School nurses and the Affordable Care Act
Today we’re pleased to feature a guest blog by Erin Maughan, Director of Research at the National Association of School Nurses.
By Erin Maughan PhD, MS, RN, APHN-BC Director of Research at the National Association of School Nurses (NASN) and Donna Mazyck MS, RN, NCSN, Executive Director at NASN
The passage of the Patient Protection and Affordable Care Act (ACA) provides exciting opportunities for school nursing, particularly related to Medicaid enrollment, health promotion and care coordination.
The ACA expands Medicaid eligibility, one of the primary forms of health coverage for low-income children. School nurses are in a strategic position as health care professionals to advocate for, and assist students and their families as they navigate the Medicaid enrollment process to ensure all students have access to care. As more families and students become eligible for Medicaid coverage, the ACA opens opportunities for more school health services to be reimbursable by Medicaid. The reimbursed funds can in turn help to fund current and additional school nursing positions, to ensure students have access to a school nurse.
The ACA also emphasizes wellness promotion and invests in prevention to improve health and reduce overall health costs. Since 1902, the school nurse role has focused on keeping students healthy and promoting health. To support community prevention efforts, the ACA provides funding to advance activities that improve nutrition and increase physical activity, promoting healthy lifestyles and reducing obesity-related conditions and costs; programs in which school nurses are often involved. Under the ACA, states may have the ability to receive reimbursement for school health services and activities related to community-based prevention, health education and counseling programs such as immunizations, integrated behavioral health screening, suicide prevention activities, substance use programs and others.
Finally, the ACA promotes coordinated care models, including accountable care organizations, patient-centered medical homes, health information technology electronic health records; and it offers financial incentives to provide quality care in a cost-effective way. Evidence already exists that school nurses, acting as case managers, improve money and outcomes in the school setting . Health care reform provides an opportunity to expand that role. The ACA realigns payment incentives by promoting high-quality, efficient care and offering options to providers who are interested in better coordinating care for patients and using health care dollars more wisely. This creates incentive for physicians to work more closely with other health providers in the community. For example, school nurses in Oregon developed an agreement with local pediatric clinics to set up a coordinated care pilot project. The ACA also encourages the use of electronic health records to assist in coordinating care. Nemours has partnered with school nurses in Delaware to allow the nurses access to provider records. This has improved efficiency of care and student health outcomes, while also increasing the communication between providers, schools and families.
Implementation of the ACA presents new opportunities for school nurses to be a part of a larger health care system focused on increased access to primary care, improved care coordination and an emphasis on prevention and wellness –- efforts school nurses have focused on from the beginning. This is what the future of health care looks like, and it makes the work and expertise of school nurses more important than ever before.
We also look forward to recognizing school nurses and the wonderful work they’re leading through our first annual School Nurse Leadership Award. You can learn more about the award and download an application here.
We are accepting applications through March 7, 2014.