Posts Tagged ‘ACA’

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Recent Nurse Blog Posts of Interest, Inhaled Insulin, a Note on Top Blogs Lists

April 4, 2014

By Jacob Molyneux, AJN senior editor/blog editor

Here you will find some links to nursing blog posts, a look at this week’s Affordable Care Act health exchange enrollment numbers, and a couple of items of interest about new treatments or studies, plus a note on blogs that award other blogs badges. A grab bag, so bear with me…

crocus shoots, early spring, I think/ via Wikimedia Commons

crocus shoots, early spring, I think/ via Wikimedia Commons

At the nursing blogs:

RehabRN has a post about a friend who was bullied by a nurse of much higher authority in the same hospital. Such stories, if true, are always upsetting. What can you do but take it when the power differential is so great?

At the INQRI blog (I’m not going to tell you what the initials stand for except that it has something to with quality, research, and nursing), there’s a post about why stroke survivors need a team approach to palliative care.

Megen Duffy (aka Not Nurse Ratched) has a really very good post at a site she sometimes blogs for. I already shared it via a tweet yesterday, but it deserves more. It’s called “Nursing Will Change You.”

At Infusion Nurse Blog, there’s a post addressing IV solution shortages (now happening on top of shortages of some common and necessary drugs due to a variety of reasons). It gives some practical steps clinicians and organizations can take to conserve and is definitely worth a quick look.

A sweet little post called “Nursing Sisters” is at Adrienne, {Student} Nurse. It’s about how nurses help each other out, starting right from the beginning in nursing school.

Read the rest of this entry ?

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Nursing, HIV/AIDS, Continuity of Care, Treatment Advances, and the ACA: The Essentials

March 6, 2014

As the Affordable Care Act takes effect, a timely overview in AJN of recent developments in screening, treatment, care, and demographics of the HIV epidemic

CascadeofCare

The ‘cascade of care’ (from the AJN article)

The newly released March issue of Health Affairs is devoted to looking at the ways the Affordable Care Act (ACA) will affect Americans with HIV/AIDS and those who have recently been in jail. One crucial feature of the ACA is that it prevents insurance companies from refusing coverage to those with a number of preexisting conditions. If you have a preexisting condition and don’t get insurance through work, you know how important this is.

Unfortunately, a large majority of those with HIV and AIDS do not have private health insurance. One article in the March issue of Health Affairs draws attention to the plight of the 60,000 or so uninsured or low-income people with HIV or AIDS who will not receive health insurance coverage because their states are among those that have chosen to opt out of the ACA provision that expands Medicaid eligibility. This means many patients in these states may lack consistent care and reliable access to life-saving drugs.

Antiretroviral therapy (ART) improves patient quality of life and severely reduces expensive and debilitating or fatal long-term health problems in those with HIV/AIDS. As noted in AJN‘s March CE article, “Nursing in the Fourth Decade of the HIV Epidemic,”

The sooner a patient enters care, the better the outcome—especially if the patient stays in care, is adherent to combination antiretroviral therapy (cART), and achieves an undetectable viral load.

The authors, pointing out that only 66% of those with HIV in the U.S. are currently “linked to care” and, of these, only about half remain in care, argue that

“[e]ngaging and retaining people with HIV infection in care is best achieved by an interdisciplinary team that focuses on basic life requirements, addresses economic limits, and treats comorbid conditions such as mental illness and hepatitis C infection.”

But there’s a lot more in this article about screening, advances in drug therapy, treatment, and epidemiology that all nurses will need to know as the ACA brings more HIV-infected patients into every type of health care setting. Here’s the overview, but we hope you’ll read the article itself, which is open access, like all AJN CE features: Read the rest of this entry ?

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AJN’s Top 15 Most Viewed Articles in 2013

January 24, 2014
by rosmary/via Flickr

by rosmary/via Flickr

We thought readers might be interested in seeing which articles and topics got the most page views in 2013. Many of these articles are open access, including a number of CE articles as well as the articles from our Evidence-Based Practice: Step by Step series. Some articles require an AJN subscription or individual article purchase. Several of the articles in this list were from recent years other than 2013; a couple were much older, but are evidently still relevant, since not every idea in nursing is ephemeral or subject to improvement by the next generation.—Jacob Molyneux, senior editor

1. “Asking the Clinical Question: A Key Step in Evidence-Based Practice” – (March, 2010) – part of AJN‘s EBP series

2. “Improving Communication Among Nurses, Patients, and Physicians” – (November, 2009)

3. “The Seven Steps of Evidence-Based Practice” – (January, 2010) – part of our EBP series

4. “Nurses and the Affordable Care Act” – (September, 2010)

5. “From Novice to Expert: Excellence and Power in Clinical Nursing Practice” – (December, 1984; not HTML version; readers must click through to PDF version)

6. “COPD Exacerbations” – (CE article; February, 2013)

7. “Therapeutic Hypothermia After Cardiac Arrest” – (CE; July, 2012)

8. “From Novice to Expert” – (March, 1982; article looks at stages to mastery; no html version, so click the PDF link on the landing page)

9. “Men in Nursing” – (CE; January, 2013)

10. “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections” – (June, 2013) – part of EBP series Read the rest of this entry ?

