Article Outline
The healthcare reform debate continues to heat up, with misinformation, fear, anxiety, and partisanship obliterating the tremendous need for change in the status quo. Nurses cannot deny the need for healthcare reform, whether they are in an official capacity, in collegial relationships, or with friends and family. Our experience and concerns about more than 47 million Americans without healthcare insurance are horrifying.
At the same time, nurses are not strangers to the advocacy role. We have been educated to be patient advocates because we chose the profession of nursing. Leadership by necessity mandates that we are involved at the next level as advocates for access to care for all.
Regardless of the outcome, it is my hope and prayer that a viable solution will be reached and that nurses will participate in moving this country toward a new and better healthcare system. I recognize that there is no simple answer, and the problems are exceedingly complex; however, I would like to share my thoughts prior to the approval by Congress of any healthcare reform.
1.We have not had a systematic approach to either the delivery or financing of healthcare to date. One could say that our health system is anything but a system since there are so many disconnects, particularly between financing and delivery. It is of note that insurance companies' profits continue to increase.
2.In the name of politics and as a result of multiple competing interest groups, we often have partial solutions that do not achieve the desired results of access, affordability, and efficiency. We are spending 16% of our income for healthcare, the highest in the world, and yet our outcomes in life expectancy and infant mortality are worse than other western nations. President Obama has indicated that our cost under the current system had a 5.5% increase for last year, although inflation was at a negative rate. At the same time, the lobbyists are spending $1.4 million per day to inhibit competition in the healthcare arena.
3.Certainly, the fear of increasing costs to cover all Americans is a realistic concern, yet in the short term, there is an opportunity to reinvent the way to do business by altering the cultural and historical practices that are supported by a cost-based system. We must overcome the difficulties inherent in changing an organization to prepare for the future. In the long term, reduction in costly chronic care, often provided at the acute level, and prevention and avoidance of crises, such as emergency situations from lack of access, can save billions of dollars.Recently, I was delighted to read that Alan Aviles, the chief executive officer (CEO) of New York City Health and Hospitals Corporation, the largest municipal healthcare system in the nation, focused on the inefficiency and waste in his own system. Through inventory improvements, such as implementing the “just in time” supply system, he and his staff have been able to provide savings in the millions, which he estimates will be in the billions of dollars when cumulated over a number of years.
4.From my perspective as a former CEO for a public hospital system and as a chief nursing officer (CNO) in large institutions, initial changes must be made in the financing system.
5.I find it interesting that many individuals, often seniors, are adamantly opposed to a public government-run option, yet ask any senior if he or she is willing to give up Medicare (a government-run option). Ask veterans who use the Veterans Administration (VA) system (a government-run option); they will rave about the providers, the efficient service, and availability of continuous online information. This is not to imply that these systems are perfect. Medicare needs more oversight of those who abuse the system, and the diagnosis-related group (DRG) system for hospitals conflicts with the payment system for physicians. Although physicians using the latter system are reimbursed for the amount of work they do, the former are reimbursed based on an episode of care—a built-in conflict from day 1. Developing a system for care providers based on care episodes with a focus on prevention must be a priority.
6.Imagine the money that could be saved if we could just standardize a system used by all payers while implementing electronic systems to facilitate accurate and timely documentation. The time spent in documentation for different insurance carriers and the issue of resolving claims immediately, thereby reducing consistent denials, would reduce untold hours of clerical time alone.
7.Multiple other avenues being explored by many experts must be examined as well. For example, one group of physicians supports a single-payer system. Can you imagine combining Medicare, Medicaid, and a public-supported option? The savings in administrative costs would be immense, but of course, this is not on the table for a variety of reasons. Whether one agrees with this approach or not, the fact is that there are strong provider groups willing to make the changes necessary and the processes more efficient and user friendly for both providers and patients. Strong professional organizations are working diligently to assist in implementing healthcare reform.
8.The litigation issue must be addressed, which relates to consumer requests for excess diagnostic work and treatments, and the mentality of providers doing too much for fear of being sued.
Nursing leaders need to take a position on supporting reform, whether as individuals or part of an organization that they work in or as part of their professional organization. It is not rocket science to realize that, indeed, there is a lot of opportunity to streamline the system, whether in clinics, hospitals, or provider offices, etc., but it does mean changing the way we have done business for the past 50 years. We already know that more is not better. Nursing leadership must be at the forefront in advocacy for patients, cost controls, efficiency, and a new, collaborative financing and delivery system.
In Memoriam
We honor the fallen nurses at Fort Hood, who demonstrated their commitment to the profession and to the global community. We should never forget the sacrifices of our former colleagues, Lieutenant Colonel Juanita L. Warman, ARNP, Captain John Gaffaney, psychiatric nurse, Captain Russell Seager, ARNP, and Michael Chaill, a physician assistant. Our prayers and blessing go the loved ones of these courageous heroes, as well as the other victims of this tragedy. They truly exemplify nursing leadership at its zenith.
Roxane Spitzer, Editor in Chief
