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Guest Editorial: Debt Crisis: Opportunity for Nursing Action
The Centers for Medicare & Medicaid Services (CMS) estimate current Medicare spending to be $556 billion or approximately 3.6% of our gross national product (Kaiser Family Foundation, 2010). This is a huge expenditure at a time when our federal government is being forced to seek serious ways to reduce spending. In fact the 2010 Patient Protection and Affordable Care Act calls for a $155 billion decrease in Medicare payments to hospitals over the next decade (Perez, 2011). In addition, countless individual hospitals and long-term-care facilities are already losing millions each year and depend heavily on Medicare payments.
On top of this, the Budget Control Act of 2011 (the so-called “debt deal”) was recently passed. This law calls for a 12-member “super committee” to find new ways to reduce our federal budget by at least $1.5 trillion during the next decade. Although it is unclear where cuts will be made, Medicare spending will likely receive serious scrutiny. It would not be surprising if another $150–$200 billion were cut from Medicare by this super committee.
What does this mean to nursing and, in particular, rehabilitation nursing?
Most hospitals and long-term-care facilities are already examining their options, care protocols, staffing needs, and organizational efficiencies. Nurses need to become active members of these clinical leadership committees and study the most salient factors affecting length of stay, readmissions within 30 days of discharge, effective staffing patterns, and care coordination policies that need to be evaluated and improved whenever possible (e.g., transfer summaries from unit to unit, facility discharge summaries, gathering data on key benchmarks and barriers and facilitators to their achievement).
Once again, nurses have a unique opportunity to participate in the reshaping of caregiving. Who is better prepared than the more than 2.6 million employed registered nurses in the United States (U.S. Department of Labor, Bureau of Labor Statistics, 2011) to make recommendations and execute positive changes in our care delivery system model?
Kaiser Family Foundation. (2010). Total number of Medicare beneficiaries, 2010. Retrieved August 23, 2011, from www.statehealthfacts.org.
National Institute of Nursing Research. (n.d.). Changing practice, changing lives: 10 landmark nursing research studies. Retrieved August 23, 2011, from www.ninr.nih.gov/NR/rdonlyres/27F3FB10-FE62-4119-9FA9-1140B6950AFF/0/10LandmarkNursingResearchStudies508.pdf.
Perez, K. (2011). Medicare zero: A comprehensive analysis of the impact of health reform and debt deal on Medicare funding of hospitals and strategies of financial survival. Retrieved August 23, 2011, from http://marketing.medeanalytics.com/acton/form/1156/0060:d-0001/0/index.htm.
U. S. Department of Labor, Bureau of Labor Statistics. (2011). Occupational outlook handbook, 2010-11 edition. Retrieved August 23, 2011, from http://www.bls.gov/oco/.