Clinical Nursing Initiatives Begin to Show Benefits An AACN program improves patient outcomes while lowering costs.
I
t’s called the Clinical Scene Investigator (CSI) Academy. It’s an effort of the American Association of Critical-Care Nurses (AACN) program designed to build nurses’ expertise and leadership skills. The goal is to enhance patient care while decreasing costs. And it’s already working. The CSI Academy is now in six regional groups comprising 42 hospitals. So far, hospitals in Massachusetts, North Carolina, and Indiana have released results of their efforts, which show a combined anticipated savings of $20 million, according to program
irector Susan Lacey. The final d groups, in New York, Pennsylvania, and Texas, are expected to announce their results later this year. At participating institutions, a team of three or four staff nurses at a hospital work with a mentor and CSI faculty to identify problems related to patient care and investigate possible solutions. Each participating hospital received a $10,000 grant to support the team during its 16-month participation. At Beth Israel Deaconess Medical Center in Boston, nurses participating in the program were able to decrease episodes of delirium by
60%, and the use of benzodiazepines was reduced by more than 80%. The projected annual savings at this one location was $1.7 million. At St. Vincent Indianapolis Hospital, nurses created a “mobility team” to work with patients on ventilators, resulting in a 10-hour reduction in the average time patients were intubated. The projected annual savings was $337,000. The AACN’s Web site (www. aacn.org/csi) has a free database of information on each of the academy projects.—John Welsh, MN, RN
For Some Hospitals, the ACA Increases Revenue States without Medicaid expansion may not see the same results.
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ecause the Affordable Care Act (ACA) reduced certain Medicare and Medicaid payments to hospitals, there was concern that the law would have a negative impact on urban hospitals that care for large numbers of low-income, uninsured patients. However, some safety net hospitals have seen a fasterthan-expected decrease in the number of uninsured patients, which has resulted in an increase in revenue. Medicare and Medicaid payments to “disproportionate-share hospitals” help those facilities cover costs for uncompensated care. In 2013, costs for uncompensated care ran to an estimated $85 billion, and at least 65% of those costs were offset by government payments, according to
[email protected]
one recent study. The ACA reduces these federal payments based on the assumption that hospitals would see fewer uninsured patients. This is proving to be the case— at least in the 25 states that have expanded Medicaid. Take Harborview Medical Center in Seattle. Washington has expanded Medicaid, and according to a report in Kaiser Health News (http://bit.ly/ UnAupm), the number of uninsured patients at Harborview fell from 12% last year to 2% this spring. As a result, the hospital’s revenues are expected to increase by $20 million this year. Other urban hospitals, both safety-net and investor-owned facilities, have reported similar decreases in the proportion of uninsured patients since January,
when expanded Medicaid coverage took effect. In contrast, hospitals in states that chose not to expand Medicaid are facing funding cuts without a corresponding drop in uncompensated care. Likewise, although an online poll by the American College of Emergency Physicians showed an increase in ED visits since implementation of the ACA, some hospitals are beginning to report decreases, with more patients seeking care at primary care clinics instead of the ED. In Denver, for instance, visits to primary care offices have increased by 14% this year while ED visits have dropped by 2%.—Karen Rosenberg Coughlin TA, et al. Health Aff (Millwood) 2014;33(5):807-14; Miller S. Inquiry 2012; 49(winter 2012–2013):317-26.
AJN ▼ September 2014
▼
Vol. 114, No. 9
19
I
t’s called the Clinical Scene Investigator (CSI) Academy. It’s an effort of the American Association of Critical-Care Nurses (AACN) program designed to build nurses’ expertise and leadership skills. The goal is to enhance patient care while decreasing costs. And it’s already working. The CSI Academy is now in six regional groups comprising 42 hospitals. So far, hospitals in Massachusetts, North Carolina, and Indiana have released results of their efforts, which show a combined anticipated savings of $20 million, according to program
irector Susan Lacey. The final d groups, in New York, Pennsylvania, and Texas, are expected to announce their results later this year. At participating institutions, a team of three or four staff nurses at a hospital work with a mentor and CSI faculty to identify problems related to patient care and investigate possible solutions. Each participating hospital received a $10,000 grant to support the team during its 16-month participation. At Beth Israel Deaconess Medical Center in Boston, nurses participating in the program were able to decrease episodes of delirium by
60%, and the use of benzodiazepines was reduced by more than 80%. The projected annual savings at this one location was $1.7 million. At St. Vincent Indianapolis Hospital, nurses created a “mobility team” to work with patients on ventilators, resulting in a 10-hour reduction in the average time patients were intubated. The projected annual savings was $337,000. The AACN’s Web site (www. aacn.org/csi) has a free database of information on each of the academy projects.—John Welsh, MN, RN
For Some Hospitals, the ACA Increases Revenue States without Medicaid expansion may not see the same results.
B
ecause the Affordable Care Act (ACA) reduced certain Medicare and Medicaid payments to hospitals, there was concern that the law would have a negative impact on urban hospitals that care for large numbers of low-income, uninsured patients. However, some safety net hospitals have seen a fasterthan-expected decrease in the number of uninsured patients, which has resulted in an increase in revenue. Medicare and Medicaid payments to “disproportionate-share hospitals” help those facilities cover costs for uncompensated care. In 2013, costs for uncompensated care ran to an estimated $85 billion, and at least 65% of those costs were offset by government payments, according to
[email protected]
one recent study. The ACA reduces these federal payments based on the assumption that hospitals would see fewer uninsured patients. This is proving to be the case— at least in the 25 states that have expanded Medicaid. Take Harborview Medical Center in Seattle. Washington has expanded Medicaid, and according to a report in Kaiser Health News (http://bit.ly/ UnAupm), the number of uninsured patients at Harborview fell from 12% last year to 2% this spring. As a result, the hospital’s revenues are expected to increase by $20 million this year. Other urban hospitals, both safety-net and investor-owned facilities, have reported similar decreases in the proportion of uninsured patients since January,
when expanded Medicaid coverage took effect. In contrast, hospitals in states that chose not to expand Medicaid are facing funding cuts without a corresponding drop in uncompensated care. Likewise, although an online poll by the American College of Emergency Physicians showed an increase in ED visits since implementation of the ACA, some hospitals are beginning to report decreases, with more patients seeking care at primary care clinics instead of the ED. In Denver, for instance, visits to primary care offices have increased by 14% this year while ED visits have dropped by 2%.—Karen Rosenberg Coughlin TA, et al. Health Aff (Millwood) 2014;33(5):807-14; Miller S. Inquiry 2012; 49(winter 2012–2013):317-26.
AJN ▼ September 2014
▼
Vol. 114, No. 9
19
