By Elizabeth Moore
Traditionally, care coordination has been a central role for nurses, who are key to ensuring patients’ multidimensional needs are being met at the bedside, as they transition from one care setting to the next, and as they live their lives in the community. Opportunities for nurses to lead and innovate within care coordination are flourishing—although challenges remain.
That said, in declaring 2018 as a Year of Advocacy, the American Nurses Association (ANA) and nurse experts are committed to promoting nurses’ roles in care coordination and have developed new resources that will help them gain recognition for their efforts.
A guide to action
With the January 2018 publication, Care Coordination: A Blueprint for Action for RNs, authors Gerri Lamb, PhD, RN, FAAN, and Robin Newhouse, PhD, RN, NEA-BC, FAAN, provide nurses with a plan to advance care coordination practice and advocacy.
“We believe there is a pressing need for a short, to-the-point book that educates nurses about key issues in nurse care coordination and recommends specific actions that can make a difference,” said Lamb, an Arizona Nurses Association member and center director and research professor at the college of nursing and health innovation at Arizona State University. She noted that in addition to offering opportunities for advancing nurse care coordination, the current healthcare environment also presents many challenges.
“It is critical to understand the issues and take meaningful action now,” said Lamb, who edited and coauthored an earlier book, Care Coordination: The Game Changer—How Nursing is Revolutionizing Quality Care.
“The high cost of chronic diseases and the fragmented nature of care have created an exponential increase in the need for care coordination,” said Newhouse, dean and distinguished professor of the Indiana University School of Nursing and an Indiana State Nurses Association member. She noted that most patient care transitions are best done by RNs or advanced practice registered nurses (APRNs), particularly when a patient requires assessment of complex physical, mental, and social needs.
Care Coordination: A Blueprint for Action for RNs was designed to prompt nurses to lead and deliver effective care coordination and influence policy toward meeting healthcare needs for people, families, and caregivers in all settings.
The blueprint’s action issues
The core of the publication is its six action issues for nurses who want to advance nurse care coordination. Each of these is, according to the book, “pivotal to advancing nurse care coordination” and “practical, strategic, and actionable.” The issues are:
- engaging patients, families, and caregivers
- demonstrating competency and readiness
- optimizing teams and teamwork
- using documentation and health IT
- measuring performance
- understanding payment.
Framing each action issue with three topics—what we know, what’s trending, and what RNs can do—the authors offer practical suggestions and specific actions and resources for RNs to influence the future of nurse care coordination. For instance, measuring what nurses do to contribute to care coordination outcomes is a critical issue in advancing care coordination practice and payment policy, and one that has been examined in great detail by workgroups convened by ANA and the American Academy of Nursing. One action recommended in Care Coordination: A Blueprint for Action for RNs is for all nurses to identify and share measures they are using to fill important gaps about specific care coordination activities and demonstrate nursing’s impact on health and system outcomes. In addition, Newhouse said,
“We need to make sure these measures are part of the patient care record.” The authors write, “Nurses must make the compelling case that they are essential to advancing care coordination. Nurses and the nursing profession have the knowledge, experience, and data to make this case—we must act.”
ANA and the path to payment
When constraints on time and communication limit coordination of care, patients suffer.
“That’s where we see medication errors and patients not seeing the value of a follow-up visit,” said Cheri Lattimer, BSN, RN, executive director of the National Transitions of Care Coalition and a member of the 2017 ANA Care Coordination Panel. Nurses have the knowledge and experience to be the best agents of care coordination, she added, noting that while every care provider has some responsibility for coordinating care, “in reality, it is the nurse, the nurse case manager, and the advanced practice nurse who spend the most time with the patient throughout.”
Lattimer expressed concern that unqualified individuals without proper training are working as care managers. “It’s important to have performance measures and qualifications and to define the scope of work that’s necessary,” she said.
ANA has long advanced nurses’ role in care coordination and developed comprehensive resources to support them. ANA panels convened in 2010, 2013, and 2017 have corroborated the essential role of RNs in care coordination, built guiding principles, identified structural components, and crafted definitions and competencies that have helped steer the movement toward payment and recognition.
Additionally, the passage of the Patient Protection and Affordable Care Act (ACA) in 2010 put a spotlight on care coordination.
“With ACA, [care coordination] became part of the language,” explained Barbara Lutz, PhD, RN, CRRN, PHNABC, FAAN, FAHA, FNAP, McNeill Distinguished Professor at the University of North Carolina-Wilmington School of Nursing and a member of the ANA Care Coordination Panel. Now that Medicare pays for some types of care coordination, the healthcare system has embraced the practice, according to nurse experts.
A new white paper from ANA, “Medicare Payment for Registered Nurse Services and Care Coordination,” examines the current ways Medicare pays for nursing services and patient care coordination, and how legislative or regulatory actions would allow care coordination programs to compensate nursing services. The paper discusses payment for APRNs, including nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse-midwives, and certified registered nurse anesthetists, as well as registered nurses (RNs and other degree-credentialed nurses) through another benefit category.
The ANA white paper outlines three statutory or regulatory changes that would facilitate access to nursing services and an opportunity through a Centers for Medicare and Medicaid Services section 1115A waiver to study direct payment to RNs to show Medicare cost savings and quality improvement goals. These statutory or regulatory proposals include recommendations for paying NPs and CNSs at the same rate as physicians, suggest using consistent and more expansive definitions of “physician,” and propose changes to the statute to allow direct payment to RNs for performing care coordination activities.
In this Year of Advocacy, RNs are encouraged to explore the new resources and make a commitment to act. Lamb and Newhouse emphasized that “taking action on even one issue—even a small action—will create a ripple of changes. There is much we can accomplish together.”
ANA resources for care coordination can be found at nursingworld.org.
Elizabeth Moore is a writer at ANA.