Posts Tagged ‘health care reform’

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Hospital Execs Assert They’re ‘Scared to Death’ by Reform Measures

April 26, 2010

By Shawn Kennedy, AJN interim editor-in-chief

On Friday, at the Association of Health Care Journalists (AHCJ) meeting in Chicago, I attended a session in which a panel of hospital executives discussed how their facilities would be affected by health care reform. They weren’t really sure of anything except that they’d probably lose money.

The panel included Richard Gamelli of Stritch School of Medicine and the Loyola University Health System, Jeffrey Hillebrand from NorthShore University HealthSystem, and Jim Skogsbergh from Advocate Health Care.

Skogsbergh was the most dire: “I’m scared to death about health care reform and I’m not sure how it will all shake out. The only thing I do expect is to that I’m going to get paid a lot less.” An attendee asked if hospitals would do better now that patients they cared for as charity patients would have health insurance under the new law. Gamelli answered that that depended on the insurance. Currently, he said, his facility is only reimbursed for 90% of costs incurred by Medicaid patients and 50% of those incurred by Medicare patients.

Where’s the innovation? The session was disappointing in that it was mostly about how these megahospital systems would deal with the financial implications. It would have been interesting to have a perspective from a small community hospital. And other than a program mentioned by Hillebrand to try to reduce hospital readmissions among patients with chronic disease, there seemed to be little focus on finding new approaches to cutting costs through improving quality.

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Posted in health care reform, health information technology (HIT), nursing innovations, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | Leave a Comment »

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‘What’s Not to Like?’ A British Nurse, Recently Treated for Cancer, Weighs In on U.S. Health Reform

March 26, 2010

Here’s a little perspective on health care reform in the U.S. from AJN’s contributing editor on international health. Jane Salvage, RGN, BA, MSc, HonLLD, FQNI, is a visiting professor at the Florence Nightingale School of Nursing and Midwifery, King’s College, London, and recently spent a year on the Prime Minister’s Commission on the Future of Nursing and Midwifery.

At 10 Downing Street

Just two weeks ago I learned I had a stage 1 endometrioid adenocarcinoma—a cancer in the lining of my womb. In many other countries today, and in the UK until recent years, this would eventually have killed me. But here I am today, happily home after a hysterectomy, probably cancer-free, thanking my lucky stars and our British National Heath Service (NHS).

My life has been saved by an army of people, from nurses and doctors to lab assistants, many of whom I’ll never meet. All my high quality care was free at the point of delivery, efficiently funded from my taxes instead of boosting the profits of insurance officials or millionaire surgeons. And I am pleased that my taxes have also subsidized the care of the demented, impoverished old lady in a nearby bed, even though her hollering and howling kept us awake most of the night.

What’s not to like? A great deal, you’d think from the nonsense talked about our UK NHS during your U.S. health reform debates. Last September, visiting the Robert Wood Johnson Foundation Initiative on the Future of Nursing, I stayed at the same Washington, DC, hotel as a group of anti-reform protesters. They seemed full of hate, for the world as well as for President Obama, and their ignorant, implacable opposition astonished and scared me.

Just before I went into hospital earlier this week, I cheered at the news of the passing of Obama’s health care bill. By the time I came out less than 30 hours later, the Republicans were already busily trying to sabotage the reforms, as they will continue to do. Fellow nurses, don’t let them do it. Fight them all the way. You need all the help you can get—let us know what we can do.

And please don’t believe the lies told about the NHS on Fox News by minor right-wing British politicians who have zero credibility back here. To be sure, there’s plenty that needs fixing in our system, and we’re working on it. I’ve spent the past year on the Prime Minister’s Commission on the Future of Nursing and Midwifery in England, identifying problems but also widespread good practice. We suggested some ways forward in our final report, launched on March 2. Drafting this report and then unexpectedly becoming a patient myself—seeing things from the other side of the fence—has reminded me, in a humbling way, of the greatness of our NHS. For all its faults it remains a brilliant system, and you’d be hard put to find a British nurse, doctor, or patient who isn’t a staunch supporter.

If ‘socialist  health care’ means supporting your family and fellow citizens and ensuring no one dies of undetected cancer or bankrupts themselves having treatment, I’m all for it.

