaid expansionis resulting inmore jobs for healthcare workers. Some Florida hospitals also re-


ported decreases in the amount of money spent on charity care last year, but Briggs fears hospitals will face cuts and closures as federal re- imbursement programs for indigent care come to an end. In Florida, ED use is rising as uninsured people come in for primary care, said Briggs, who works in an ED. “I see folkswho are trying to make ends meet, and they don’t have access to healthcare.”


What to watch: A number of non- Medicaid expansionstates are working on compromise proposals and getting backing from the business commu- nity and hospital associations. State nursing associations are supporting these efforts. But legislators in Ten- nessee andUtah recently voted down expansion programs proposed by Republican governors. Briggs said a similar program in Florida faces “an uphill battle,” though it is backed by the state chamber of commerce and large businesses. Some opponents of Medicaid expansion believe it would put a financial burden on the state, whichalready spends a largeportionof itsbudgetonMedicaid.Othersoppose the federal government being involved in healthcare. Briggs and others who support Medicaid expansion believe the bestway to change peoples’minds may be to emphasize the economic benefits of coveringmore people.


Pay for performance


How it affects nursing practice: Providers are starting to identify areas for improvement “before bad things happen,” said JohnWelton, PhD,RN, professor andsenior scientist forhealth systems research at the University of ColoradoCollege ofNursing inAurora. HHS goals create in- centives for hospitals to make changes, but Welton believes they focus too much on poor quality, includ- ing things related to nursing care such as pressure ulcers, infec- tions and falls. “In many ways,


nursing care has been a part of a bundle for years and nurses now have an oppor- tunity to more concretely define the value of those services for patients and families,” said JeanMoody-Wil- liams, MPP, RN, deputy director of the Center for Clinical Standards and Quality for CMS. She cited SAMA Healthcare’s primary care programin rural Arkansas, inwhich teams with a physician, NP, care coordinator and three RNs provide preventive care for about 19,000patients, identifying those athighrisk and finding commu- nity resources to help them.


ICD-10 conversion Read more


Howit affects nursing practice: ICD-10 conversion mostly will affect physicians and advanced practice nurses who make diagno- ses, Harrington said. “But it does impact RNs in important ways where their documentation is used to code diagnoses and bill,” she said. Pressure ulcers, for


Full practice authority and interoperability of data systems are covered in part 2 of the State of the Industry series:


Nurse.com/


Article/Inside- Industry-Part2


instance, are diag- nosed using nursing documentation to show their severity. Nurses need to make sure their documen- tation aligns with the 123 medical diagnoses for pressure ulcers in the ICD-10 system,


she said, so physicians and others can accurately record a diagnosis. Also new for ICD-10 is the need to document whether a patient is left-handed, right-handed or ambi- dextrous, Harrington said, because a patient who becomes paralyzed from a stroke or other condition on the dominant side will requiremore rehabilitation, and reimbursement will be higher.


What to watch: Right now, it’s dif- ficult to document and reimburse for RN care, but more specific and inte- grated data collection methods even- tuallywill showall elementsof nursing care for a single patient,Welton said. He and others are developingmodels tomeasureoutcomes, effectiveness and performance of nursing care delivery systems and individual nurses. For example,Welton said, themodel could show how different nurses manage pain anduse the results tostandardize best practices and outcomes. Nurses need to be involved in de-


veloping and testing the measure- ments “rather than waiting to see what is imposed by the payers and policy makers,”Welton said.


What towatch: The ICD-10 dead- line has been moved several times, but Harrington and others believe the Oct. 1 date will be final. Har- rington is concerned the literature and educational materials she’s seen seem to downplay changes for bedside RNs. “When people think medical di-


agnoses, they think physicians or APRNs, they don’t think RNs,” she said. Besides pressure ulcers, she has found about 25 areas that affect prac- ticing RNs in their documentation and practice. CNOs need to pay at- tention to these changes, she said, “or they’re going to be blindsided.” •


Cathryn Domrose is a staff writer.


READ THE EXPANDED VERSION of this article: Nurse.com/Article/ Inside-Industry


2016 • NURSE.com/Careers 21


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