Current Trends in Nursing PracticeBy Pamela McNiff

 

Essential Questions

· How do quality metrics in health care affect patient outcomes?

· How do wellness initiatives and patient-centered care affect reimbursement rates?

· How do federal regulations address the current opioid crisis and reimbursement rates?

· How does federal funding through the Health Care and Education Reconciliation Act affect nursing education and trends related to employment?

· Why are the American Nurses Association Political Action Committee initiatives important in nursing?

Introduction

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In recent years, the cost of health care has become increasingly unsustainable. Cost and quality concerns, coupled with caring and paying for medical treatments, has created a need for change. This chapter will review the current health care laws and quality metrics that are driving this change. Additionally, health care professionals need to understand identified outcomes and values, as these metrics directly affect nursing and the trends related to employment and education. The  Affordable Care Act (ACA)  of 2010 addressed a push for quality and value that is now directly linked to providers’ and organizations’ pay and reimbursement. Federal regulations and the opioid crisis in the United States is also linked to pay for performance and current policies to address this issue. The Health Care and Reconciliation Act addresses the nursing shortage and ongoing education for all levels of nursing with the support of the American Nurses Association (ANA). Current nursing knowledge should include:

· Pay for performance (P4P),

· Quality metrics to improve processes of care,

· Value and quality of outcomes directly,

· Federal regulation for opioid use, and

· Federal funding and support for nursing education.

This chapter will explore the need for nurses to understand current metrics, how they directly affect nursing, and the importance of higher education to produce optimal patient outcomes.

Health Care Laws

In order for health care in the United States to be sustainable and provide quality patient care, economic change must occur. Health care expenditures are rising—so much so that more resources per capita are devoted to health care in the United States than in any other nation (Salmond & Echevarria, 2017).

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To address these costs,  pay for performance (P4P)  was developed, which rewards providers and organizations for delivering quality care with the goal of improving patient outcomes. This accountability process was established through the Centers for Medicare and Medicaid Services (CMS) as an incentive for improving patient care, lowering costs, and holding accountable those providers and organizations whose data does not show improvement. Quality metrics have been established in partnership with CMS and the Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services (HHS), which publicly reports patient outcomes by way of the  Hospital Consumer Assessment of Health Plan Survey (HCAHPS) . Quality measures in acute care organizations include:

· Client care experience (HCAHPS),

· Delivery of care,

· Efficiency of care, and

· Client-specific outcomes (e.g. morbidity, mortality, rates of infection, falls).

According to Torgan (2013), P4P programs shift the focus from basic care delivery to high-quality care delivery. Examples of questions asked on HCAHPS include:

1. Did the nurses communicate well?

2. Were the nurses responsive?

3. Did the nurses explain medications before dispensing them?

4. Was the area around the room quiet at night?

5. Did the doctors communicate well?

6. Was pain controlled?

7. Were the room and bathroom clean?

8. Was information given about your recovery?

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While HCAHPS are the focus for acute care organizations, quality metrics for the ambulatory care setting are determined by the  Healthcare Effectiveness Data and Information Set (HEDIS) .  Created by the National Committee for Quality Assurance (NCQA), these metrics directly measure the clinical quality performance of health plans (Maurer, 2017). There are currently 94 measures across 7 domains of care (National Committee for Quality Assurance [NCQA], n.d.); therefore, it is essential that providers are familiar with how quality is being defined and measured in order to have full participation and achieve quality patient care.

Table 2.1 provides an example of 6 of the 94 current HEDIS measures from 2018, comparing the three main types of health plans: commercial or self-pay/employer insurance, Medicaid, and Medicare. Boxes marked with an “X” represent HEDIS measures that each health plan is required to follow. As depicted in the table, commercial health plans and Medicaid plans require every patient between the ages of 18–64 to be asked whether they have obtained a flu vaccination that year. Under the HEDIS Medicare guidelines listed, all but the flu vaccine must be included.

Table 2.1

Example of HEDIS 2018 Measures

HEDIS Measure 2018	Commercial	Medicaid	Medicare
Fall Risk Management			X
Osteoporosis Testing in Older Women			X
Physical Activity in Older Adults			X
Medicare Outcomes Survey			X
Flu Vaccination Ages 18-64	X	X
Pneumococcal Vaccination Status for Older Adults			X

The data obtained from these reports gives the consumer a comprehensive view of the performance of employers’ health plans and are designed as a report card for improving quality of care. In the ambulatory care setting, quality performance may be determined by any of the HEDIS measures; therefore, it is important that practitioners become familiar with how quality is being defined and measured.

