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ANA: Care coordination should be reimbursed

Tuesday June 12, 2012
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The federal government, healthcare insurers and other healthcare financing systems should acknowledge the central role of RNs in providing effective care coordination services, according to a position statement from the American Nurses Association.

These services should be fully funded to improve healthcare quality and patient outcomes and reduce costs through a more efficient use of resources, the ANA stated. Care coordination must be defined, measured and documented by healthcare financing systems to create direct financial and systemic incentives for the function.

Care coordination is a long-held core professional standard and competency for RNs and integral to patient care quality, satisfaction and the effective and efficient use of healthcare resources, the ANA noted. Despite its importance in filling many gaps in patientsí care plans, care coordination is neither well-documented nor reimbursed as a distinct component of patient care.

ANA leaders recently met with Marilyn Tavenner, RN, BSN, MHA, acting administrator of the Centers for Medicare & Medicaid Services, to discuss how to measure and pay for care coordination and how it can achieve savings for beneficiaries.

"Itís long overdue that this nursing service is highlighted, accounted and paid for, just like other essential healthcare services that a patient receives," ANA President Karen A. Daley, RN, PhD, MPH, FAAN, said in a news release. "Patients know that nurses are coordinating their care. They want to better understand their plan of care and be assured of continuity."

Along with the position statement (http://bit.ly/Kqn4DL), the ANA released a report, "The Value of Nursing Care Coordination," which highlights studies about the positive impact of nurse-led and nurse-managed care coordination. Benefits include improved patient outcomes, increased health system efficiency and lower healthcare costs, according to the report. For example, studies show that patient-centered care coordination reduces ED visits and hospital readmissions, lowers total annual Medicare costs, improves patient satisfaction and confidence to self-manage care and increases safety for older adults during transitions between settings.

RNs have received wide recognition for being leaders and innovators in designing and implementing successful team-based coordination programs that improve patient care and reduce costs, according to the ANA. Care coordination generally involves ensuring that a patientís needs and preferences for health services and information are communicated and delivered effectively among healthcare providers, functions and settings over time.

Specific aspects of care coordination include development of a care plan and assistance in identifying care options, guided by the preferences and needs of patients and their families; management of care to maximize independence and quality of life; communication with the patient, family and support network, and providers, especially during transitions between care settings; and advocacy of dignified care.

Nurses can perform care coordination as part of a multidisciplinary healthcare team or independently within their scope of nursing practice. "The nurseís role is to ensure that essential services for the patient donít fall through the cracks, which can easily happen in our current fragmented system of care where good communication between healthcare providers or settings is often lacking," Daley said.

The position statement also advocates expanding research to examine RNsí evolving roles and contributions to care coordination and more fully incorporating care coordination practices and theories into pre-licensure nursing education and continuing education.


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