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Posted in health care reform, international nursing, nursing perspective | Tagged , , , , , | 8 Comments »

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Will Anyone Miss Accidents As ‘Preexisting Conditions’ and Other Insurance Doubletalk?

March 22, 2010

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

It’s interesting to have a firsthand encounter pertinent to the HCR story that is consuming the headlines. Recently, my son had a fall and dislocated his shoulder. He knew what had happened because he did it as a freshman in high school, some 10 years ago while playing sports. So he went to an ER and had the shoulder popped back in, saw an orthopedist as recommended, and went for physical therapy—all covered by his insurance plan. But all his claims for reimbursement were denied. The reason the company gave: his dislocated shoulder was considered a ‘preexisting condition.’

After my husband peeled me off the ceiling, we approached this methodically—we gathered forms, wrote letters, requested letters from the hospital, the orthopedist, the physical therapists—and appealed the ruling. After a bit, we received a response saying that they’d reconsidered and would cover the injury according to policy.

This is not a terribly compelling or poignant case, but it’s an example of the “first deny all claims” approach of some companies. Yes, it was resolved on appeal fairly easily, but why did it need appealing in the first place? I can’t imagine what patients and families with chronic illness must go through in trying to get treatment covered.

If the only thing health reform does is to eliminate the unjust use of preexisting conditions to deny coverage, it will get rid of one of the most critical obstacles to access to care.

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Posted in health care reform, patient perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | 6 Comments »

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Might Health Care Reform Happen? And What Will It Mean for Nurses?

March 19, 2010

By Shawn Kennedy, AJN editorial director/interim editor-in-chief

The final push towards the staircase.../ caspermoller, via Flickr

Sometime in the next few days, Congress may bring the health care reform issue to a final vote and even a resolution of sorts, though one never knows what new twists may occur before then. I can’t even imagine what will occupy the news if it really does pass. (Philandering professional athletes and pilfering politicians better beware as newspapers seek new headlines.) 

Many Americans are calling their legislators to tell them what they want and don’t want. At the same time, many remain confused by the complexity of the legislative process as well as the particulars of the legislation. The final push received a boost this week from projections by the Congressional Budget Office that the bill would cut the budget deficit by $1.2 trillion over the next two decades. 

As nurses, we need to be knowledgeable and concerned with how health care will shape up—we’ll be delivering it. For information on the current bills under consideration, here’s two accessible sources: the Washington Post has a comparison of what the already passed Senate bill and the reconciliation version under consideration by the House include; the New York Times provides a pdf of the House bill.

Here’s a short list of provisions related to nursing likely to be in a final bill (as we noted in a post back in December about a useful ANA chart comparing House and Senate bills at the time):

  • increased financial support for nursing recruitment and advanced education
  • increased funding for graduate education for nursing faculty
  • increased funding for education for students who will practice in underserved areas
  • establishment of a Public Health Workforce Corps
  • increased Medicare reimbursement rates for advanced practice nurses, including nurse–midwives
  • pilot programs to provide reimbursement under Medicare for nurse practitioners to create or lead “medical homes”
  • increased reimbursement to school-based health clinics under Medicaid

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Posted in health care reform, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 5 Comments »

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Advanced Practice Nurses: Pushed Forward by Health Reform Advocates, Pushed Back by Physicians over Turf – Enough Already!

March 12, 2010

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

As we’ve noted in past posts on this blog and in AJN editorials in August 2006 and August 2008, organized medicine does not want to acknowledge that nurses can practice independently.  And now the turf war between advanced practice nurses (APRNs, which include nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists) and physicians is heating up.

In California, physicians are suing the state for allowing nurse anesthetists to practice without supervision, using patient safety as a reason. In Kentucky, physicians are opposing legislation to expand the scope of practice for NPs—at issue is whether NPs should need a signed collaborative arrangement with a physician (even though the physician does not supervise the NP). According to an article by a Louisville, Kentucky, newspaper, the Courier-Journal, the physicians charge high fees for their signature or demand a percentage of the practice.  The bill, though, passed the state House committee on March 4, with several members questioning the ethics of physicians’ requiring fees.

