As nurses, we’ve always believed quality is important. We’ve dutifully filled out our audits and reported errors on tedious forms; now we enter data into electronic systems. We continue to educate staff, measure competencies, mount campaigns, review peers, benchmark outcomes, complete checklists, and create teams to improve specific quality measures. Yet we know our advanced healthcare system is ranked as highly inefficient, one of the world’s most costly, lacking in ways to track patients longitudinally and lacking transitions across care venues.
All that is about to change. As part of the Patient Protection and Affordable Care Act of 2010 (ACA, Public Law 11-148), Secretary of Health and Human Services Kathleen Sebelius is required to submit a 2011 National Quality Strategy to Congress by January 1, 2011. The framework of the strategic plan will include three pillars—better care, more affordable care, and healthier people and communities. The ACA also contains many provisions to increase access to high-quality, patient-centered, affordable care.
One goal is to link payment with results, commonly referred to as value-based purchasing. In October 2012, a hospital value-based purchasing program for Medicare recipients will be tied to public reporting of outcomes and patient perceptions of care. Starting in January 2015, physicians’ payments will be based on the quality of care they provide. The recently announced Center for Medicare and Medicaid Innovation (CMMI) will bring together stakeholders to explore innovations in healthcare delivery and payment, with the goals of improving population health and reducing costs. CMMI will identify approaches that achieve better care, more efficient payment mechanisms, and better coordination from primary care through advanced episodic and lifelong care.
You may be hearing a lot of buzz about Accountable Care Organizations (ACOs). In a much-needed shift from paying for volume to paying for necessary and effective care, Medicare will provide incentives for providers to be part of ACOs in 2012 to better coordinate care, improve quality, focus on prevention, and
decrease unnecessary hospitalizations. The reward for providers is keeping a portion of the savings from reduced costs. While some healthcare experts are concerned ACOs could drive costs higher, this approach represents a fundamental shift to payment for better outcomes—a key strategy in ending our addiction to current Medicare and Medicaid fee-for-service payments that reward more services, not necessarily the right services. (For a complete timeline of programs enacted in the ACA, visit www.healthcare.gov/law/timeline/.)
A far-reaching quality strategy is the National Priorities Partnership (NPP), convened by the National Quality Forum. Forty-eight members strong, NPP seeks to transform health care by eliminating harm, waste, and disparities and reducing the disease burden. Its priorities and actions for system-wide change promise collaboration among power brokers who will settle for nothing less than sweeping change. The American Nurses Association is an integral part of the plan. In a web-exclusive article, Gerri Lamb and Bonnie Mowinski Jennings describe nursing’s contributions to achieving priorities for improving health care and the inherent call for a united effort with public and private stakeholders to accomplish these goals. (CLICK HERE.)
Fortunately, our toolbox is full for the journey to transform care and achieve higher quality. We’re ready to move from a decade of studying and planning to a decade of doing. Our toolbox contains electronic records—blueprints that map progress, record essential information, and report key events. We have methods to hammer out waste by using guidelines and results from comparative effectiveness research. We have tools to measure and report what is working, where successful innovation is occurring, and how we can achieve scalability across care sites. We have the knowledge needed to level the field and whittle away at healthcare disparities. We have an imperative to plug the holes across the continuum of care.
Financing health care is crippling our economy and necessitates chiseling back the misuse and overuse of care. Transformation isn’t just about constructing new models. It’s also about being willing to dismantle and abandon ways of the past that are part of a crumbling and outdated foundation. We all need to don our customized tool belts and get to work—on the front lines and at the policy tables as a force for change.
Pamela F. Cipriano, PhD, RN, FAAN, NEA-BC