As the federal government continues to change the way health care professionals are reimbursed, strategies to meet HEDIS measures have posed several challenges for providers. To improve patient outcomes, the model of  population health , which analyzes data collected to improve both clinical and financial outcomes and manage patient care, must address behavioral determinates that are dependent upon the individual client, such as cigarette smoking, physical activity, and drug use. To achieve positive outcomes and improved health for individuals, collaboration is essential. According to Salmond & Echevarria (2017), with new reimbursement models, health care organizations will be incentivized to address health behaviors to improve patient outcomes and generate savings.

To support these models, many physician practices and hospital organizations are partnering and aligning operations to achieve these goals. While necessary to address rising health care costs, these payment models can become a financial hardship for some, making it crucial for health care professionals and organizations to collaborate.

The Affordable Care Act of 2010

The  ACA, also known as Obamacare, was the product of two pieces of legislation: the Patient Protection and Affordable Care Act and the  Health Care and Education Reconciliation Act of 2010 . This legislation was developed, implemented, and signed into law by President Barack Obama on March 23, 2010 (Healthcare.gov, n.d.). The first section of the bill expanded Medicaid coverage and introduced comprehensive health plans with the expectation that the reforms would improve medical insurance coverage across populations. Insurance companies were then held accountable to provide services within the  ACA Marketplace  by offering more choices and options for obtainable, affordable medical insurance at lower costs. The second section of the bill was developed to fund the educational needs of health care.

The CMS also partnered with individual states to develop and identify priorities for eligibility within Medicaid and the  Children Health Insurance Program (CHIP)  to support low-income Americans with children. The intent of ACA and CMS was to fill the gaps left by private insurance plans and those uninsured or underinsured and in need of coverage because of low income. The ACA Marketplace  is a means of coordination with insurance companies to provide low-cost insurance and determine eligibility for all types of insurance based on income. Tax credits are utilized to make insurance premiums through the ACA Marketplace affordable, and insurance companies are required to cover those individuals with preexisting conditions. Table 2.2 represents the major provisions of the ACA.

Table 2.2

Major Provisions of the Affordable Care Act

Provision	Explanation
Preexisting Conditions	This provision ensures that insurance cannot be denied based on preexisting conditions.
Young Adult Coverage	Ensures that dependent children may remain on their parents’ health insurance plan until the age of 26.
Preventative Care Services	Ensures that health care plans must fully cover preventative care such as screenings and immunizations.
Spending Limits	Insurance companies cannot set a dollar amount on what they spend on benefits for the patient’s care during time of enrollment.
Menu Labeling	Restaurants must list the calorie amount on their menus of each food item or meal.
Prevention and Public Health	Funding will be allocated for public health and preventative care within communities.
Community Transformation Grants	Funding will be awarded to a variety of state, local, and tribal agencies that contribute to building community and implementation of evidence-based health programs.

Note. Adapted from “The Affordable Care Act and Mental Health Services,” by C. A. Walker, 2014,  Journal of Psychosocial Nursing and Mental Health Services, 52(9), 4.

While the ACA was designed to encourage better patient outcomes with lower associated costs and expanded access to care for more Americans, in some cases, the ACA has led to higher insurance premiums and fewer choices within the health care marketplace. In April of 2018, CMS issued a bulletin regarding benefit and payment parameters for 2019. According to CMS, “the final rule is intended to advance the Administration’s goals for increasing flexibility, improving affordability, strengthening program integrity, empowering consumers, promoting stability, and reducing unnecessary regulatory burdens associated with the Patient Protection and Affordable Care Act in the individual and small group health insurance markets” (Centers for Medicare and Medicaid [CMS], 2018b, para. 3). As key provisions have been modified to support affordability for the individual and family, individual states have been given more control over their insurance markets to promote and encourage participation within the ACA Marketplace.

