Affordable Care Act « Off the Charts

Posts Tagged ‘Affordable Care Act’

Early Spring Web Roundup: Insomnia, Early Delivery, Persistence, Painkillers, Overtesting

April 6, 2012

Cherry Blossoms, Washington, DC/by cliff1066, via Flickr

We’ve been a little quiet here on the blog this week. Maybe it has to do with the opening of baseball season or signals a hangover from media coverage of the Supreme Court give-and-take about the Affordable Care Act last week and the endless guesses about how the court is likely to vote come June. Or maybe all our nurse bloggers are using spare time to clean out closets, sweep the cherry blossoms and sale inserts from the sidewalk, purge the inbox, box up the humidifier, watch Mad Men, or whatever. But here are a few things we’d like to draw your attention to:

If the windy spring nights wake you (or your patients) to the sound of a trash can lid flying away, maybe this will help: As described in the Drug Watch column in AJN‘s April issue, a sublingual form of the drug zolpidem (think Ambien) has now been approved, with the fancy name Intermezzo, for people who wake in the middle of the night and start hearing the same song over and over in their heads or thinking of the perfect comeback to that snippy waiter.

Also in the April issue, an AJN Reports looks at efforts to get people not to opt for potentially risky early delivery of their babies, and a Reflections essay called “Giving Up—Or Not” details one nurse’s patience and persistence in trying to get a patient to start wanting to live again after major surgery. Here’s an excerpt:

We encourage, beg, cajole, and nag him—to feed himself, to sit in the chair, to roll over. Healing is work, we tell him.

But his body has turned on itself as a substitute for food. His long series of complications has left him discouraged and depressed. If staying comfortable impedes his progress, he’s willing to live with the trade-off.

Sam opens his eyes when I walk into his room, then closes them again. While I assess him, I tell him the plans for the day.

He puts a finger over his trach. “Do I have to have a bath? I feel so tired.” His voice is soft and slightly rasping.

You might have noticed recent headlines about prescription painkiller abuse in the U.S. Read the rest of this entry ?

Posted in health care reform, nursing perspective | Tagged ACOs, Affordable Care Act, AJN, Cherry blossom, Intermezzo, nurses, physical therapy, prescription drug abuse | Leave a Comment »

The Affordable Care Act on Trial

March 16, 2012

By Maureen Shawn Kennedy, MA, RN, editor-in-chief

Courtesy of Kaiser Health News

According to the National Conference of State Legislatures, 47 states have enacted some legislation to block or limit various requirements of the Affordable Care Act (ACA). And a week from Monday, on March 26, the Supreme Court will begin hearings on the constitutionality of the law, as 26 states bring suit against the federal government. The primary issue for the Court: can the federal government mandate that individuals must purchase health insurance?

Other closely related issues the court has also set aside time to consider are whether other provisions of the law can still be implemented or must be voided if the individual mandate is struck down, the legality of the proposed Medicaid expansion, and whether the court must in fact wait until the individual mandate is actually implemented in 2015 before even considering its legality.

So how do many Americans feel? The Kaiser Family Foundation has been tracking opinions on the law and offers an excellent interactive chart that shows opinions according to different variables, including age, income, political party affiliation, gender, and current insurance status. Their findings may surprise you.

For more information about the Affordable Care Act and it implications for nursing, here are some links to AJN’s coverage since it was signed into law in 2010:

“Nurses and the Affordable Care Act,” Mary Wakefield
“What Future for the Affordable Care Act,” Diana Mason
“Health Care Reform and a System in Flux,” Jacob Molyneux

Posted in health care reform | Tagged Affordable Care Act, health care reform, Individual mandate, Mary Wakefield, Medicaid, nurses and health care reform, President Obama, U.S. Supreme Court | Leave a Comment »

Diabetes Plus Marijuana Plus Medical Errors Minus Nursing Blogs

January 12, 2012

What’s new in health care news this week?

