The damp chill that came and went with the clouds in Seattle made it feel more like October than April during the American Organization of Nurse Executives annual meeting this week. But the weather had little to do with why October was such a popular subject among attendees. The autumn month marks the start of Medicares policy to stop payment for hospital patients avoidable complications and injuries.
Economist and nurse Peter Buerhaus, director of Vanderbilt Universitys Center for Interdisciplinary Health Workforce Studies, cited Medicares switch as a potential boon for or threat to nurses as he set out an otherwise optimistic overview of his latest workforce analysis.
Buerhaus, with long-time collaborators David Auerbach, of the Congressional Budget Office, and Douglas Staiger, an economist at Dartmouth College, authored a just-released book on the nations chronic nursing shortage. His address to the Seattle conference covered the nursing workforces yearly gainsand lossessince the millennium, and major demographic changes behind any growth. He also offered a relatively upbeat forecast for future supply.
I am really quite bullish, he said. Growth in the nurse workforce surged last year, particularly in the last six months, after a modest rebound in 2006. After a net loss of more than 10,500 nurses in 2004 and 2005, healthcare gained roughly 18,700 nurses in 2006. The industry added a whopping 84,200 nurses last year despite a slight drop in real wages of 1.7%, which Buerhaus attributed to the flagging economy and the tumultuous housing market. Theres a lot of economics working to drive nurses into the workforce, he said.
Buerhaus and his collaborators have scaled back their projected shortage to 285,000 nurses by 2020. Thats compared to a shortfall of 765,000 by that same date that the trio of analysts forecasted five years ago, a figure Buerhaus said would have been catastrophic. We might as well just have the asteroid hit us and get it over with, he said.
Still, the nation faces a serious need for nurses, he said. And quality improvement effortsuch as Medicares financial incentives for quality reporting and performancemay help focus employers and policy-makers attention on nurses. An educated, prepared and numerically strong nursing workforce will help improve quality, he said. We have more friends than we ever had before.
But with that attention comes accountability and fear that nurses will be blamed for quality lapses and errors. (He took a moment to emphatically reject mandated nurse-to-patient ratios as a way to improve nursing performance and work conditions. Theres a time to regulate problems and a time to fix them, he said. Ratios are self-inflicted economic, political and social destruction.)
Medicares shift in October to no pay for no performance will help make a business case for the profession among hospital executives who see nursing as a sizable expense, said John Welton, an associate professor and faculty chairman at the Medical University of South Carolinas College of Nursing. This is the first time registered nurses directly affect revenue, he said.
The National Quality Forum has endorsed 15 quality measures that research has tied to nurse performance. Of them, three are among the preventable conditions that Medicare will no longer pay hospitals to treat: bed sores, catheter-associated urinary tract infections and falls. CMS in April proposed adding four nurse-sensitive measures to its pay-for-quality reporting effort in 2010 (April 21, p. 28).
Welton presented research before a rapt crowd of more than 350 attendees on how hospitals may bill Medicare based on the intensity of nursing care. Medicare pays for nursing as part of room and board. Adjusting Medicares billing to reflect nurses' time and skills will improve accuracy of healthcare's distorted payment system, Welton argued. Nursing lags way behind in its ability to demonstrate its value, he said.
It was Raymond Kurzweil, an inventor and prognosticator, who, of all the conference speakers, proposed the most unsettling solution for healthcares endemic waste and error.
Widely known as a scientist and entrepreneur, Kurzweil argues that information and technology evolve at an exponential rate.
Consider, he said, that an early computer at Kurzweils alma mater, the Massachusetts Institute of Technology, occupied an entire building. Consumers today carry infinitely more powerful computers in their pockets. Next, he said, computers will navigate our blood stream and brains to destroy disease and improve human capabilities.
Health and medicine are going to follow this progression, Kurzweil told the crowd. We are going to be able to transform who we are.
Kruzweils appearancehe delivered his remarks remotely, as a three-dimensional imagebolstered the sci-fi quality of his predictions. The inventor, also an author, film director and entrepreneur, appeared as a disembodied torso and head in a shaft of bright light. His arms trailed off into black with his hands emerging into the light as he gestured.
Manipulating genes that control fat storage will allow us to eat with impunity, Kurzweils disturbingly life-like image argued. Drug development will move from hit-or-miss discovery to tailored pharmaceuticals. Technology coursing through the blood will boost oxygen capacity and improve athletic performance, he said. Such advances are not an alien invasion coming over the horizon. Its going to expand who we are, he said.
Kurzweils spectral image and his faith in a technology-enhanced future (he described biology as sub-optimal compared with the promise of engineering and nanotechnology) appeared to unnerve some of the assembled nurses. One questioner opened with a gentle rebuke of a purely technological answer to human suffering by noting that spirituality plays a role in human caring.
Progress will allow us to transcend biology, but not humanity, Kurzweil countered.
Its a prediction, like the others, that will be tested by time.