Nurses have been and continue to fight for the right to practice, and during this period where the government is seeking solutions to health reform, this is a battle that shouldn’t have to happen—a view shared by Stephen Ferrara, NP, at A Nurse Practitioner’s Place (“I have tried to refrain from taking the bait from some recent negative opinions regarding nurse practitioner delivered care”). Read the rest of this entry ?

Posted in advocacy/political action, health care reform, nurse practitioners, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 2 Comments »

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Notes from the Healthweb and Nursosphere

March 5, 2010

This week Not Nurse Ratched has an amusing, meandering, and thoughtful post about the uses of Facebook by patients in the hospital. There’s a short excerpt below, but read the whole thing here.

They update Facebook constantly. CONSTANTLY. They have us take photos of injuries they can’t reach so they can post the photos to Facebook. I am not making this up. “I want a photo of my hideously dislocated ankle/knee/shoulder but I can’t move, so would you mind using my phone to take a picture for me?” And they keep updating and updating. I have actually said, “I’m about to give you a medicine that is going to render you unconscious immediately, so you should set your phone down.”

How could we have a weekly Web roundup that doesn’t at least mention health insurance reform? The spotlight has been slowly turning toward the insurers themselves, a crucial part of the equation (along with cost control and many other factors). This week Secretary of Health and Human Services Kathleen Sebelius met with the top executives of insurance companies to demand an explanation for the steep increases in rates seen in the last year.

salmonella/via CDC

If you’re looking for yet another reason why processed food isn’t good for you (besides the frequent presence of high fructose corn syrup and massive doses of salt, and the inaccurate packaging claims that the foods are “healthy” and “lean”), this week the NY Times reported news of a widespread food recall, stating that “[t]housands of processed food products – from chilis to hot dogs to dips – contain an ingredient that federal food regulators say was contaminated with salmonella . . . “

Also this week: hopes were crushed for a pill thought promising for the treatment of Alzheimer’s. Garry Schwitzer of HealthNewsReview.org isn’t surprised, though–no one’s better at pointing out the way drugs are hyped by mainstream coverage, whether they work and are safe or not. Here’s the short take at his blog.

Lastly, for some widely varying provider-level perspectives on palliative care and end-of-life issues, there’s an excellent roundup of posts and links to blogs and Websites at the Palliative Care Grand Rounds hosted by Larry Beresford.

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Posted in health care reform, nursing perspective, palliative care | Tagged , , , , , , , , | 1 Comment »

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Why the ‘Greatest Generation’ Is Bagging Groceries (No, It’s Not Because of Taxes)

March 2, 2010

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

In surfing the Web Monday, I came across this interesting tidbit on the blog run by Gary Schwitzer, creator of HealthNewsReview.org, a site devoted to assessing the accuracy of health news coverage. He quoted statistics from a report  by the Center for Public Integrity, which claims that “there are eight lobbyists for every member of Congress.” The number of lobbyists went from about 1,400 in the first quarter of 2009 to nearly 3,700 by year’s end. 

I see elderly people in the supermarket bagging groceries—some may like the company, but others are doing it to pay for medical care not covered under plans. My uncle—one of the “greatest generation”—used to cut his pills in half to make them last longer. Does this qualify as “rationing care”? Read the rest of this entry ?

Posted in health care reform, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 5 Comments »

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Notes from the Web

February 25, 2010

Here are a few items of interest on today’s Web as these huge wet snowflakes actually start to accumulate on rooftops here in NYC and the horizon (New Jersey, that is, across the thin wedge of the Hudson River you can see from AJN offices) closes steadily in:

Kim at Emergiblog has a nice post dealing with changing her mind about whether or not she wanted to get a BSN.

And this post by Anne Dabrow Woods at In the Round (excerpted below) got our attention for its honesty about the difference between treating a condition in the hospital and treating it at home in a family member—and also because it put a human face on an article we ran in our February issue about ostomy complications and management.

My oldest daughter was diagnosed with ulcerative colitis when she was 7 years old and despite aggressive treatment for her disease; she required a total colectomy, temporary ileostomy, and an ileo-anal anastamosis when she was 12. As a nurse I thought I was equipped to care for her ileostomy; was I ever wrong. I had experience taking care of hospitalized patients with ostomies, but I quickly learned caring for someone who is active is a totally different story.

