Health Reform and Health Policy
Health reform may have finally passed in legislation (The Patient Protection and Affordable Care Act, Public Law 111-148), but it still remains on many peoples' minds as the process of implementation begins. NONPF urges all NP educators, students, and clinicians to be familar with health reform implementation and current health policy initiatives. It is never too late to speak up and to use your voice to make a difference.
Key Issues for NPs
When health reform legislation was in development, the following were identified as key issues for NPs by the The Nurse Practitioner Roundtable (a collaboration of the AANP, ACNP, GAPNA, NAPNAP, NPWH, and NONPF).
- Full recognition and utilization of nurse practitioners as primary care providers in all health care systems/ models
- Full recognition of nurse practitioner practices in coordinated care models such as Medical/Health Homes.
- Full participation of nurse practitioners and nurse practitioner practices in Accountable Care Organizations
- Full participation of nurse practitioners and nurse practitioner practices in chronic care and transitional care models included in the legislation
- Maintenance of the nondiscrimination language contained in the Senate Finance Bill
- Maintenance of the funding stream for Nurse Managed Clinics in the HELP bill.
- Maintenance of the Graduate Nurse Education Funding Stream as proposed in the Senate Finance Bill
- Authorization of nurse practitioners to certify patients eligible for home health care services.
Some of these issues were addressed in the Patient Protection and Affordable Care Act and some require further work. The NP Roundtable continues to work collaboratively on promoting these issues and seeking action to reduce and/or eliminate barriers to NP practice. More updates will be forthcoming.
Current Legislation
The following are specific bills of relevance to NPs.
Topic Area: Home Health Care
Bill(s) & Committees of Jurisdiction:
- The Patient Protection and Affordable Care Act did not fully address the barriers to NPs ordering home health care services directly without physician oversight.
- Rep. Allyson Schwartz (PA), an ongoing champion of nursing and NP issues, has introduced H.R. 4993 , the Home Health Care Planning Improvement Act of 2010. The bill would amend Title XVIII of the Social Security Act to allow NPS, PAs, CNMs, and CNSs to order home health services, collaborate with a physician in accordance with state law, and improve access for Medicare beneficiaries
- The bill has 34 co-sponsors.
- Committees of jurisdiction are Ways and Means and Energy and Commerce.
Action Needed:
If you are from PA, send your thanks to Rep. Allyson Schwartz for this bill and for getting so many co-sponsors!
Speak up to your Representative(s) to support this bill.
Primary Care
A new issue of Health Affairs is available online and focuses completely on primary care:
Reinventing Primary Care:
May/June 2010; Vol. 29, No. 5
The below Table of Contents is available online at: http://content.healthaffairs.org/content/vol29/issue5/index.dtl
From The Editor-in-Chief
Reinventing Primary Care: A Task That Is Far ‘Too Important To Fail’
Susan Dentzer
Health Affairs 29(5): 757
http://content.healthaffairs.org/cgi/content/full/29/5/757
Entry Point
The End Of The Beginning: Enactment Of Health Reform
Health Affairs 29(5): 758-759
http://content.healthaffairs.org/cgi/content/abstract/29/5/758
History & Background
Reflections On The Past And Future Of Primary Care
Joel D. Howell
Health Affairs 29(5): 760-765
http://content.healthaffairs.org/cgi/content/abstract/29/5/760
Primary Care: A Critical Review Of The Evidence On Quality And Costs Of Health Care
Mark W. Friedberg, Peter S. Hussey, and Eric C. Schneider
Health Affairs 29(5): 766-772
http://content.healthaffairs.org/cgi/content/abstract/29/5/766
Practice Redesign And The Patient-Centered Medical Home: History, Promises, And Challenges
Charles M. Kilo and John H. Wasson
Health Affairs 29(5): 773-778
http://content.healthaffairs.org/cgi/content/abstract/29/5/773
Transforming Primary Care: From Past Practice To The Practice Of The Future
David Margolius and Thomas Bodenheimer
Health Affairs 29(5): 779-784
http://content.healthaffairs.org/cgi/content/abstract/29/5/779
ANALYSIS & COMMENTARY A Martian’s Prescription For Primary Care: Overhaul The Physician’s Workday
Lawrence P. Casalino
Health Affairs 29(5): 785-790
http://content.healthaffairs.org/cgi/content/abstract/29/5/785
Urgency Of Problem
The Multi-Stakeholder Movement For Primary Care Renewal And Reform
Paul Grundy, Kay R. Hagan, Jennie Chin Hansen, and Kevin Grumbach
Health Affairs 29(5): 791-798
http://content.healthaffairs.org/cgi/content/abstract/29/5/791
Primary Care: Current Problems And Proposed Solutions
Thomas Bodenheimer and Hoangmai H. Pham
Health Affairs 29(5): 799-805
http://content.healthaffairs.org/cgi/content/abstract/29/5/799
Primary Care And Why It Matters For U.S. Health System Reform
Robert L. Phillips, Jr. and Andrew W. Bazemore
Health Affairs 29(5): 806-810
http://content.healthaffairs.org/cgi/content/abstract/29/5/806
The Urgency Of Preparing Primary Care Physicians To Care For Older People With Chronic Illnesses
Chad Boult, Steven R. Counsell, Rosanne M. Leipzig, and Robert A. Berenson
Health Affairs 29(5): 811-818
http://content.healthaffairs.org/cgi/content/abstract/29/5/811
Medical Homes: A Solution?