Diabetes everywhere. There’s an entire Health Affairs issue devoted to the topic of “Confronting the Growing Diabetes Crisis.” It looks at many interrelated issues, such as the personal financial burden of having diabetes over the course of a lifetime, whether it’s best to put scarce health care resources into focusing on prevention or treatment, models for community-based lifestyle programs for those with type 2 diabetes, the positive effects of the Affordable Care Act on giving those with diabetes access to affordable health insurance and crucial care, genetic factors related to type 2 diabetes, and a great deal more. Inevitably, many of the articles focus on type 2 diabetes, which is so closely linked to America’s obesity epidemic.

by Jorge Barrios, via Wikimedia

Joint studies. The New York Times reported this week on a large government study showing that, whatever one believes about marijuana’s psychological effects or the efficacy of its various medical uses, long-term marijuana smoking—at least one joint per day, every day of the year—does not impair lung function or contribute to the development of COPD. Will this change anyone’s mind about whether this drug is evil, a panacea for all ills, or somewhere in between? Probably not.

Unreported harm. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services issued a report last week stating that only 14% of medical errors and other events that harm Medicare patients were reported by hospital employees. The report calls for improving reporting systems and the creation of a list of ”potentially reportable events.” According to the New York Times story on the topic, adverse events that have gone unreported include ”medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners.”

Which leads us (or does it?) into nursing blogs. Many of the ones in our blogroll have been pretty silent in the past few months, or longer, and it’s not clear why. Some bloggers are taking a break, some have burned out or decided to use their time for other things (like going back to school), some have simply decided to spend more time on Facebook or sharing their thoughts by ’microblogging’ on Twitter (or are simply playing lots of Words With Friends on their smartphones). There are almost certainly many interesting new nursing blogs we don’t yet know about that are taking their places. If you know about them, please let us know. We need to take some time and do some digging. And we plan on doing a serious revision of the blogroll in the next few weeks.—JM, senior editor

Posted in patient safety | Tagged Affordable Care Act, bedsores, blogging, diabetes, Health Affairs, marijuana, nurses, Office of the Inspector General | 5 Comments »

Year-End Take: A Hopeful Trend in U.S. Health Care?

December 27, 2011

Photo by James Russo, via Flickr

Less Is Sometimes More
A hopeful trend that’s gained some serious momentum this year—and may be connected to both the recession and some provisions of the Affordable Care Act—is that we’re beginning to question whether we really need quite so many tests and drugs. By ‘we’ I mean researchers, some journalists, some nurses and physicians, and of course patients. The answers aren’t always clear, and there’s plenty of room for disagreement on many such issues, but at least we’re asking the right questions more often, rather than retreating in fear and simply hurling around the word “rationing”:

Who really benefits from prostate and breast cancer screening and who is more likely to be harmed, and why? When are you too young or too old to be likely to benefit from a certain type of screening? When does aggressive care at the end of life cease to make sense? Are we confusing a risk factor with a disease, an association with causation, relative risk with absolute risk?

Does that drug you see relentlessly marketed in advertisements during breaks in the network news actually help you? Which physicians are being paid as consultants in support of various drugs, tests, or treatments, and does this compromise their objectivity? And so on. The latest example of this kind of analysis I’ve stumbled across can be found here: “Disease Creep: How We’re Fooled Into Using More Medicine Than We Need.”

The Many Faces of Nursing
So, that’s one good sign as the year heads toward its close. Another is that nurses are making their voices heard and finding new roles and new ways to use their knowledge and skills as our system begins to slowly transform itself. And they are also blogging and sharing ideas on Twitter, organizing in support of safe staffing and fair wages, getting elected to Congress and assuming major leadership positions in health care organizations, providing essential primary care as nurse practitioners, spearheading quality improvement initiatives, learning new technologies, volunteering in disaster zones, doing exciting new research, providing crucial and compassionate bedside care, advocating for patients, and much more.

This blog will probably be pretty quiet until the New Year. Be well.—JM, AJN senior editor/blog editor

Posted in health care reform, nursing perspective | Tagged Affordable Care Act, aggressive medicine, association vs. causation, breast cancer, direct marketing, end of life care, prostate screening | 3 Comments »

Bad News, Good News: Berwick, a Casualty of Politics, Succeeded at CMS Helm by a Nurse

November 30, 2011

By Shawn Kennedy, MA, RN, editor-in-chief

Marilyn Tavenner

When Donald Berwick steps down from his post as administrator of the Centers for Medicare and Medicaid Services (CMS) on December 2, he’ll turn the reins over to Marilyn Tavenner, MHA, BSN, RN. Tavenner is not a new face at CMS—she served as acting administrator prior to Berwick’s July 2010 appointment by President Obama and has been principal deputy administrator at CMS since February 2010.

As noted by an article in The Washington Post, Berwick is stepping down in the face of organized opposition to his nomination by Republicans in Congress, who have vowed to block the confirmation he’d need to continue after his recess appointment expires on December 31.

