care quality. Focused on the ambulatory experience, this organization has most recently determined tools for best measuring patients' engagement while not overburdening them with lengthy survey instruments.
National Partnership for Women & Families
Also not a newcomer but more actively engaged than ever in the policy‐making that affects social determinants and health disparities that concern nurses, the National Partnership for Women & Families (www.nationalpartnership.org) has been and continues to be a strong advocate for the following policies: the Pregnancy Discrimination Act, the Civil Rights Act, the Family and Medical Leave Act, the ACA, state‐wide paid family leave programs, and numerous local and state paid sick days laws. A longstanding supporter of equal rights for women and equal pay, the Partnership has taken on the work of advancing racial equity. It is also advocating that Congress protect US workers in its response to the COVID‐19 emergency.
The National Partnership has also taken the lead for the Consumer Partnership for eHealth. A unique coalition of more than 50 leading consumer and patient organizations (representing more than 127 million Americans), this partnership works to advance health information technology (IT) and health information exchange in ways that measurably improve the lives of individuals and their families.
National Governors Association
Normally involved in working with the President to address matters of national security and defense, since the beginning of the pandemic early in 2020 and the resulting economic slump, Governors have been directing their states’ resources where they are needed most and where they will achieve the greatest impact. Governors have been actively engaged in delivering state services to protect public health and to stimulate economic recovery and growth. They are working with state legislators to make appropriate policy and implement their states' own emergency measures to improve safety for patients, health care workers, and residents and to prevent spread of the virus to other states and communities. The National Governors Association (www.nga.org) has provided platforms for Governors to communicate with each other and to easily follow what is happening in other states across the country on a daily basis.
Academy of Oncology Nurse & Patient Navigators
The Academy of Oncology Nurse & Patient Navigators (AONN+; https://aonnonline.org) is the largest national specialty organization dedicated to improving patient care and quality of life by defining, enhancing, and promoting the role of oncology nurse and patient navigators. This organization of over 8,200 members was founded in 2009 to provide a network for all professionals involved and interested in patient navigation and survivorship care services to better manage the complexities of the cancer care treatment continuum for their patients. It views itself as an organization consisting of “professional patient advocates” and, to that end, it supports and serves its members. This organization links to a separate credentialing arm and encourages nurse and patient navigator certifications as a means of enhancing and ensuring the quality of its members’ practice.
A Step Back: Affordable Care Act Emerged Where Efforts Converged
In March 2010, the US Congress passed and the President signed into law the ACA. Although the provisions were many and even over 10 years later remain amazingly controversial, from the perspective of driving improvements in quality several key provisions of the law, as they have been phased in, have provided significant opportunity to reshape delivery of care. Nurses played a critical role in designing and supporting passage of these provisions and have since had significant opportunity to influence, recommend, and in some cases design innovations in care delivery that are consistent with these provisions and with implementation of various aspects of the law focused on the improvement of quality. Nurses have also benefited from the emphasis on quality in clinical practice through inclusion in pay for quality reimbursement structures and alternative payment models that replace fee‐for‐service models. The following are some of the key provisions specific to quality and safety.
Improving Health Care Quality and Efficiency
The law established the Centers for Medicare and Medicaid Services (CMS), which conducts pilot demonstrations to test new ways of delivering care to patients. The Innovation Center develops new payment and service delivery models in accordance with the requirements of Section 1115A of the Social Security Act. Additionally, Congress has defined, through both the ACA and previous legislation, a number of specific demonstration projects to be conducted by CMS. This Center continues to search for existing and promising innovative programs that can be replicated or scaled up to improve the quality and safety of health care delivered, while also reducing the rate of growth in health care spending for Medicare, Medicaid, and the Children’s Health Insurance Program (https://innovation.cms.gov/innovation‐models/map#).
New and promising innovations occur in numerous states and are continually seeking additional participants. A few of the latest entrants include a variety of initiatives focused on Accountable Care Organizations (ACOs). For instance, one innovation is studying the quality and cost of providing Program of All‐Inclusive Care for the Elderly (PACE) program services under Medicare and Medicaid models of care. Another is working to improve kidney care choices and end‐stage renal disease (ESRD) models of care for Medicare recipients. Yet another demonstration provided incentive payment awards to participating nursing homes that perform the best or improve the most in terms of quality. Nurses and nursing care figure prominently in each of these demonstrations. Included in this provision, the Department of Health and Human Services (HHS) was required to submit a National Strategy for Quality Improvement in Health Care that would include these programs in addition to those of third‐party payers.
Linking Payment to Quality Outcomes
Since 2010 the ACA has established a Hospital Value‐Based Purchasing (VBP) program for traditional Medicare participants. No longer do hospitals receive reimbursement for care based exclusively on the quantity of services delivered. This program offers financial incentives to hospitals to improve the quality of care provided to Medicare patients through CMS regulations implemented through the Hospital Inpatient Prospective Payment System (IPPS). This method of payment rewards institutions based on how closely they adhere to best clinical practice, as well as on their improvement of the patients’ experiences of care during hospitalization. The Hospital VBP program works for Medicare patients by creating disincentives and rewarding reductions during acute care inpatient stays based upon reviewing the following:
Eliminating or reducing adverse events (health care errors resulting in patient harm).
Adopting evidence‐based care standards and protocols in order to obtain the best outcomes for Medicare patients.
Incentivizing hospitals to develop processes that improve patient experience.
Increasing the transparency of care quality for consumers, clinicians, and others.
Recognizing hospitals that provide high‐quality care at a lower cost to Medicare.
CMS withholds participating hospitals’ Medicare payments by a percentage specified by law (2%). It uses the estimated total amount of those reductions to fund value‐based incentive payments to hospitals based on their performance in the program. CMS applies the net result of the reduction