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Tightly Scripted: One NP’s Experience with Retail Clinics

November 1, 2013

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Retail health clinics (walk-in clinics that are in a retail setting such as a drugstore or discount department store)KarenRoush have become an effective mode of providing increased access to care for many people and a growing source of employment for nurse practitioners (NPs). Their place in the health care arena may take on even more significance as the Affordable Care Act (ACA) increases access to care for previously uninsured people.

I worked as an NP in a retail clinic for about six months while working on my PhD. I left because of concerns I had about the model of practice. It didn’t have to do with the fact that I had to mop the floor at closing time or collect the fees and cash out the “drawer” every night. Nor because I spent eight hours alone in a small windowless room tucked away in the back of a drugstore. Those aspects were not great, but they weren’t deal breakers.

What was a deal breaker was the rigid programming of my practice. The computer was in control. From the moment the patient checked in at the kiosk outside my door, every action was determined by the computer.

The organization I worked for prided itself on following evidence-based practice, but someone forgot to tell them that the patient’s history, presentation, and personal experience, as well as a clinician’s expert knowledge, are also part of the evidence. And as much as they insisted the programming was guided by evidence, it was clearly also guided by what would result in the highest level billing code.

From the moment I entered the chief complaint in the computer, it directed me on what to include in the history and what to do for the exam. The problem was that unless I filled out all the information, I couldn’t go on to the next screen. Say I have a feverish four-year-old with tonsillitis, screaming in her mother’s arms, and the computer insists I take her blood pressure. Why? Because there is strong evidence that strep throat is associated with pediatric cardiovascular disease? Nope. It’s because the more systems you include in your exam, the higher the billing code. As a result, I find myself struggling to take an unnecessary blood pressure, causing unnecessary distress for a sick toddler. But unless I put a value in the box asking for the blood pressure, I can’t proceed with the exam. Read the rest of this entry ?

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They’re Not Taking Away Our Puppies (And God Help Them If They Do)

September 30, 2013

By Jacob Molyneux, AJN senior editor/blog editor

I am amazed at the amount of time being wasted on the relatively mundane matter of health care exchanges. It seems we are now facing a government shutdown; there are creepy and misleading advertisements funded by conservative billionaires like the Koch brothers in order to scare people from signing up for insurance; some red states have actually enacted laws forbidding the health care navigators from helping people understand the new system and sign up for it, and many of these states have refused to create their own exchanges to help their citizens comply with the new law.

The ACA is a law. You can’t just ignore it if it doesn’t meet your personal preferences or political ideas. Given the heated rhetoric the Republicans are trotting out about it, you’d think the government was trying to take away our puppies, instead of implementing ideas originally floated by Republicans themselves to make life a bit easier for millions of Americans whose life decisions are unduly ruled by crazy health care billing practices, byzantine insurance regulations, discrimination against those who have chronic conditions, insanely varying pricing for simple tests, and the like. Read the rest of this entry ?

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One Is the Loneliest Number

September 13, 2013

By Shawn Kennedy, AJN editor-in-chief

The great Bartholdi statue, liberty enlightening the world: the gift of France to the American people.  Speculative depiction published the year before the statue was erected. In this depiction the statue faces south; it actually faces east/Wikimedia Commons

The Bartholdi statue, liberty enlightening the world: the gift of France to the American people. Speculative depiction published the year before the statue was erected. In this depiction the statue faces south; it actually faces east/Wikimedia Commons

I’ve been struck recently by how the United States sometimes seems to stand apart from other nations. This is sometimes called “American exceptionalism.”

The most obvious example of this is the recent push—temporarily put on hold due to the emergence of negotiations about the possible handover of Syrian chemical weapons to Russia—to garner support among other nations for a military strike against the Syrian government in response to its use of chemical weapons against its own people.

