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.

On the other hand, the new employer presents a very attractive job offer. In fact, some of the benefits are much better. I cannot resist this lover employer. Sometime this fall, just short of 20 years with my current employer, I will have a new employer.

Health care delivery in the United States is not only unjust—it is unsustainable. The ACA is one effort to fix both of these problems, putting the health care industry in flux. The question is not, “Will it change?” but “How?” Collectively, insurers and physicians have known this for a while, and react politically. Nurse leaders attend meetings in Washington, representing nursing’s voice in the conversation. The influencers with the most money have the biggest lobbies, but it’s too soon to call the final product of these discussions.

I continue to support increased access to health care; however, it is naive to believe it can be accomplished without sacrifice.

I am reconciled to the change occurring in my career. In fact, I will go so far as to say I am cautiously optimistic that I will find the change beneficial in some ways. As in any 20-year relationship, it’s not like my old job, while very good, was perfect.

I was recently considering all of this while strolling through the hospital lobby, where I ran into a friend from another department. “Hey, I hear your unit is getting a new employer. How’s that working for you?” he asked. “Oh, fine. No worries,” I replied. “I still have a job. You know, I’m a nurse. We come with the room.”

I could still hear his laughter all the way from the other end of the hall.

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