Health Care Reform Bill Clears Final Hurdles of Budget Reconciliation|
On March 25, 2010, House Democrats voted 220 to 207 to approve a package of fixes to the underlying health care reform law, The Patient Protection and Affordable Care Act, signed by President Obama on March 23. This bill — with provisions that originated in the Senate and were passed by the House on Sunday, March 21 — contains major health system reform elements. Refinements to this bill were included in the Health Care and Education Affordability Reconciliation Act, which also passed the House on Sunday night.
Initial analysis of the Patient Protection and Affordable Care Act indicates that many of the provisions the NLN supported made it into the final law. This includes provisions to:
- Increase workforce supply and support training of health professionals through scholarships and loans
- Support primary care training and capacity building
- Provide state grants to providers in medically underserved areas
- Educate and recruit providers to serve in rural areas
- Promote training of a diverse workforce and promote cultural competence training of health care professionals
- Address the projected shortage of nurses and retention of nurses by increasing the capacity for education, supporting training programs, providing loan repayment and retention grants, and creating a career ladder to nursing
- Provide grants for up to three years to employ and provide training to family nurse practitioners who provide primary care in federally qualified health centers and nurse managed health clinics
- Support the development of training programs that focus on primary care models such as medical homes, team management of chronic disease, and those that integrate physical and mental health services
Congress Passes Medicare Funding for Nursing Education
Contained in the newly passed health care reform legislation are provisions to strengthen Medicare support for nursing education by providing additional funding to train APRNs through five demonstration projects. A number of nursing organizations, including the NLN, had diligently worked to get these provisions into the health care reform legislation that was before Congress.
The concept is as follows:
Currently, Medicare contributes approximately $150 million per year to support nursing education compared to $12 billion going to hospitals for physician education. Since few nurses receive their primary training in hospital-based programs today, Medicare should instead support the education and training of nurses who care for Medicare beneficiaries, whether in the hospital or in other venues, as well as training for nurses in administrative and leadership positions to implement delivery system reforms.
Payments could continue to be made to hospitals but should also be available for the costs of graduate nursing education in other settings through contractual agreements. This education could be provided — and the funding flow directly — through organizations that have affiliations with accredited schools of nursing, which in turn partner with non-hospital, community-based settings.
Medicare reimbursement would be expanded to include graduate nursing education costs attributable to the training and preparation of APRNs, giving them the skills necessary to provide the various types of care and all other nursing services appropriate for the Medicare population. The provision for five graduate school nurse education demonstration projects directs the Department of Health and Human Services Secretary to establish the program under Medicare and it authorizes a $50 million appropriation from the Medicare Hospital Insurance Trust Fund for each of the fiscal years 2012 through 2015.
ANSR Alliance Releases Consensus Document
The ANSR (Americans for Nursing Shortage Relief) Alliance released its 2010 Consensus Document entitled, Assuring Quality Health Care for the United States: Building and Sustaining an Infrastructure of Qualified Nurses for the Nation. The NLN is one of the co-facilitators of the Alliance and a key player in the development of the Consensus Document. A downloadable PDF can be found at www.nln.org/governmentaffairs/newsletter/ansr_cd.pdf.
The ANSR Alliance is the largest collaborative effort among nursing associations working to pass legislation to stem the nursing shortage. Fifty-five nursing organizations support its legislative platform. The comprehensive approach detailed in the Consensus Document combines public policy initiatives with nursing association efforts to highlight the rewards of nursing, bring more nurses into the profession, and provide opportunities for professional advancement.
Survey Finds a Growing and More Diverse Nursing Workforce
According to a report — The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses — released by the Health Resources and Services Administration (HRSA) on March 17, the number of RNs in the United States grew to a new high of 3.1 million between 2004 and 2008. In addition to this 5 percent increase, the report, published every four years by HRSA's Bureau of Health Professions, also reflects a growing diversity in the backgrounds of nurses. In 2008, 16.8 percent of nurses were Asian, Black/African-American, American Indian/Alaska Native, and/or Hispanic — an increase from 12.2 percent in 2004. The two largest groups represented were non-Hispanic Asian (5.5 percent) and non-Hispanic Black/African-American (5.4 percent).