Check for Understanding

1. How does P4P improve patient outcomes?

2. What is HEDIS, and what does it measure?

3. What is HCAHPS, and what does it measure?

4. Why has it been difficult to keep insurance companies involved with the ACA Marketplace?

Federal Regulation of Opioid Use and the Opioid Crisis

Prior to the mid-1990s, pain control for individuals was often poorly managed. In response, advocates, such as the American Pain Society, proposed changes in pain-management practices. In 2001, The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations), determined that pain is a subjective measure, and self-reporting of pain must be accepted by the medical establishment. Concurrently, pharmaceutical companies began to shape medical practice and public opinion by aggressively promoting and marketing opioids with unintended consequences.

According to the Centers for Disease Control and Prevention (CDC) (2016), since 2000, the rate of deaths from drug overdoses has increased by 137%, including a 200% increase in overdose deaths involving opioids. These increases included heroin, which is an illegally made opioid, and illicitly manufactured fentanyl, which is a synthetic opioid. In 2015 alone, 33,091 deaths in the United States were attributed to an overdose involving opioids (Laderman & Martin, 2017). Figure 2.1 provides estimates of overdose deaths involving opioids by type in the United States from 2000–2016. While different strategies are used to determine overdose deaths related to opioids, two interconnected trends have been identified: a 17-year increase in deaths from prescription opioid overdoses and a recent surge in illicit opioid overdoses driven by heroin and fentanyl (Centers for Disease Control and Prevention [CDC], 2017). Additionally, the CDC has noted that history of misuse of prescription opioids is the strongest risk factor for starting heroin use.

Figure 2.1

Overdose Deaths Involving Opioids

Note. Adapted from “Opioid Data Analysis and Resources,” by the Centers for Disease Control and Prevention, 2017.

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The   Comprehensive Addiction and Recovery Act (CARA) of 2016 , became law on July 22, 2016. The legislation was established to give practitioners who dispense controlled substances the ability to dispense a narcotic drug in Schedule III, IV, or V for the purposes of maintenance and treatment or detoxification treatment (Department of Justice, 2018). Specific details regarding nurse practitioners (NPs) were also addressed in an expanded version of this bill as a means to support and treat those addicted to narcotics. Per the provisions within CARA, dispensation of narcotics for the use of detoxification cannot exceed 180 days to address the physical and psychological effects of withdrawal. The goal of these provisions is to gradually reduce the dosage of narcotics and ultimately have the individual achieve a drug-free state.

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In 2017, the HHS declared that the opioid crisis was a public health emergency and announced the following five-point strategy to combat the opioid crisis.

1. Better  addiction prevention, treatment, and recovery services through the support of grants and waivers to cover the cost of treatment for the individual to achieve long-term recovery

2. Better data to improve and understand the crisis through public reporting with the focus on high-risk populations

3. Better pain management from healthy, evidence-based methods of pain management

4. Better targeting of overdose reversing drugs, which includes presidential budgetary support to achieve these goals

5. Better research through a partnership with the HHS and the National Institute of Health (NIH) (Department of Health and Human Services [HHS], 2017)

The CDC has also provided recommendations for prescribing opioids for chronic pain that is not associated with palliative care, cancer, or end-of-life care. These guidelines have been put in place to help primary care providers navigate pain management options that are alternatives to opioids.

Reimbursement, Restrictions, and Monitoring Opioid Prescriptions

As federal and legislative regulations continue to address the opioid crisis, it is likely that providers and organizations that find alternative treatments and prescribe fewer opioids will receive higher reimbursement rates. Similar to HEDIS measures, insurance companies have and will be changing policies regarding what they will cover in terms of opioid medications and positive or negative patient outcomes. Prior authorizations, quantity limits, and drug utilization reviews are currently being used or implemented to determine the necessity of opioids and what alternative treatment methods have been used prior to prescribing opioids.

According to Wachino (2016), to optimize care while discouraging fraud, waste, and abuse of prescribed opioids, states are encouraged to consider implementing programs that provide ancillary care for beneficiaries diagnosed with chronic pain who have been found to be receiving unusually high doses of opioids, seeing multiple prescribers or pharmacies. The use and access of state prescription drug monitoring needs to be supported in order to identify inappropriate prescribing activity and those individuals who seek out opioid prescribers through various providers. Given the urgency of the opioid epidemic, CMS has finalized several new rules for 2019:

· For opioid naïve patients, all initial opioid prescriptions will be limited to a 7-day supply.