In his most recent post, Anonymous Doc is as usual thoughtful and honest (except for that anonymity thing, of course . . . which does, whatever its drawbacks, kind of free him up as a writer). He moves from considering the fairly superficial question of whether it’s appropriate for him to suggest that a sweating patient take off her sweater to some related but perhaps deeper questions:

More than once, I’ve made a comment that’s probably too casual when we’re talking about running some blood work. Like, “I hope they don’t find [whatever].” As a fellow human being, I hope they don’t. As a doctor, am I supposed to acknowledge hope, and uncertainty? Shouldn’t I say something like “there’s an x% chance they’ll find [whatever],” or say nothing at all, and wait until they find what they’re going to find, and not scare the patient needlessly? I don’t know. They don’t train us (much) in actual patient interaction. We’re expected to pick it up, to know things automatically.

Also of significance this week, the House passed legislation to “strip health insurers of their federal antitrust exemption.” In other words, insurers may soon have to do a better job pleasing customers rather than abusing them—or face stiff competition from competitors who are willing to do so instead.

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Posted in health care reform, nursing perspective, nursing students, writing and nursing | Tagged , , , , | Leave a Comment »

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If Health Care Reform Were an ICU Patient . . .

January 27, 2010

The idea that the Health Care Reform bill is on life support is disappointing, but not surprising. It was admitted in a weakened state of health. It appears suspiciously a victim of domestic violence by special interest groups. The bruises on its body resemble the outline of handprints of the insurance companies it was created to protect our citizens from.

So writes nurse-artist-blogger JParadisi RN in a recent post, which (whatever your beliefs about whether we should do something major soon about the increasing numbers of uninsured Americans and the skyrocketing costs of health care) has particular resonance as President Obama prepares to address the nation tonight about this and other issues.


(Full disclosure: Paradisi’s artwork appeared on the October 2009 cover of AJN.)

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Posted in art and nursing, health care reform, nursing perspective | Tagged , , , | 2 Comments »

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Gallup Poll: Power Elite Believes Nurses Should Have More Say in Policy, Management

January 25, 2010

Shawn Kennedy, MA, RN, AJN interim editor-in-chief

RWJF reaction panel: Richard Hader, CNO, Meridian Health System, NJ; Mary Naylor, prof. of gerontology, UPenn.; Beverly Malone, National League for Nursing; Patricia Gerrity, 11th St. Health Center, Philadelphia; Susan Hassmiller, RWJF sr. advisor for nursing

Last week I attended a press conference in Washington, D.C., where the Robert Wood Johnson Foundation (RWJF) released a Gallup poll it had commissioned to find out what 1,500 opinion leaders (or as Gallup editor-in-chief Frank Newport put it, “the people who run things in this country”) think about nursing leadership and nurses’ influence on health care reform. 

It’s no surprise that most (69%) see nurses as having little influence on health reform. Nurses ranked at the very bottom—immediately below patients, who were below physicians in the rankings. Mary Naylor, an innovative leader from the University of Pennsylvania and part of a reaction panel, hit the nail on the head: “Everyone should be concerned that the largest group of health care providers and the consumers are the least influential.” (Those seen as having the greatest influence are government officials and insurance executives—no surprise there, either.)

In identifying what impedes nurses’ ability to be in leadership roles, here’s how the opinion leaders weighed-in:

  • 69.3% noted that nurses are not seen as important decision makers as compared with physicians.
  • 68% noted nurses were not seen as revenue generators like physicians.
  • 62.4% think nurses are focused on acute care and not prevention or health maintenance.
  • 55.8% think nurses lack a single voice in speaking on national issues.
  • 50.9% think nurses lack opportunities to move into leadership positions.

The good news is that the opinion leaders, for the most part, feel that nurses should have more influence in policy, planning, and management, especially around patient safety, improving quality, preventive care in the community, coordinating care, and “helping the system adapt to an aging population.” The top three suggestions, in answer to an open-ended question on what nurses need to do to gain more influence, were: nurses need to make their voices heard (15%), nurses need to have higher expectations and accountability (12%), and nurses needed to improve their image (10%). Read the rest of this entry ?

Posted in advocacy/political action, health care reform, media depictions of nursing, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | 4 Comments »

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