By now, most of us have seen the graphic videos on media outlets and they are indeed disturbing. There are signs of neurotoxicity in some of the victims: rigid posturing, seizures, and foaming at the mouth. According to news reports, U.S. Secretary of State John Kerry says the evidence is “undeniable” and it deserves a harsh response. While several other countries and alliances have issued statements condemning the use of chemical weapons, thus far, other than France, none have come forward to agree to military action; there seems to be little likelihood of action by the United Nations (UN).

It may well be a case of apples and oranges, but another example of how the United States stands alone in comparison to other developed countries is in our approach to health care. The passage of the Affordable Care Act (ACA), and then the Supreme Court’s upholding of its individual mandate provision, made me think this country would at last join most of the other developed nations of the world in providing for the health of its people.

But how naive I was! The resistance by opponents of the law has now moved to the states, many of which have refused to expand Medicaid or institute the insurance exchanges that are essential to providing health coverage for those currently without it and who must obtain it to meet the individual mandate. According to Kaiser Health News, a number of states are offering insurance exchanges or marketplaces where consumers not covered by employer-provided insurance can “shop” for low-cost plans and plans that fit individual health care needs and budgets (according to one report, a Minnesota resident can purchase a plan for under $100 a month). In those states which declined to set up exchanges, a federal plan will be available. Enrollment in the exchanges is set to begin October 1. Read the rest of this entry ?

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48 Years of Medicare (and Counting)

July 26, 2013

By Shawn Kennedy, AJN editor-in-chief, and Jacob Molyneux, senior editor

Next week marks Medicare’s 48th anniversary. President Lyndon Johnson signed the legislation creating Medicare on July 30, 1965, guaranteeing health coverage for the elderly. With the gradual implementation of the Affordable Care Act (ACA; 2010), Medicare, along with other government and private forms of health insurance, is undergoing changes, with efforts being made to rein in rising costs, combat fraud, tie quality of care to reimbursement, and so on.

PPresident Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

President Lyndon B. Johnson signing the Medicare Bill. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

With the ACA’s date for mandated purchase of health insurance fast approaching, some states are setting up state-run health insurance exchanges to provide consumers with a standardized menu of health insurance plans in order to make it easier to purchase a plan that fits both budget and health care needs. Other states have refused to participate (see “Policy and Politics: Update on the Affordable Care Act” in the April 2013 issue of AJN); by default, citizens of those states will instead participate in federally run exchanges.

The debate over government-sponsored health insurance is not new. According to a timeline at SocialSecurity.gov, Congressional hearings on the topic occurred as early as 1916, with the American Medical Association (AMA) first voicing support for a proposed state health insurance program and then, in 1920, reversing its position. A government health insurance program was a key initiative of President Harry Truman, but, as with the Clinton health initiative several decades later, it didn’t go anywhere because of strong opposition from the AMA and others.

AJN covered the topic in an article (AJN articles cited in this post will be free until August 26) in the May 1958 issue after a health insurance bill was introduced in 1957 by representative Aime J. Forand of Rhode Island  (HR 9467). Yet again, one of the staunchest opponents was the AMA. In the September 1958 issue, “at the request of the American Medical Association,” AJN published an article by its general manager, explaining the AMA’s opposition.

Many commentators have pointed out that the ACA, frequently attacked and undermined by its opponents during these years of its gradual implementation, may one day be seen much as we now see Medicare, which was also widely attacked when it began—that is, the ACA may be simply taken for granted as a necessary, if complex and flawed, program that many people depend upon. Read the rest of this entry ?

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The ACA and Me: A Dispatch From the Trenches

June 5, 2013
Argonauta: The Beach at My Back/ oil stick on paper, 2010 by Julianna Paradisi

Argonauta: The Beach at My Back/ oil stick on paper, 2010 by Julianna Paradisi

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

 “Reality is the leading cause of stress among those in touch with it.”—Jane Wagner

By 2014, up to 30 million Americans will have gained access to health care insurance under the Affordable Care Act (ACA). As a nurse human being, I support increased access to health care. However, it is naive to believe it can be accomplished without sacrifice.

My job is a casualty of the ACA.

But let’s backtrack:

It’s more accurate (but less dramatic) to say that our country’s need of better health care delivery significantly affects my job. Most hospital nurses are familiar with Medicare tying reimbursement to patient outcomes. Further, built into the ACA is a requirement that hospitals expecting Medicare reimbursement form accountable care organizations (ACOs):

Under the proposed rule, an ACO refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the patients they serve with Original Medicare (that is, those who are not in a Medicare Advantage private plan). The goal of an ACO is to deliver seamless, high quality care for Medicare beneficiaries. The ACO would be a patient-centered organization where the patient and providers are true partners in care decisions.

