The Impacts of the Affordable Care Act on Preparedness Resources and Programs Workshop Summary (2014) / Chapter Skim
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4 The Evolving Health Workforce
4 The Evolving Health Workforce
Pages 37-50
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From page 37... ...
• Leveraging nonphysician clinicians can go a long way toward alleviating projected physician shortages. • An emerging care paradigm, referred to as mobile integrated health care practice or community paramedicine, centers on the concept of patient navigation to reduce preventable emergency department visits and readmissions and to increase capacity of the health care system.
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From page 38... ...
This chapter assesses what the current workforce looks like and how the ACA is establishing opportunities for expanded roles, new directions, and training needs to supplement expanded scopes of practice and ensure full availability of care across providers in a disaster. WORKFORCE IMPLICATIONS OF NEW CARE SETTINGS New care delivery models are being developed to meet the needs of the growing number of covered individuals seeking care, under the new paradigm of value-based reimbursement, Cairns explained.
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From page 39... ...
Rather it is a matter of whether the payment incentives can be aligned to allow for and to reward innovation. Turner summarized how some of the health reform trends discussed are impacting the health workforce, both in the adequacy of the workforce to provide day-to-day care and the ability to flex and surge to manage increased demand in an emergency.
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From page 40... ...
CHANGES IN HOSPITAL OPERATIONS IMPACTING WORKFORCE Hospitals are still the core of our surge management strategy, said Chad Priest, a senior executive advisor for MESH Coalition,4 and the surge management platform is still based on acute care capacity. 4 MESH is a nonprofit, public–private partnership focused on enabling health care providers to respond effectively to crisis events and remain viable through recovery.
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From page 41... ...
As an example, Priest said that hospital systems in central Indiana recently purchased a linen services company and now provide themselves with their own linen services. He suggested that hospitals might also pool together to provide emergency management support to one another in much more meaningful and direct ways.
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From page 42... ...
Mobile Integrated Health Care: Community Paramedicine and Patient Navigation As an example of new provider roles in the community, Matt Zavadsky, Director of Public Affairs at the MedStar Mobile Community Health Program, described how MedStar is evolving from an emergency medical services (EMS) organization into a mobile integrated health care organization, and how this has impacted the workforce and local community.
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From page 43... ...
. However, the ACA and health care financing reform creates an environment for innovation and the opportunity for a new EMS role as a mobile integrated health care practice, or "community paramedicine." As the demand for health care services increases, the Association of American Medical Colleges predicts that by 2025, there will be a shortage of more than 130,000 physicians (AAMC, 2010)
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From page 44... ...
Reducing Nonemergent EMS Transports to the Hospital The MedStar Community Health Program was designed to reduce nonemergent EMS calls and connect patients to resources in the community. Regular callers to 911 (those who call 911 15 or more times in 90 days)
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From page 45... ...
This "navigation-re " eady" workfoorce adds valuue to the heallth care sy ystem daily and a can be reeady to assesss, treat, and rrefer in a larggescale incident i as well. w Other disciplines thatt could be traained to extennd the wo orkforce in an a emergency y, or on a daaily basis, innclude medical, nursing, and allied health studeents; home hhealth agencyy personnel; or retired d health caree workers.
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From page 46... ...
The Mobile Integrated Health Care program has helped the community by increasing the capacity of the hospital and the health care system, returning thousands of ED and inpatient bed hours, in other words, freeing up beds and staff time that were previously used because all 911 calls resulted in transports to the hospital. It has improved collaboration across the health care continuum, and providers in the program work very closely with primary care and ED physicians.
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From page 47... ...
TRAINING The ACA has a variety of health workforce training provisions that can be divided into five main sections: Health Workforce Training, Public Health Infrastructure, New Public Health Programming, Health Workforce Analysis and Planning, and Funding (APHA, 2011)
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From page 48... ...
As they become more distanced from these basic procedures, their ability to give help and support on the ground lags, which could limit capacity to respond in a disaster. By contrast, Cairns said the special operations medics at Fort Bragg have each inserted hundreds of central lines and must insert about six or seven IVs and central lines during training to be considered competent.
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From page 49... ...
Expanding health care workforce training to include some of these important pieces, at all levels of practice, can augment responding capabilities in an emergency, as well as contribute to more streamlined routine care. 7 Reports, workshops, and other resources on crisis standards of care can be found at http://www.iom.edu/crisisstandards.
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