· CMS will continue to build and expand the Overutilization Monitoring System (OMS) to identify those beneficiaries considered to be at high risk for opioid addiction using real-time safety alerts at the time of dispensing and to address and support these individuals through case managers and prescribers (Centers for Medicare and Medicaid [CMS], 2018a).

With the CMS recognizing the need to address the opioid epidemic and implementing the necessary changes now, other health care insurance companies are likely to implement and adopt these strategies in order to address this issue.

Check for Understanding

1. What was the catalyst for the opioid crisis?

2. What is the underlying theme of the HHS five-point strategy for the opioid crisis?

3. How do the opioid crisis and CMS rules affect those who prescribe opioids?

Nursing Shortage

The nursing shortage in America is cause for concern, especially given the increasing age of the baby boomer generation (Cox, Willis, & Coustasse, 2014). Statistics point to a 26% increase in the need for registered nurses (RNs) nationwide. As the current nursing workforce begins to reach retirement age, there is more cause for concern related to losing skilled leaders in the profession. A high rate of turnover associated with the nursing profession, attributed to factors such as job dissatisfaction and staffing concerns, is adding to the nursing shortage (Cox et al., 2014). In particular, novice nurses have reported particularly high levels of burnout and choose to leave the profession (Lin, Viscardi, & McHugh, 2014). Proposed solutions such as nurse residency programs and mandated safe staffing ratios are supported by the ANA. Nurse residency programs offer a designated amount of time in which a novice or new graduate nurse has additional education, mentor support, and additional resources to set them up for success when taking assignments on their own (Lin et al., 2014).

Additionally, the lack of sufficient nurse faculty to train new nurses has been cited as a factor contributing to the nursing shortage of nurses as well, with nearly 42,000 applicants to nursing schools being denied in 2006 (Cox et al., 2014). The HHS offers a nurse faculty loan program to address the dire need for nurses; however only a small number of nurses have been allocated these funds (Feldman, Greenberg, Jaffe-Ruiz, Kaufman, & Cignarale, 2015). Scholarship programs such as these, as well as mentoring programs to support nurse faculty, are necessary to increase recruitment and retention of full-time faculty to approve and properly train the host of students waiting to attend nursing school (Feldman et al., 2015).

Health Care and Education Reconciliation Act of 2010

As part of the ACA, provisions were enacted to ensure funding was available to those pursing health care degrees through federal funding, grants, loans, and employers obligation to support staff in continuing education through the Health Care and Education Reconciliation Act of 2010. With the current nursing shortage continuing to worsen as the baby boomer generation retires, it is imperative that nursing is supported across health care in order to enhance and support patients and programs. These provisions included:

· Beginning July 1, 2010, all new federal student loans will originate through the Direct Loan program, instead of through the federally-guaranteed student loan program.

· Includes $36 billion over ten years to increase the maximum Pell Grant to $5,550 in 2010 and to $5,975 by 2017.

· Indexes the Pell Grant to the Consumer Price Index starting in 2013, to match the rising costs of college.

· Addresses the FY 2011 shortfall in the Pell Grant program.

· Expands the Income-Based Repayment program. Starting in 2014, the bill will cap new borrower’s loan payment at 10 percent of their net income, after adjustments for basic living costs, and would forgive any remaining debt after 20 years.

· Invests $2.55 billion in Historically Black Colleges and Universities and Minority-Serving Institutions.

· Includes $750 million for college access and completion support programs for students, including increased funding for the College Access Challenge Grant program, which funds programs at states and institutions aimed at increasing financial literacy and student retention. (Senate Democrats, n.d.)

Nursing Trends Related to Employment and Advanced Practice Nursing

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Wellness and continuum of care models that have become the mainstay to keep individuals well will require more RNs with advanced nursing degrees to fill the gaps caused by the shortage of primary care physicians. To have affordable continuing educational opportunities, ongoing expansion of programs will be necessary to improve the nursing workforce. With funding support through the ACA, priorities and goals can be addressed through local and state organizations to increase the nursing workforce. In September 2010, the American Association of College of Nursing (AACN) announced the expansion of the nation’s centralized application service for RN programs, NursingCAS, to include graduate nursing programs to ensure that all vacant seats in nursing schools are filled to better meet the need for RNs, advanced practice nurses (APRNs), and nurse faculty (American Association of College of Nursing [AACN], 2017). In 2016, more than 38,800 vacant seats were identified in baccalaureate and graduate nursing programs. NursingCAS provides a way to fill these seats and maximize the educational capacity of nursing schools.