In commenting on these statistics, HRSA administrator Mary Wakefield said, "We are encouraged by growth in the numbers and diversity of registered nurses, and HRSA is committed to continuing this trend to ensure an adequate supply and distribution of nurses in the future."
Other initial findings include:
- 50 percent of RNs have achieved a baccalaureate or higher degree in nursing or a nursing-related field in 2008, compared to 27.5 percent in 1980.
- The number of RNs with master's or doctorate degrees rose to 404,163 in 2008, an increase of 46.9 percent from 2004, and up from 85,860 in 1980.
- The average age of RNs increased from 46.8 years in 2004 to 47.0 in 2008, representing stabilization after many years of continuing large increases.
- Nearly 45 percent of RNs were 50 years of age or older in 2008, a dramatic increase from 33 percent in 2000 and 25 percent in 1980.
- The average of annual earnings for RNs in 2008 was $66,973, an increase of almost 15.9 percent since 2004 slightly outpacing inflation.
- An estimated 444,668 RNs received their first US license over the period from 2004 to 2008.
This latest HRSA report includes comparisons from its eight recurring surveys, and is based on data gathered from its 2008 survey of 55,171 nurses with active RN licenses representing all 50 states and the District of Columbia. The data cover educational background, practice specialty areas, employment settings, position levels, job satisfaction and salaries, geographic distribution, and personal demographics (e.g., gender, racial/ethnic background, age, and family status). A final report with complete findings will be published this summer.
FROM THE STATES . . .
Ohio Bill Addresses Nurse Faculty Shortage
Spurred by a challenge from local college president Faye Grund of MedCentral College of Nursing, the Ohio Nurses Association (OHA) has developed legislation (HB 457) that would enable nurse educators to retain their faculty positions while working to complete the nurse practitioner program and attain certificates to prescribe medicine in Ohio. Grund noted that the primary reasons for the acute shortage of nurse faculty, as documented in the study released recently by the NLN and the Carnegie Foundation, were an aging and overworked faculty earning less than nurses entering clinical practice and less than advanced degree holders in other disciplines. Since many faculty members aim to become nurse practitioners, but most are not able to complete the program within the allotted time without giving up their faculty positions, Grund asked ONA to address this obstacle to attracting and retaining nurse educators.
Under current Ohio law, nurses must complete a 1,500-hour supervised externship in one year, with an option for a one-year extension, to obtain prescriptive authority. HB 457, co-sponsored by Representatives Jay Goyal (D-Mansfield) and James Zehringer (R-Fort Recovery), would give faculty members more time to continue teaching and complete their externship. Grund said the bill, if approved, would allow more faculty to keep their positions. "For us, the loss of a faculty member, even one, is significant," she added.
Coalition Tackles Iowa's Nursing Shortage
In Iowa, a coalition formed to study the state's nursing shortage and to craft legislation designed to remedy the problem, has been hard at work since last February. Now, having completed its research, the group — made up of key individuals from government agencies, the health industry, and the state's educational institutions — has put together a draft bill. The legislation proposes a data clearinghouse for workforce information, the creation of a single data pool within Iowa Workforce Development, and gives that agency the authority to request any other state agency's data for inclusion in one, cohesive report — a major problem in the past.
In recognition of the fact that budget appropriations would be difficult to obtain in the state's current fiscal climate, the legislation does not specifically request funds. It does, however, lay the foundation for how funding will flow when and if money becomes available by providing the infrastructure and guidance state agencies will need for revenue flow into the project.
Two specific programs would benefit from this foundation. A proposed nursing education scholarship program would offer scholarship assistance to individuals who seek higher degrees to serve as educators for other nurses. The other, a nursing clinical infrastructure account, would support existing — and possibly create new — environments where nurses can hone their clinical skills.
Also, because the lack of educators has forced at least 500 nursing students to be turned away each year from the state's existing nursing programs, the legislation proposes that further incentives be provided for 50 new nurse educators. In exchange for a four-year commitment to teach in an Iowa nursing program, the state would pay the tuition for those nurse educators. Through supported programs such as the University of Iowa's cohort program that makes advanced classes available at community colleges, advanced degrees would become more accessible to students across the state.