On November 23, President Obama announced his intent to nominate Tavenner for the top post. In her e-mail to CMS staff (carried on the Kaiser Health News site), Kathy Sebelius, secretary of Health and Human Resources, says of Tavenner, “Her career as a nurse, hospital administrator, and Virginia Secretary of Health and Human Resources give her unique insights that position her well to serve as Administrator.”

I certainly hope so. Berwick’s reputation and track record for pinpointing problems in our health system—and more importantly, working to do something about them through the Institute for Healthcare Improvement—was stellar, and he carried this zeal into his government position as he grappled with the daunting task of implementing reforms in the Affordable Care Act. Read the rest of this entry ?

Posted in Uncategorized | Tagged Affordable Care Act, Centers for Medicare and Medicaid Services, CMS, Donald Berwick, nurse, Tavenner | 2 Comments »

Health Care Reform Works—If You Work It

April 22, 2011

Image by urbanbohemian via Flickr

By Gail M. Pfeifer, MA, RN, AJN news director

My husband and I both recently had preventive screening colonoscopies, which are now covered under the Affordable Care Act (ACA) as preventive care for adults over 50. That coverage, if you purchased a new health insurance plan on or after September 23, 2010, which we did, means you do not have to pay a copayment or coinsurance or meet a deductible if you use an in-network provider (here’s a full list of preventive services covered under the new law). You would think that medical office billers and insurance companies would know that by now.

Although some plans have clauses that let them off the hook on this rule, ours does not—these tests should have been covered. Lucky for us, we knew it when the bills came in. To make a long story short, I was billed for the “surgery” and for the anesthesia. So I first called the billing department of the GI specialist’s office and asked them to rebill the procedure correctly, as preventive screening. No further bills from them, for me, but shortly afterward, my husband was billed by the same office for “surgery” occurring months later—same doc, same procedure, same billing office. He’s following up with phone calls as I write.

I next called the anesthesia billing office, which said our insurance company had denied the claim. I called the insurance company, which looked at our plan and found that, indeed, anesthesia should have been covered; they promised to issue a new claim number. Three weeks later, I got not one, but three, invoices from the anesthesia biller for the same deductible amount. I called them again, and they explained that, because “it takes 30 days for the new claim number to be received,” and “our system automatically sends” out invoices, I was mailed another bill (although they couldn’t explain the threesome). Seriously? Read the rest of this entry ?

Posted in health care reform, nursing perspective, patient perspective | Tagged ACA, Affordable Care Act, colonoscopy coverage, deductible, health care reform, Health insurance, inaccurate billing, preventive care | 2 Comments »

On the Web: A Tragic Choice, Wasting Berwick, Cost Control, A Nurse’s Comfort Zone

March 8, 2011

Obama Speaks to Congress on Health Care/Image via Wikipedia

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

Read the rest of this troubling post at The Health Care Blog by surgeon John Maa if you doubt that we need health care reform in this country.

A measure of how unserious we are about fixing the problem of health care quality and costs in the U.S. can be found in reports that Don Berwick, President Obama’s choice to run the Centers for Medicare and Medicaid Services (CMS), continues to have an uphill battle for confirmation, despite being widely acknowledged within the medical community as the best choice for the challenging job.

Since we’re talking policy, there’s an incisive post at the Health Affairs Blog on where our energies should—and should not—be going in controlling costs. Here’s an excerpt:

The current cry to reduce Federal deficits and debt growth by reducing Medicare and Medicaid entitlements is totally missing the key issue: the need to moderate all health care inflation. This should be the time for a national debate on how to best tackle the underlying cost problem, for the sake of our future, the economy, and access to health care.

The June 13-19, 2009 Economist editorialized: “America has the most wasteful [health] system on the planet. Its fiscal future would be transformed if Congress passed reforms that emphasized control of costs as much as the expansion of coverage that Barack Obama rightly wants.”

Why should any of this matter to nurses? Here’s a post reminding us why nurses have a stake in health care reform.

But back to nursing proper, nursing in the trenches, nursing not in the abstract but in its inescapable dailiness. Read the rest of this entry ?