In 2008, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) led a 2-year initiative to address four key issues for the future of nursing:

· The need for nurses to be able to practice to the full level of their education and training,

· Achieve higher levels of education through a seamless academic progression,

· Partner with physicians and other health care team members to redesign health care, and

· Require better data collection in order to achieve an appropriate nursing workforce.

Additionally, the link between nurse education and patient outcomes was confirmed in 2011, when Aiken (2011) found that a 10% increase in the proportion of BSN-prepared nurses reduced the risk of death by 5% (Robert Wood Johnson Foundation [RWJF], 2014).

One of the main recommendations was to ensure that 80% of all RNs will have obtained a BSN by the year 2020 (National Academies of Science, Engineering, and Medicine [NASEM], 2018). Many organizations, especially those seeking Magnet status through The Joint Commission, are now demanding that 80% of the RNs they employ obtain their BSN. This has led universities and community colleges to work together to create programs that help RNs with associate degrees to acquire their BSN in a seamless, affordable manner.

As the restructuring of the health care system continues and more APRNs, such as family NPs, are needed, the scope of practice, need for autonomy, and fair reimbursement through Medicare and Medicaid must continue to expand. Variations from state to state with regard to the scope of practice for NPs must also be addressed so that restrictions do not impede the progression for APRNs to support models of health care delivery.

Leadership in Nursing

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While the ACA has provisions to educate, train, and support APRNs, visionary leaders in nursing are needed to develop practice and institute policy. In order to cultivate and bring the future of nursing forward, it is paramount that the profession of nursing support current and future leaders throughout all areas of nursing. To build this future, nurses who wish to pursue an executive, academic, or NP role will need to earn at least a master’s degree in nursing; however, doctoral degrees are becoming more of a standard in these roles (Pullen, 2016).  “And we know that in all things God works for the good of those who love him, how have been called according to his purpose.” —Romans 8:28Nurse leaders promote and facilitate direction and collaboration at both the formal and informal levels within the nursing industry, demonstrating vital attributes that propel nursing leadership within the community. The voice of leadership in nursing is a voice for all nurses.

Advocating for the profession of nursing at the leadership level requires that nurses in advance practice have presentation skills and the ability to convey messages that support nurses at all levels and in all fields of nursing. It is imperative that nurses take an active role in establishing positions at high levels within organizations. More nurses with Doctor of Nursing Practice (DNP) and Doctor of Philosophy (PhD) degrees can be found at the levels of nursing administration, deans of nursing, chief nursing officer, and chief executive officer. Having APRNs in these positions gives nursing a voice and enhances the nursing profession.

As leadership in nursing gives a larger voice within organizations, advocacy for changes in health policy are crucial. The ANA provides critical information and influence on policies at both the state and federal level. Figure 2.2 represents the educational nursing continuum from diploma certificate to PhD or DNP and the assumed positions at each level of nursing.

Figure 2.2

Pathway of Educational Progression

Note. Adapted from “Best Types of Nursing Degrees,” by A. M. Wilson, 2011, Nurse Journal website.

As a nurse leader, involvement at the local, state, and national level benefits all nurses. The nurse leader is the active voice of a person with a global perspective who has decision-making skills in complex environments to achieve desired results within the context of nursing and the organization as a whole. Advocating for nurses is advocating for all. According to the ANA Code of Ethics (American Nurses Association [ANA], n.d.b), advocacy is the act or process of pleading for, supporting, or recommending a cause or course of action. Advocacy may be for persons, whether as an individual, group, population, or society, or for an issue, such as potable water or global health. Nursing leaders are true advocates for the profession and the health care population as a whole. These top thinkers have the ability to identify and address issues and collaborate with others in order to make change. The highest level of change takes place through legislation supported by the ANA.

American Nurses Association Political Action Committee (ANA-PAC) Initiatives

The ANA’s influence on local, state, and federal policy cannot be overestimated. The  ANA Political Action Committee (ANA-PAC)  exists and is supported through voluntary contributions in which ANA staff, the ANA-PAC Board of Trustees, and the constituent/state nurses’ associations work to identify candidates to support for federal office, regardless of party affiliation (ANA, n.d.a). These contributions are used, with complete transparency, only to support and give a voice to the thousands of nurses at all educational levels and practice settings.

