Panel members say nursing involvement key to improving quality, reducing health care costs

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URI’s Routhier Lecture Series kicks off with timely discussion on ways to improve care

KINGSTON, R.I. – April 28, 2015 – A recent international study found that the American health care system is the costliest in the world and yet it ranks 11th among wealthy countries on measures of quality, access, efficiency and equity, including areas such as infant mortality.

The study, supported by the Commonwealth Fund, says the United States spends 17.6 percent of its gross domestic product on health care, while the United Kingdom, which ranked first in the study, spends just 9.6 percent of its GDP on health care.

But six health care experts who gathered recently for the first Routhier Lecture Series at the University of Rhode Island said there is a solution to these problems and a way to respond to the demands of the Affordable Care Act. That solution is the 2.7 million nurses across the country working in hospitals, patients’ homes, skilled nursing facilities, pharmacies, private medical practices and the free clinics that serve the poor.

They talked about nurses serving as case managers, overseeing every aspect of care as part of a concept called patient-centered care. In this concept the nurse would coordinate care with hospitals, outpatient services, doctors’ offices, pharmacists and clinics.

“Often the most expensive ‘ingredients’ in American-produced goods and products is the cost of health care for employees, which impacts both product affordability and U.S. global competitiveness,” said Betty Rambur, a Visiting Routhier Scholar at URI’s College of Nursing, former dean of the College of Nursing at the University of Vermont and a nationally recognized expert on health finance and economics. “But we are seeing a growing understanding of the difference between health and health care.”

She said that estimates of waste in the U.S. health system range from 21 percent to 47 percent.

Rambur said that slowly the country is moving from a volume-driven, fee-for service approach to a value-driven approach that puts “nurses in a pivotal position to drive changes” as they relate to the Institute for Healthcare Improvement’s, Triple Aim—better health for the population, better care for individuals and lower cost through improvement.

Anne Schmidt, vice president of Patient Care Services and the chief nursing officer at South County Health Care System, said payment reforms in the Affordable Care Act are tied to the Triple Aim. She said instead of episodic care, which is the treatment of an acute illness or injury with single trips to the hospital or the doctor’s office, American health care is moving toward a comprehensive approach that reduces the need for acute hospital services while keeping patients healthy in their homes and communities.

“Within the Affordable Care Act, nurses will be central to managing such conditions as diabetes, obesity, heart disease and other chronic illness,” she said.

Angelleen Peters-Lewis, senior vice president and chief nursing officer at Women & Infants Hospital, said nurses must position themselves and be seen as clinical care leaders who are experts at inter-professional collaboration and pursue lifelong learning in the field, even after they earn master’s degrees or doctorates.

In addition, the nurse must be a leader of innovation, a designer of new health care models and a scholar.

“No one spends more time with patients than nurses do,” Peters-Lewis said. “Sometimes it’s as much as 16 hours a day.”

Who better to be at the forefront of patient-centered care, she asked the audience.

Nancy Roberts, president and chief executive officer of the Visiting Nurse Service of Care New England, has been in community care for more than 30 years. “No setting gives a nurse as much autonomy and a greater role in managing a patient’s care than community (home) care,” Roberts said.

Under the Affordable Care Act, individuals will not be hospitalized at the rate they are today, she said.

“The ability to provide skilled and supportive care in the home is central for older adults who want to age in place,” Roberts said. “If a patient has access to personal care and homemaking services, for as little as four to six hours a week, combined with symptom management, the need for long term placement can be delayed for up to 24 months. Nurse practitioners are well positioned to manage the care of older adults in the home.

“The care transition role leverages the unique skills of the registered nurse,” Roberts said. “The best way to prevent re-admission is to ensure prompt access to primary care. The average length of time before a person sees his or her doctor after a hospital stay is 21 days. Much can happen in that time frame. Nurse practitioners deployed to a patient’s home within 24 hours of hospital discharge can serve as the bridge between primary care and hospitalization.”

Marie Ghazal, chief executive officer of the Rhode Island Free Clinic, wrapped up the panel discussion.

“We call ourselves the safety net for the safety net,” she said. “We leverage $5 million in care with a $1 million budget.”

She said the greatest change for the Clinic came when many of its patients obtained health insurance through the ACA, which meant that patients could now see health care professionals in private practice. It also meant that the Clinic was able to eliminate its lottery system for deciding who receives care and who doesn’t, and to welcome more new patients than ever before who still remain beyond the reach of Affordable Care Act reforms.

“We (in health care) all have to change our strategies so that we work together more effectively and efficiently,” Ghazal said. “As just one example, our Clinic is partnering with CVS Health to open its pharmacies for free service to our patients. Through this partnership, patients now benefit from an increased level of care. This should be the goal for us all.”

The program’s moderator, Esther Emard, a Routhier visiting faculty member and former president of Harvard Pilgrim Health Care of New England, concluded the program with this quote from Florence Nightingale:

“May we hope that when we are all dead and gone, leaders will arise who have been personally experienced in the hard, practical work, the difficulties and the joys of organizing nursing reforms, and who will lead far beyond anything we have done.”