Posted in Uncategorized | Tagged Affordable Care Act, catastrophic illness, Donald Berwick, HCR, health care reform, medical bankruptcy | 1 Comment »

Nurses, Hospitals, and Social Media: It Depends What Business You’re In

January 19, 2011

By Julianna Paradisi, RN

Zuckerberg/via Flickr, World Economic Forum

Before the placenta picture posted on Facebook by a nursing student made national news, I read Time Magazine’s “Person of the Year 2010,” by Lev Grossman. Born in 1984, Mark Zuckerberg, the inventor of Facebook, is decades younger than the average working nurse. According to the article, so many people now belong to Facebook that if the Web site were a country “it would be the third largest, behind only China and India.” To refuse to recognize the social impact of Facebook is to miss the boat.

Throughout the nurse blogosphere, nurses are demanding that hospitals create policies about the use of social media. Some hospitals have. Not surprisingly, these documents state that no unauthorized photographs of staff, patients, or patient care areas should be taken, let alone posted on the Internet.

Hospitals with social media policies are not necessarily squelching their employees’ right to freedom of speech. They don’t want to spend time and money in court defending their public image. They already spend lots of money on marketing. They are in the business of patient care, not entertainment. So hospitals with social media polices take the position that you can post or tweet to your heart’s content, but should keep in mind the following:

Nothing you post is private.
If your online behavior disrupts patient care or creates hospital liability, the hospital reserves the right to fire you.

Consider your personal commitment to your own rights. Do you really want to catch every ball that’s thrown to you? Hospitals don’t want to spend their time and money on social media lawsuits. Do you?

Social media is not going away. One of Mark Zuckerberg’s profitable insights is that people like reading about and seeing their friends and friends of friends online. A few years ago, many of us were upset when the Patriot Act made it possible to force libraries and bookstores to report which books their patrons read. Now we want everyone to know what books we “like,” and no one seems to mind that Amazon tracks what we read, then focuses ads according to our purchases.

My own concept of privacy is changing. Read the rest of this entry ?

Posted in art and nursing, ethical issues, health care reform, media depictions of nursing, patient perspective, social media, writing and nursing | Tagged Affordable Care Act, ethics, Facebook, HIPAA, Mark Zuckerberg, Patient Protection and Affordable Care Act, Patriot Act, privacy, social media | 6 Comments »

HCR: Been There, Done That

January 18, 2011

By Maureen ‘Shawn’ Kennedy, AJN editor in chief

I was doing some research in the AJN archives and came across an editorial written in November 1993 by Virginia Trotter Betts, then-president of the American Nurses Association. “The Best Buy in Health Care” (click through to the PDF option; article will be free until July 18) reads like it was written with the Institute of Medicine’s Future of Nursing report in mind. Here’s an excerpt for those who don’t have access to the AJN archives (a shameless plug: subscribers have full access to ALL the issues of AJN, back to the very first issue in 1900—a treasure trove of nursing history):

“But we must also face the fact that such reform will require significant changes in nursing. Nurses will have to operate with greater autonomy and deliver care to a broader clientele. To foster enhanced roles for nurses as case managers and team leaders, nursing administrators must alert the work environment to offer a continuum of care on site and off site. Nurse educators will need to offer innovative programs, curricula, and clinical placements that prepare nurses for careers characterized by critical thinking and maximum flexibility. Nurse researchers will need to add more health care system, economic and policy studies to their repertoire.”

And another:

“Nurses want to do more in a reformed system to facilitate access at a reasonable cost. We want to do what we are educated to do – provide basic health services like well and ill baby care, immunizations, and health screenings; manage chronic conditions; care for the sick and dying using both technology and interpersonal techniques; and a multitude of other essential services that are well within our expertise. We want to educate our client and our communities and form a health care partnership with them. We are team players and are ready to try to make new systems work for consumers.”

If only nurses ruled the world . . .

Posted in from the archives, health care reform, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged Affordable Care Act, American Nurses Association, HCR, scope of practice | Leave a Comment »

Off the Charts

Posts Tagged ‘Affordable Care Act’

Early Spring Web Roundup: Insomnia, Early Delivery, Persistence, Painkillers, Overtesting

The Affordable Care Act on Trial

Diabetes Plus Marijuana Plus Medical Errors Minus Nursing Blogs

Year-End Take: A Hopeful Trend in U.S. Health Care?

Bad News, Good News: Berwick, a Casualty of Politics, Succeeded at CMS Helm by a Nurse

Health Care Reform Works—If You Work It

On the Web: A Tragic Choice, Wasting Berwick, Cost Control, A Nurse’s Comfort Zone

HCR: Been There, Done That

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