In other words, hospitals are expected to stop competing for Medicare dollars and work together to reduce duplication of services, decreasing costs within their communities. This is not an entirely new idea in health care. Trauma and neonatal tertiary care centers existed before I graduated from nursing school. They provide advanced health care technology to communities unable to afford them.

ACOs go beyond this concept, however, mandating “partnerships or joint ventures arrangements between hospitals and ACO professionals.”

For example, one hospital will purchase the most advanced machine for radiology, while its competitor will invest in the latest laser surgery technology. Patients needing either will be referred to the center in their community providing that service, thereby increasing its number of billable Medicare patients, decreasing cost and duplication of services. This is my understanding of some of the changes taking place in accordance with the ACA. May I remind you, I am a staff oncology nurse, not an economist.

Here’s how ACOs affect me: My job as an oncology infusion nurse is being combined with those of another hospital offering similar patient services. The short version: After 20 years of employment, along with my coworkers I will have a new employer.

I know it’s just business. I go to work, and every two weeks receive a paycheck for my hours. Every two weeks, my employer and I are even. Still, it feels a little like how I imagine if, after 20 years of marriage, your spouse informs you he is leaving for no particular reason: “It’s not you, it’s me.”

Initially, I couldn’t help but feel abandoned.

A person’s reaction to such situations is clouded by sentiment. There are concerns about possible changes to regular work routines. There is worry over potentially commuting to other work sites. The funniest one occurred while I perused the hospital gift shop, lamenting to myself about the loss of my employee discount. Then I remembered: “We don’t have an employee discount, you sentimental fool!” Feelings of rejection play tricks on memory. Read the rest of this entry ?

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Michelle Obama: Health Care Reform the ‘Right Thing to Do’

September 5, 2012

The full transcript of Michelle Obama’s moving convention speech can be found here.

Here she is on making difficult decisions:

“But at the end of the day, when it comes time to make that decision, as President, all you have to guide you are your values, and your vision, and the life experiences that make you who you are.”

On health care reform:

“When it comes to the health of our families, Barack refused to listen to all those folks who told him to leave health reform for another day, another president. He didn’t care whether it was the easy thing to do politically – that’s not how he was raised – he cared that it was the right thing to do.

He did it because he believes that here in America, our grandparents should be able to afford their medicine…our kids should be able to see a doctor when they’re sick…and no one in this country should ever go broke because of an accident or illness.

And he believes that women are more than capable of making our own choices about our bodies and our health care…that’s what my husband stands for.”

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Campaign-Inspired Hot Summer Friday Thoughts

August 10, 2012

By Shawn Kennedy, AJN editor-in-chief

Commuting in and out of Manhattan gives me plenty of time to listen to the radio and of course, with Election Day a mere 90 days away, the presidential campaign offers reporters a lot of fodder for commentary. And of course, the evening papers and television stations—both national and local—augment what’s on the radio all day. Here’s a sampling of health care–related campaign news that I’ve heard and read this week.

According to the Kaiser Foundation’s Health Tracking Poll, July figures show that overall, two thirds of Americans support Medicaid expansion under the Affordable Care Act (ACA), but when it comes to whether their own states should expand programs, support drops to less than half (49%), while 43% want to keep the status quo. Importantly for candidates, “four in 10 Americans say they could still change their minds on the law.”

My take: The failure of the Democrats to adequately explain the reforms, together with the misinformation from the Republicans (death panels—need I say more?), are leaving the public confused.  The winner in November will be the candidate who can convince the voters that the ACA is either good or bad for them on a person level. (And yes, the economy is now the overriding issue, but health care will keep resurfacing as an emotional and “values” issue in the coming months.)

Senate Majority Leader Harry Reid (D–Nevada) accused candidate Mitt Romney of not paying taxes for 10 years while he was employed at Bain Capital. The Washington Post Fact Checker blog details why Reid’s claims don’t ring true—and awards him “four Pinocchios.” (Romney received three Pinocchios when he said it’s “usual” for candidates to only release two years of tax returns.)

My take: it’s going to be a very long 90 days of campaign rhetoric.

And my favorite for the week: several news stories reported that John Schnatter, the founder and CEO of Papa John’s pizza, told shareholders that, to protect their interests, he will be forced to raise pizza prices under “Obamacare.” ABC News reports that he said that “the cost of providing health insurance for all of his pizza chain’s uninsured, full-time employees comes out to about 14 cents on a large pizza,” and he will pass this cost along to customers.

My take: How is this newsworthy? Will customers really drive all the way to the restaurant (at $~4.00 a gallon for gas) and leave when they learn the price is 14 cents more? I can’t wait to hear Jon Stewart’s take on this.

I may start listening to all music, all the time.

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