ANALYSIS & COMMENTARY Driving Quality Gains And Cost Savings Through Adoption Of Medical Homes
Daniel Fields, Elizabeth Leshen, and Kavita Patel
Health Affairs 29(5): 819-826
http://content.healthaffairs.org/cgi/content/abstract/29/5/819
Prospects For Rebuilding Primary Care Using The Patient-Centered Medical Home
Bruce E. Landon, James M. Gill, Richard C. Antonelli, and Eugene C. Rich
Health Affairs 29(5): 827-834
http://content.healthaffairs.org/cgi/content/abstract/29/5/827
The Group Health Medical Home At Year Two: Cost Savings, Higher Patient Satisfaction, And Less Burnout For Providers
Robert J. Reid, Katie Coleman, Eric A. Johnson, Paul A. Fishman, Clarissa Hsu, Michael P. Soman, Claire E. Trescott, Michael Erikson, and Eric B. Larson
Health Affairs 29(5): 835-843
http://content.healthaffairs.org/cgi/content/abstract/29/5/835
Group Health’s Move To The Medical Home: For Doctors, It’s Often A Hard Journey
Harris Meyer
Health Affairs 29(5): 844-851
http://content.healthaffairs.org/cgi/content/full/29/5/844
Structuring Payment For Medical Homes
Katie Merrell and Robert A. Berenson
Health Affairs 29(5): 852-858
http://content.healthaffairs.org/cgi/content/abstract/29/5/852
Current Yardsticks May Be Inadequate For Measuring Quality Improvements From The Medical Home
Eric S. Holmboe, Gerald K. Arnold, Weifeng Weng, and Rebecca Lipner
Health Affairs 29(5): 859-866
http://content.healthaffairs.org/cgi/content/abstract/29/5/859
Specialty Care Medical Homes For People With Severe, Persistent Mental Disorders
Vidhya Alakeson, Richard G. Frank, and Ruth E. Katz
Health Affairs 29(5): 867-873
http://content.healthaffairs.org/cgi/content/abstract/29/5/867
Workforce & Teams
How Teams Work—Or Don’t—In Primary Care: A Field Study On Internal Medicine Practices
Benjamin J. Chesluk and Eric S. Holmboe
Health Affairs 29(5): 874-879
http://content.healthaffairs.org/cgi/content/abstract/29/5/874
Career Flexibility Of Physician Assistants And The Potential For More Primary Care
Roderick S. Hooker, James F. Cawley, and William Leinweber
Health Affairs 29(5): 880-886
http://content.healthaffairs.org/cgi/content/abstract/29/5/880
Choice Of Specialties Among Physician Assistants In The United States
Perri A. Morgan and Roderick S. Hooker
Health Affairs 29(5): 887-892
http://content.healthaffairs.org/cgi/content/abstract/29/5/887
The Role Of Nurse Practitioners In Reinventing Primary Care
Mary D. Naylor and Ellen T. Kurtzman
Health Affairs 29(5): 893-899
http://content.healthaffairs.org/cgi/content/abstract/29/5/893
ANALYSIS & COMMENTARY Unleashing Nurse Practitioners’ Potential To Deliver Primary Care And Lead Teams
Joanne M. Pohl, Charlene Hanson, Jamesetta A. Newland, and Linda Cronenwett
Health Affairs 29(5): 900-905
http://content.healthaffairs.org/cgi/content/abstract/29/5/900
Why Pharmacists Belong In The Medical Home
Marie Smith, David W. Bates, Thomas Bodenheimer, and Paul D. Cleary
Health Affairs 29(5): 906-913
http://content.healthaffairs.org/cgi/content/abstract/29/5/906
Patients' Perspectives
If You Build It, Will They Come? Designing Truly Patient-Centered Health Care
Christine Bechtel and Debra L. Ness
Health Affairs 29(5): 914-920
http://content.healthaffairs.org/cgi/content/abstract/29/5/914
ANALYSIS & COMMENTARY Measuring Patient Experience As A Strategy For Improving Primary Care
Katherine Browne, Deborah Roseman, Dale Shaller, and Susan Edgman-Levitan
Health Affairs 29(5): 921-925
http://content.healthaffairs.org/cgi/content/abstract/29/5/921
Payment & Incomes
Paying For Performance In Primary Care: Potential Impact On Practices And Disparities
Mark W. Friedberg, Dana Gelb Safran, Kathryn Coltin, Marguerite Dresser, and Eric C. Schneider
Health Affairs 29(5): 926-932
http://content.healthaffairs.org/cgi/content/abstract/29/5/926
Can We Close The Income And Wealth Gap Between Specialists And Primary Care Physicians?
