WK 2 DQ 1

The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March of 2010.
Identify the impact of this legislation on your nursing practice by choosing two key nursing provisions
outlined in the American Nurses Association "Key Provisions Related to Nursing" summary at
http://www.rnaction.org/site/DocServer/KeyProvisions_Nursing-PublicLaw.pdf?docID=1241&verID=1.
Discuss how these two provisions have impacted, or will impact, your current practice of nursing

The Patient Protection and Affordable Care Act (PPACA) aims to push for a reform in healthcare by
changing the way healthcare is managed and the accessibility of that healthcare. Nurses are at the
forefront of healthcare. Throughout the PPACA provisions that affect Registered Nurses are seen. One
provision that has impacted my current nursing practice is the Nursing Student Loan Program. “Section
5202 (p. 489) provides updates to the loan amounts for the Nursing Student Loan program and specifies
that, after 2012, the Secretary has discretion to adjust this amount based on cost of attendance
increases (ANA, 2010). This affects me directly because without the availability of student loans, I would
not be able to afford tuition to attain my BSN and hopefully MSN shortly after. Education prices
continue to rise and for many, only option for paying for it is with student loans. “For the 2012–13
academic year, annual prices for undergraduate tuition, room, and board were estimated to be $15,022
at public institutions, $39,173 at private nonprofit institutions, and $23,158 at private for-profit
institutions. Between 2002–03 and 2012–13, prices for undergraduate tuition, room, and board at public
institutions rose 39 percent, and prices at private nonprofit institutions rose 27 percent, after
adjustment for inflation”(IES, 2013). Another provision that will affect my nursing practice is the
Geriatric Nursing Career Incentives provision. “Section 5305 (p. 504) includes a provision that authorizes
HHS to award grants to advanced practice nurses who are pursuing a doctorate or other advanced
degree in geriatrics and who, as a condition of accepting a grant, will agree to teach or practice in the
field of geriatrics, long-term care, or chronic care management for a minimum of 5 years” (ANA, 2010).
“Between 2000 and 2050, the number of older people is projected to increase by 135%. Moreover, the
population aged 85 and over, which is the group most likely to need health and long-term care services,
is projected to increase by 350%. Over this time period, the proportion of the population that is over the
age of 65 will increase from 12.7% in 2000 to 20.3% in 2050; the proportion of the population that is age
85 and older will increase from 1.6% in 2000 to 4.8% in 2050. The ageing of the population will have a
major impact on the organization and delivery of health care. Of particular importance will be the shift
from acute to chronic illnesses and the likely growing shortage of health care workers, especially nurses
and paraprofessionals. The ageing population will require focusing on chronic diseases, such as
Alzheimer’s disease, heart disease, and osteoporosis, rather than acute illnesses. First, the style of
medicine will need to change from one-time interventions that correct a single problem to the ongoing
management of multiple diseases and disabilities; doctors and patients will have to have an ongoing
relationship designed to help patients cope with illnesses rather than curing them. Second, with chronic
illness often comes disability, meaning that long-term care services, such as nursing homes, home
health, personal care, adult day care, and congregate housing, will become much more important
sources of care. There has been increasing concern about the current and future supply of acute and
long-term care workers, especially nurses. Because of the ageing registered nurse workforce, by the year
2020, the registered nurse workforce is forecast to be roughly the same size as it is today, declining
nearly 20% below projected workforce requirements” (Tilly & Wiener, 2002). Giving advanced practice
nurses an incentive to care for the geriatric population will be an integral part of reforming our
healthcare.

American Nurses Association (ANA). (2010). Key Provisions Related to Nursing. Retrieved from
http://www.rnaction.org/site/DocServer/KeyProvisions_Nursing-PublicLaw.pdf?docID=1241&verID=1

Institute of Education Sciences (IES). (2013). Digest of Education Statistics: Undergraduate Prices.
Retrieved from http://nces.ed.gov/programs/digest/d13/

Tilly, J. & Weiner, J. M. (2002). Population ageing in the United States of America: implications for public
programmes. International Journal of Epidemiology (31)4. doi: 10.1093/ije/31.4.776. Retrieved from
http://ije.oxfordjournals.org/content/31/4/776.full

WK 2 DQ 2

Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery
team. How is this advantageous to patient outcomes?

Nurse-managed Health Clinics (NMHCs)

What is a NMHC? PPACA establishes a new grant program to fund nurse-managed health clinics for the
purpose of providing comprehensive primary care and wellness services to underserved or vulnerable
populations.

How are NMHCs organized? NMHCs are nurse-practice arrangements that are required to be led by
advance practice nurses. By the terms of PPACA, they must be associated with a school, college,
university or department of nursing, federally qualified health center, or independent nonprofit health
or social services agency. The law authorizes the appropriation of $50 million for FY 2010 and whatever
sums are deemed necessary for each of the fiscal years 2011 through 2014.

What are Nursing’s opportunities? Nurses, especially nurse practitioners, have the skills and opportunity
to reframe how primary care is delivered, a goal shared by the recently enacted PPACA. Primary care,
wellness education, management of chronic diseases and conditions, coordination and integration of
care are all building blocks to a “reinvented” health care system that attempts to contain costs, while
optimizing patient outcomes.

Some studies have demonstrated that primary care delivered by nurse practitioners is cost-effective.xiv
In an environment intent on slowing the growth of health care costs (often referred to as “bending the
cost curve”), data from nurse-managed primary care settings may continue to build the case for the
quality and cost imperatives of removing remaining barriers to primary care practice by nurse
practitioners. It is anticipated that, in particular, data gleaned from the reporting requirements of HHS
grants (such as for NMHCs) will demonstrate that permitting nurses to practice to the full extent of their
professional scope results in improved outcomes and value-driven health care. The expansion and
reallocation of existing healthcare workforce resources to meet new needs under PPACA demand that
barriers to this goal be removed.

http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-
Briefs/Care-Delivery-Models.pdf