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The ANA-PAC Board of Trustees lobbies at the local, state, and national level to support individuals who understand the principles and policies and will endorse those initiatives that are targeted as key legislative policies that impact the profession of nursing. Showing strength by influencing policy gives nurses a public voice, which brings change and puts a spotlight on the nursing profession. Each year the ANA-PAC committee aims to support candidates who support specific initiatives relevant to the future of nursing. Three of those initiatives include health care reform, safe staffing, and nursing workforce development.

Health Care Reform

· Ensuring universal health care for all that provides comprehensive physical and mental health care

· Supporting preventative care services through primary care entities

· Support a partnership between the government and private sector to assist individuals who do not have the means to cover the cost of health care

· Funding to ensure a skilled workforce in nursing

Safe Staffing

· Continuing to enact safe staffing legislation through The Safe Staffing for Nurse and Patient Safety Act (S. 2446, H.R. 5052)

· This bill considers the nurses’ educational background, experience, availability of personnel, geography, technology, and acuity of patients

Nursing Workforce Development

· Supporting Title VIII Nursing Workforce Reauthorization Act (H.R. 959), which is a bipartisan bill aimed as supporting the ongoing educational needs of nurses through federal funding

· Securing funding for nursing grants to support advanced nursing education, workforce diversity, practice and retention, National Nurse Service Corp, Nurse Faculty Loan Program, and comprehensive nurse geriatric education

The economic value of the ANA cannot be overstated. Every nurse needs a voice, and the ANA is crucial in delivering that voice at the legislative level. This voice is needed to create change and make a stand on public issues that affect the nursing profession on a daily basis. Only through working together will nurses achieve the strength and support needed to develop, empower, and change the face of nursing and health care today.

Check for Understanding

1. How does the Health Care and Education Reconciliation Act support the nursing shortage?

2. What expansion through the AACN was put in place to support nursing programs for nursing education?

3. Why is nursing advocacy important?

4. What is the ANA-PAC, and what are the initiatives currently being targeted?

Reflective Summary

Health care is an ever-changing and complex part of the economy. As legislation changes and costs increase, the underlying need for safe and proficient nursing care remains imperative. The ACA created changes that directly impact the patient’s ability to attain care and receive valuable preventative treatments. The nursing profession faces many challenges in order to continue providing the highest level of care to their complex and growing patient population. Concerns, such as safe staffing, burnout, and a lack of nurse faculty, require careful and thorough contemplation in order to devise sustainable solutions that benefit nurses and the patient population.

Key Terms

ACA Marketplace: State website  for subsidized health insurance under the Affordable Care Act.

American Nurses Association Political Action Committee (ANA-PAC): Provides funding to federal candidates in order to make positive changes in nursing without regard to party affiliation.

Affordable Care Act (ACA): Health care reform legislation with multiple provisions signed into law by U.S. President Barack Obama and became known as Obamacare; among the provisions include health insurance coverage to uninsured, measures to lower costs and improve health care system efficiency, preventative care, extension of care to dependents under the age of 26, and prohibited insurance claim denial or higher premiums for preexisting conditions.

Children Health Insurance Program (CHIP): Health insurance coverage for children of parents whose income is too high to qualify for Medicaid but too low to pay for private health insurance coverage.

Comprehensive Addiction and Recovery Act (CARA) of 2016: A law set in place on July 22, 2016 to address the opioid crisis in the United States.

Healthcare Effectiveness Data and Information Set (HEDIS): Measures a broad range of health issues; this data is collected to determine whether improved patient outcomes are being achieved; set forth through the National Committee for Quality Assurance (NCQA).

Healthcare and Education Reconciliation Act of 2010: Provisions enacted through the Affordable Care Act to ensure funding to those pursing health care degrees through federal grants, loans, and employers.

Hospital Consumer Assessment of Health Plan Survey (HCAHPS): Metrics that publicly report patient outcomes for specific quality metrics in acute care organizations; put in place by the National Committee for Quality Assurance (NCQA).

Pay for Performance (P4P): A payment model developed and established through the Centers for Medicare and Medicaid (CMS) as an incentive for improving patient care and lowering health care costs.

Population Health: Defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group.

