Care and concern

Key to implementing accountable care organizations (ACOs) could already live in your institution--the registered nurse, according to an America's Health Insurance Plans .

With today's expanded role of the nurse going beyond traditional responsibilities, nurses act as care coordinators, disease managers, data analysts, and process managers, among other things, according to the article.

As ACOs increasingly focus on improved care coordination and delivery, nurses may be the perfect fit for evaluating current resources and staffing levels, as well as solving problems effectively.

"Well-designed analytics are critical to clearly understanding the opportunities for improving outcomes, setting goals, and assessing downstream measures of progress in the ACO model," said Patty Jones, RN, MBA, in the article. "Nurses have the opportunity to play a role in accurately reviewing information about the targeted populations and identifying members who will be well-served by the organization's programs, as well as measuring progress.

Although some nursing experts appear to embrace the general tenants of the proposed ACO rules, some are less enthused and issues remain unresolved.

Case management and care coordination concerns

“The focus is that we support the goals of nursing integration into ACOs, but the language specific to care coordination is a concern. We feel that it has neglected to recognize the contribution of nursing,” said Lisa Summers, CNM, DrPH, senior policy fellow, department of nursing practice and policy, American Nurses Association.

“Care coordination is a building block on which much of the ACO quality improvement and cost control provisions are built. And care coordination is a core competency for the nursing profession; it is what nurses do. Yet the proposed rule largely disregards the contributions of professional nursing in both clinical services and patient management, and as a result, loses the opportunity for real cost savings,” Summer said.

Another professional organization that includes nurses has a different take on the issue of care coordination: “We strongly support the emphasis placed by [Centers for Medicare and Medicaid Services] in the proposed rule on the importance of improving care coordination for Medicare beneficiaries,” said Patrice V. Sminkey, RN, chief staff executive, Commission for Case Manager Certification. “Our position is that a board-certified case manager is uniquely positioned to improve care coordination performed in an ACO by implementing plans of care.”

The difference in positions is that not all certified case managers are nurses; they can include many healthcare professionals that “practice independently,” such as social workers. The difference hinges on the emphasis of RNs’ role in care coordination.

The ANA’s position is: “The care coordinator should be a health professional from any of several different disciplines for most patients; however, for many, a registered nurse is often the best care coordinator.