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ANA pleased with recent changes to ACO rules

Wednesday October 26, 2011
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In a statement about the final rules for Accountable Care Organizations, the American Nurses Association commended federal regulators for expanding the roles of RNs but also called for further improvements to recognize the value of care coordination provided by nurses.

The Centers for Medicare & Medicaid Services announced the final rules for ACOs, a new model in which primary care doctors, specialists, hospitals and care providers receive incentives to coordinate care for Medicare patients. (See a fact sheet about ACOs at http://1.usa.gov/qSy518).

After releasing the proposed rule last spring, CMS took comments and issued the final rule Oct. 20. The ANA voiced satisfaction that the final rule contained several sought-after changes from the proposed rule, including:

• Medicare beneficiaries who get most of their care from a nurse practitioner or clinical nurse specialist can maintain that primary care relationship within the ACO. Under the proposed rule, a patient's ability to access the ACO depended only on services provided by physicians.

"By recognizing a beneficiary's true primary care provider, this change promotes continuity of care and honors patients' rights to choose their providers," the ANA stated. The final rule recognizes advanced practice nurses as "significant assets" in the effort to promote quality and cost savings within ACOs.

• Qualified health professionals, including RNs, will be recognized as leaders in quality assurance and process improvement initiatives within an ACO. The ANA pushed for this change in the final rule, noting it would mark a step toward fulfillment of a central recommendation in last year's Institute of Medicine report, "The Future of Nursing: Leading Change, Advancing Health," which stated: "Nurses should be full partners with physicians and other healthcare professionals in redesigning healthcare in the United States."

Through recognition of nurses' roles as primary care providers and care coordinators in ACOs, "CMS has strengthened the plan outlining how accountable care organizations will operate," ANA President Karen A. Daley, RN, PhD, MPH, FAAN, said in a news release. "ACOs must be more than just a business structure for compensating the members of the healthcare team, but a means to achieve the larger goal of providing true patient-centered care that is essential to improving quality and reducing costs."

The ANA also was pleased to see CMS explicitly acknowledge the concerns it expressed, as well as issues raised by other nursing organizations.

"The changes between the proposed and final ACO rules reflect the positive influence nursing organizations can exert on the way healthcare is delivered in this country when we are unified in the best interests of patients and the nursing profession," ANA CEO Marla J. Weston, RN, PhD, said in the news release.

The ANA stated that the final rule for ACOs could have gone even further in its providing ways to recognize and measure nurses' contributions to care coordination and improvement in care quality: "Care coordination is a core foundation of professional nursing practice, reflecting interdisciplinary communication skills, evaluation, judgment and decision-making by nurses, and is not achieved by reliance on health information technology alone."

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