References

American Association of College of Nursing. (2017). Fact sheet: Nursing shortage. Retrieved from http://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage-Factsheet-2017.pdf

American Nurses Association. (n.d.a). American Nurses Association: Political action committee. Retrieved from https://ana.aristotle.com/SitePages/pac.aspx

American Nurses Association. (n.d.b). Year of advocacy. Retrieved from https://ana.aristotle.com/SitePages/YearOfAdvocacy.aspx

Centers for Disease Control and Prevention. (2016). Increases in drug and opioid overdose deaths — United States, 2004-2014. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm

Centers for Disease Control and Prevention. (2017). Opioid data analysis and resources. Retrieved from https://www.cdc.gov/drugoverdose/data/analysis.html

Centers for Medicare and Medicaid. (2018a). 2019 Medicare advantage and part d rate announcement and call letter. Retrieved from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-02-2.html

Centers for Medicare and Medicaid. (2018b). HHS notice of benefit and payment parameters for 2019. Retrieved from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-09.html

Cox, P., Willis, K., & Coustasse, A. (2014). The American epidemic: The U.S. nursing shortage and turnover problem. Retrieved from: https://mds.marshall.edu/cgi/viewcontent.cgi?referer=http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwj2ysub_9vdAhU0HDQIHZz5CvQQFjAAegQICBAC&url=http%3A%2F%2Fmds.marshall.edu%2Fcgi%2Fviewcontent.cgi%3Farticle%3D1125%26context%3Dmgmt_faculty&usg=AOvVaw2XD9drwnos58RVyQkkrn9A&httpsredir=1&article=1125&context=mgmt_faculty

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Department of Justice. (2018). Rules – 2018. Retrieved from https://www.deadiversion.usdoj.gov/fed_regs/rules/2018/fr0123_2.htm

Feldman, H., Greenberg, M., Jaffe-Ruiz, M., Kaufman, R., & Cignarale, S. (2015). Hitting the nursing faculty shortage head on: Strategies to recruit, retain, and develop nursing faculty.  Journal of Professional Nursing, 31(3), 170-178. doi: 10.1016/j.profnurs.2015.01.007

Healthcare.gov. (n.d.). Read the affordable care act. Retrieved from https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/

Laderman, M., & Martin, L. (2017). Health care providers must act now to address the prescription opioid crisis. Retrieved from https://catalyst.nejm.org/act-now-prescription-opioid-crisis/

Lin, P. S., Viscardi, M. K., & McHugh, M. D. (2014). Factors influencing job satisfaction of new graduate nurses participating in nurse residency programs: A systematic review.  Journal of Continuing Education in Nursing,  45(10), 439–452. doi: 10.3928/00220124-20140925-15

Maurer, J. (2017). What is HEDIS and what does it mean to you? Retrieved from http://magellanhealthinsights.com/2017/03/15/what-is-hedis-and-what-does-it-mean-to-you/

National Academies of Science, Engineering, and Medicine. (2018). Robert Wood Johnson Foundation and the AARP partner to establish the future of nursing: campaign for action. Retrieved from http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Action-Taken.aspx

National Committee for Quality Assurance. (n.d.). HEDIS and performance measurement. Retrieved from https://www.ncqa.org/hedis/

Pullen, R. (2016). Leadership in nursing practice.  Nursing Made Incredibly Easy!, 14(3), 26-31. doi: 10.1097/01.NME.0000481442.05288.05

Robert Wood Johnson Foundation. (2014). Building the case for more highly educated nurses. Retrieved from https://www.rwjf.org/en/library/articles-and-news/2014/04/building-the-case-for-more-highly-educated-nurses.html

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing.  Orthopedic Nursing, 36(1), 12-25. doi: 10.1097/NOR.0000000000000308

Senate Democrats. (n.d.) The health care and education reconciliation act. Retrieved from https://www.dpc.senate.gov/healthreformbill/healthbill61.pdf

Torgan, C. (2013). Patient outcomes improved by pay for performance. Retrieved from https://www.nih.gov/news-events/nih-research-matters/patient-outcomes-improved-pay-performance

Wachino, V. (2016). CMCS informational bulletin: Best practices for addressing prescription opioid overdoses, misuse and addiction. Retrieved from https://www.medicaid.gov/federal-policy-guidance/downloads/CIB-02-02-16.pdf