Bryan T. Vaughn, Steven R. DeVrieze, Shelby D. Reed, and Kevin A. Schulman
Health Affairs 29(5): 933-940
http://content.healthaffairs.org/cgi/content/abstract/29/5/933
Rhode Island’s Novel Experiment To Rebuild Primary Care From The Insurance Side
Christopher F. Koller, Troyen A. Brennan, and Michael H. Bailit
Health Affairs 29(5): 941-947
http://content.healthaffairs.org/cgi/content/abstract/29/5/941
ANALYSIS & COMMENTARY Physician Payment Reform: Principles That Should Shape It
Cara S. Lesser, Harvey V. Fineberg, and Christine K. Cassel
Health Affairs 29(5): 948-952
http://content.healthaffairs.org/cgi/content/abstract/29/5/948
Practice Profiles
The Struggle To Support Patients’ Efforts To Change Their Unhealthy Behavior
Richard J. Baron and Emily Desnouee
Health Affairs 29(5): 953-955
http://content.healthaffairs.org/cgi/content/full/29/5/953
Community Collaboration To Improve Care And Reduce Health Disparities
Jennifer Cook, J. Lloyd Michener, Michelle Lyn, David Lobach, and Fred Johnson
Health Affairs 29(5): 956-958
http://content.healthaffairs.org/cgi/content/full/29/5/956
A Direct Primary Care Medical Home: The Qliance Experience
William N. Wu, Garrison Bliss, Erika B. Bliss, and Larry A. Green
Health Affairs 29(5): 959-962
http://content.healthaffairs.org/cgi/content/full/29/5/959
Transforming The Role Of Medical Assistants In Chronic Disease Management
Karen Nelson, Maria Pitaro, Andrew Tzellas, and Audrey Lum
Health Affairs 29(5): 963-965
http://content.healthaffairs.org/cgi/content/full/29/5/963
‘Core Teams’: Nurse-Physician Partnerships Provide Patient-Centered Care At An Iowa Practice
Christine A. Sinsky, Thomas A. Sinsky, Debra Althaus, Joan Tranel, and Maggie Thiltgen
Health Affairs 29(5): 966-968
http://content.healthaffairs.org/cgi/content/full/29/5/966
A Safety-Net System Gains Efficiencies Through ‘eReferrals’ To Specialists
Alice Hm Chen, Margot B. Kushel, Kevin Grumbach, and Hal F. Yee, Jr.
Health Affairs 29(5): 969-971
http://content.healthaffairs.org/cgi/content/full/29/5/969
Chicago: Using Evidence-Based Rules To Make Smarter Referrals
Barbara S. Fischer, Enrique Martinez, Mary Driscoll, and Terrence Conway
Health Affairs 29(5): 972-975
http://content.healthaffairs.org/cgi/content/full/29/5/972
An Employer-Directed Health Plan That Seeks To Reenergize Primary Care
Raymond Zastrow, Thomas Van Gilder, and Leonard J. Quadracci
Health Affairs 29(5): 976-978
http://content.healthaffairs.org/cgi/content/full/29/5/976
Form Follows Function: A Redesigned Pediatric Office
Susan Okie
Health Affairs 29(5): 979-981
http://content.healthaffairs.org/cgi/content/full/29/5/979
New Models & Innovations
A National Strategy To Put Accountable Care Into Practice
Mark McClellan, Aaron N. McKethan, Julie L. Lewis, Joachim Roski, and Elliott S. Fisher
Health Affairs 29(5): 982-990
http://content.healthaffairs.org/cgi/content/abstract/29/5/982
Higher Health Care Quality And Bigger Savings Found At Large Multispecialty Medical Groups
William B. Weeks, Daniel J. Gottlieb, David E. Nyweide, Jason M. Sutherland, Julie Bynum, Lawrence P. Casalino, Robin R. Gillies, Stephen M. Shortell, and Elliott S. Fisher
Health Affairs 29(5): 991-997
http://content.healthaffairs.org/cgi/content/abstract/29/5/991
The Growth Of Retail Clinics And The Medical Home: Two Trends In Concert Or In Conflict?
