National Nurses United

The not-so-brave new world of healthcare technology ■ Rapid transfer of patients to outpatient facilities, nursing homes, or hospice that have fewer regulations and fewer, typically lesser-skilled, lesser-paid staff. Kaiser is presently pushing to lay off medical-surgical RNs and shifting work to hospice and clinic settings. Other industry giants hope to follow this path. Their goal: to sign up "covered lives," customers who are required to buy insurance while the insurer/provider can more directly control expenditures for care and more easily slash spending. The ACA encourages these developments through financial penalties for hospital readmissions, an incentive to keep people out of the hospital. Additionally, the law promotes the establishment of Accountable Care Organizations (ACOs), essentially combinations of hospitals and doctors groups that receive financial incentives for meeting artificial cost-saving benchmarks. This encourages the use of lower-cost outpatient and in-home services over inpatient services. In Chicago, more than 40 percent of the "new" previously uninsured patients that Cook County receives through the ACA will be referred to these private (and non-union) centers. Big-box retailers like CVS and Wal-Mart are setting up clinics that can operate with reduced staff and barebones budgets. On the hospital level, Kaiser is producing prefab health clinics that can be installed quickly and cheaply nationwide. Nearly 70 percent of healthcare executives expect outpatient care to account for more than 40 percent of their system's revenue within five years, Modern Healthcare reported last August. The May 2013 national jobs report from the Bureau of Labor Statistics shows the trend is well underway. While hospital jobs are declining, employment numbers rose significantly for ambulatory care services and outpatient care. JUNE 2013 the aca, and President Obama's stimulus program before it, pushed the use of healthcare technology programs with financial incentives and reimbursement policies as a panacea for reducing costs and improving quality in part by reducing medical errors. Neither benefit has arrived. The amount spent by the healthcare industry on technology for electronic medical records systems alone has been estimated to be nearly $30 billion, a major factor in higher overall healthcare costs. Rampant problems with the electronic record system have emerged with an escalation in medical errors and other glitches created by expensive systems that fail to work properly and routinely override professional caregiver expertise. Employers are not likely to slow the pace of EHR systems because they enable hospitals to bill more efficiently and collect more payments, and the ACA encourages their use with financial incentives. From robotics to telemedicine to standardized diagnostic, prognostic, and treatment computer programs, much of the technology has served to displace direct, hands-on patient care by doctors and registered nurses. RNs find they are increasingly pulled away from patients to interact with computers and that time with patients is undercut by management directives to comply with dubious "patient satisfaction" scripts which are also spurred by federal reimbursement policies. We're not number one, and the ACA won't change that many of these shortcomings have been obscured in the highly charged partisan environment—from both political posturing on the right by those opposed to any reform of our broken healthcare system and the bunker mentality of liberal administration allies who tend to gloss over significant holes in a law likely to be etched in history as the primary domestic legacy of the Obama years. While the United States spends more than any other country per capita on healthcare, our barometers on quality continue to fall. Studies this year alone show the United States ranks last among 17 major industrial nations in life expectancy, but is ahead of the others in first-day infant mortality rates. That dubious record will not likely end with the ACA. Nurses will continue to make the case for immediate and longterm reform through price controls on profiteering to joining the community of nations with a genuinely universal national or singlepayer healthcare system. Charles Idelson is communications director of National Nurses United. W W W. N A T I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 19

• Cover