What Nurses Can Teach Senators About Medicare:

Medicare took center stage earlier this week at a roundtable hearing held by the Senate Finance Committee to discuss reforming America’s health care delivery system. Because care for chronically ill older adults accounts for a disproportionate share of health care spending, Senate members were seeking solutions that could demonstrate Medicare savings for this population.

Dr. Mary Naylor, the Marian S. Ware Professor in Gerontology at the University of Pennsylvania School of Nursing and director of NewCourtland Center for Transitions and Health testified at the hearing and recommended the establishment of a Medicare benefit covering a program of transitional care to help coordinate care from hospital to home in the management of chronic illness. Mary’s main point: “There is an opportunity to reform our health care system using a rich base of evidence that demonstrates that nurse-led, team-based, transitional care can improve the health outcomes of at risk chronically ill elders, reduce avoidable hospitalizations and decreased health care costs.”

I was glad to see there was a great deal of interest in the transitional care model. I think the Senators get it that a significant portion of the Medicare population is costing the system dearly and models like Mary’s are innovations that need to be considered.

I heard some serious tension between the ideas of being bold with the reorganization of health care while others were saying too much disruption would scare purchasers and patients away. I heard Senators and former CMS Director Mark McClellan as well as the Director of MEDPAC say there will be upfront costs to do things differently such as scaling up primary care services. There were more conservative Senators who didn’t want to hear this.

Senator Hatch wants to create a Commission of the Health Care Workforce in response to the call from several physician groups present that we have a shortage of primary care docs, general surgeons. Others added nurses and nurse practitioners. I didn’t hear much support for his idea. The additional bonuses for primary care docs led to the discussion about medical homes and the admission from the MEDPAC director that this isn’t just about a payment to docs but evidence based practice, health IT integrations, and so on. The importance of nurse case managers for medication management, care coordination and patient compliance was a theme especially from health systems CEOs. Good to hear.

What next? Mary Naylor recommends the following:

1. Increased preparation of health care professionals to deliver person and family centered care, and team-based, longitudinal care in multiple settings.
2. The need for robust process and outcome measures that capture elders’ and family caregivers’ goals and preferences.
3. Public reporting of quality and cost measures so as to benchmark high performers and identify practices that contribute to lower readmission rates.
4. Utilization of translational tools that enable swift application of evidence-based transitional care.
5. Ongoing investment in quality monitoring, and support for continuous quality improvement.

View Dr. Naylor’s full testimony (PDF)

For those of you who have watched the roundtable, did you have other thoughts?

I am interested in your feedback.

This entry was posted on Thursday, April 23rd, 2009 at 10:32 am and is filed under Medicare, Policy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.