Craig E. Pollack, Courtney Gidengil, and Ateev Mehrotra
Health Affairs 29(5): 998-1003
http://content.healthaffairs.org/cgi/content/abstract/29/5/998
ANALYSIS & COMMENTARY How To Forge A High-Tech Marriage Between Primary Care And Population Health
David M. Lawrence
Health Affairs 29(5): 1004-1009
http://content.healthaffairs.org/cgi/content/abstract/29/5/1004
Education & Training
Managing The New Primary Care: The New Skills That Will Be Needed
Richard M.J. Bohmer
Health Affairs 29(5): 1010-1014
http://content.healthaffairs.org/cgi/content/abstract/29/5/1010
The Challenges Of Primary Care And Innovative Responses In Osteopathic Education
Stephen C. Shannon, Silvia M. Ferretti, Douglas Wood, and Thomas Levitan
Health Affairs 29(5): 1015-1022
http://content.healthaffairs.org/cgi/content/abstract/29/5/1015
Lessons From Abroad
Lessons From Major Initiatives To Improve Primary Care In The United Kingdom
Tim Doran and Martin Roland
Health Affairs 29(5): 1023-1029
http://content.healthaffairs.org/cgi/content/abstract/29/5/1023
Reinventing Primary Care: Lessons From Canada For The United States
Barbara Starfield
Health Affairs 29(5): 1030-1036
http://content.healthaffairs.org/cgi/content/abstract/29/5/1030
Web First
The Growing Financial Burden Of Health Care: National And State Trends, 2001–2006
Peter J. Cunningham
Health Affairs 29(5): 1037-1044
http://content.healthaffairs.org/cgi/content/abstract/29/5/1037
Private-Payer Profits Can Induce Negative Medicare Margins
Jeffrey Stensland, Zachary R. Gaumer, and Mark E. Miller
Health Affairs 29(5): 1045-1051
http://content.healthaffairs.org/cgi/content/abstract/29/5/1045
Soda Taxes, Soft Drink Consumption, And Children’s Body Mass Index
Roland Sturm, Lisa M. Powell, Jamie F. Chriqui, and Frank J. Chaloupka
Health Affairs 29(5): 1052-1058
http://content.healthaffairs.org/cgi/content/abstract/29/5/1052
Taxing Soft Drinks And Restricting Access To Vending Machines To Curb Child Obesity
Jason M. Fletcher, David Frisvold, and Nathan Tefft
Health Affairs 29(5): 1059-1066
http://content.healthaffairs.org/cgi/content/abstract/29/5/1059
Narrative Matters
A Case Of ‘Medical Homelessness’
Jack M. Colwill
Health Affairs 29(5): 1067-1070
http://content.healthaffairs.org/cgi/content/full/29/5/1067
End Of A Chapter
Anna Reisman
Health Affairs 29(5): 1071-1073
http://content.healthaffairs.org/cgi/content/full/29/5/1071
GrantWatch Outcomes
GrantWatch Outcomes
Health Affairs 29(5): 1074-1075
http://content.healthaffairs.org/cgi/content/full/29/5/1074
Book Reviews
Medical Home? Not With These Doctors
David J. Rothman
Health Affairs 29(5): 1076-1077
http://content.healthaffairs.org/cgi/content/full/29/5/1076
Our National Smile
Len Finocchio
Health Affairs 29(5): 1077-1078
http://content.healthaffairs.org/cgi/content/full/29/5/1077
Book Marks
BookMarks
Health Affairs 29(5): 1079
http://content.healthaffairs.org/cgi/content/full/29/5/1079
Letters
Clinical Audits To Improve Quality
Seraphim Patel
Health Affairs 29(5): 1080
http://content.healthaffairs.org/cgi/content/full/29/5/1080
Chronic Conditions And Medicare Costs
Arvind Cavale
Health Affairs 29(5): 1080
http://content.healthaffairs.org/cgi/content/full/29/5/1080-a
DNR And Advance Directives: International Perspective
Gérald Kierzek and Valeria Rac
Health Affairs 29(5): 1080
http://content.healthaffairs.org/cgi/content/full/29/5/1080-b
Errata
Erratum
Health Affairs 29(5): 1081
http://content.healthaffairs.org/cgi/content/full/29/5/1081
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