TCNXXX10.1177/1043659614537306Journal of Transcultural NursingLudwig-Beymer

Editorial Journal of Transcultural Nursing 2014, Vol. 25(4) 323­–324 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043659614537306 tcn.sagepub.com

Health Care Reform and the Transcultural Nurse Patti Ludwig-Beymer, PhD, RN, CTN-A, NEA-BC, CPPS, FAAN1

The advent of the Patient Protection and Affordable Care Act has resulted in rapid practice changes in the United States. The goals of health care reform are to expand access and reduce the number of uninsured, reduce health insurance costs, provide a continuum of affordable insurance options, reduce the rate of increase in health care costs, and ensure patient care quality. This involves changes in insurance coverage, the delivery system, and health care financing. Each change has implications for transcultural nurses. Insurance coverage expansion is addressed through Medicaid expansion and insurance exchanges. States that have expanded Medicaid and implemented exchanges have seen a 2.5% drop in the percentage of uninsured (from 16.1% to 13.6%), whereas states that have not expanded Medicaid or implemented exchanges have seen only a 0.8% drop in the percentage of uninsured (from 18.7% to 17.9%). Only 4.9% of the population is uninsured in Massachusetts, which passed comprehensive health care reform in 2006 (Witters, 2014). Culturally competent nurses are in the ideal position to help health care consumers understand and navigate their insurance options. They can help the consumer identify the best option within the context of the consumer’s family, socioeconomic status, and culture. Under the Affordable Care Act, delivery system reform involves reorganizing care so that the risk for the volume of care, the quality of the care, and the cost of care rests with health care providers. As a result, interesting models of care are emerging that focus on disease prevention, care management across the continuum, efficiency, care standardization, and readmission reduction. Helping people stay healthy has always been the right thing to do. The culturally competent nurse can assist consumers to value and access primary care services that focus on health promotion, disease prevention, and early detection. This may involve reframing the perspectives of both health care providers and consumers. Transcultural nurses can assist providers in building culturally competent organizations that deliver culturally appropriate programs. In addition, the transcultural nurse can work with consumers to enhance health-seeking behaviors. Financial reform is addressed in the Affordable Care Act through increasing revenue and decreasing expenses. Medicare withholds a percentage of Diagnosis-Related

Group payments for both value-based purchasing and readmission penalties. Hospitals then have the ability to “earn back” the money by reducing patient readmissions and meeting key clinical outcomes, patient experience measures, clinical process measures, and efficiency measures. Many hospitals have already experienced decreased Medicare revenues from these penalties. The astute transcultural nurse can help address the cultural barriers that contribute to disparities in clinical outcomes and the patient experience. For example, the nurse can identify and link the patient to community resources prior to discharge to help decrease inappropriate readmissions to the hospital. The transcultural nurse can also help the organization examine clinical processes of care by race, religion, cultural group, or other characteristic to ensure that care is being delivered consistently to everyone regardless of characteristic. Disparities in health have long been acknowledged in the United States; these racial and ethnic disparities document the reality of unequal health care treatment. At the most basic level, disparities are evident in life expectancies. The Centers for Disease Control and Prevention reports the overall U.S. life expectancy at 78.7 years (Hoyert & Xu, 2012). However, life expectancy varies by race, with White males (76.6 years) and White females (81.3 years) living longer than African American males (72.1 years) and African American females (78.2 years). Access (getting into the health care system) and quality care (receiving appropriate, safe, and effective health care in a timely manner) are key factors in achieving good health outcomes. Presumably, access to care will improve for individuals who are newly insured under the Affordable Care Act. However, Canada’s experience with universal access to care suggests that access helps reduce but does not eliminate health disparities (Alter, Stukel, Chong, & Henry, 2011). To further diminish health disparities, transcultural nurses must lead the way in delivering culturally competent health care that focuses on the triple aim of health care (Institute for Health Care Improvement, 2014): improving the patient 1

Edward Hospital, Naperville, IL, USA

Corresponding Author: Patti Ludwig-Beymer, PhD, RN, CTN-A, NEA-BC, CPPS, FAAN, Edward Hospital, 801 South Washington St, Naperville, IL 60540, USA. Email: [email protected]

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Journal of Transcultural Nursing 25(4)

experience of care in terms of quality and satisfaction, improving the health of populations, and reducing the per capita cost of health care. The focus of this article has been on clinical practice. Similarly robust implications exist for transcultural nursing administration, education, research, and policy development. Opportunities abound for transcultural nurses now and in the future. References Alter, D. A., Stukel, T., Chong, A., & Henry, D. (2011). Lessons from Canada’s Universal Care: Socially disadvantaged patients

use more health services, still have poorer health. Health Affairs, 30, 274-283. Hoyert, D., & Xu, J. (2012, October 10). Deaths: Preliminary data for 2011 (National Vital Statistics Report, Vol. 61, No. 6). Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr61/ nvsr61_06.pdf Institute for Health Care Improvement. (2014). Triple aim for populations. Retrieved from http://www.ihi.org/Topics/TripleAim/ Pages/Overview.aspx Witters, D. (2014). Uninsured rate drops more in states embracing health law. Retrieved from http://www.gallup.com/ poll/168539/uninsured-rates-drop-states-embracing-healthlaw.aspx

Congratulations to the following reviewers for the Journal of Transcultural Nursing who will be inducted as a Fellow in the American Academy of Nursing (FAAN) in Washington D. C. in October: Victoria Vaughan Dickson, PhD, RN, CRNP - New York University (Active Reviewer) Jeanne Karen Kemppainen, PhD, RN - University of North Carolina Wilmington (Active Reviewer) Rita K. Adeniran, DrNP, RN, NEA-BC - University of Pennsylvania Health System (Active Reviewer) Lenore K. Resick, PhD, CRNP, FNP-BC, FAANP - Duquesne University (Active Reviewer) Rick D. Zoucha, PhD, RN, PMHCNS-BC, CTN-A - Duquesne University (Active Reviewer and Associate Editor)

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Health care reform and the transcultural nurse.

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