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American Academy of Nurse Practitioners National Conference

June 22, 2011
Las Vegas, NV

Remarks as prepared for delivery

Thank you, Penny, for that introduction. And thank you for your great leadership on behalf of nurse practitioners and patients across the country.

It’s good to see so many of you here this morning. Being in Las Vegas, I’m not sure whether you just woke up or you’re about to go to sleep. But either way, it’s good to be with you, and I want to take this opportunity to thank you for the incredible work you do every day. In big cities and small towns, in teaching hospitals and community health centers, America’s more than three million nurses and nurse practitioners are the heart and soul of our health care system.

But you have always been much more than healers. People remember Florence Nightingale as the “lady with the lamp,” but they often forget that she was also a statistician and one of the first people to think rigorously about reducing health care infections. Linda Richards is known as the first trained American nurse, but it’s not always mentioned that she also developed one of our nation’s first health record systems. Dorothea Dix is famous for providing compassionate care to Union and Confederate soldiers alike during the Civil War, but she also helped transform the way we treat mental illness.

Nurse practitioners in particular have a central role in health care delivery that has always helped you spot flaws in the system. And your deep commitment to your patients, including the most vulnerable among them, has also made you powerful advocates for fixing those flaws.

That’s why, over the last fifty years, there have been no more committed, passionate, and effective supporters of health reform than America’s nurse practitioners. And last March, when health reform was finally enacted, we were reminded of a valuable lesson: it may take them a while, there may be battles along the way, but in the end, nurses usually prevail.

The legislation many of you worked to pass, the Affordable Care Act, is the most transformative health legislation since Medicare. Thanks to the law, Americans now have the protection of a new Patient’s Bill of Rights that ends the worst insurance abuses like canceling someone’s insurance just because of paperwork error. We’ve ended the practice of denying health coverage to children because they have asthma or diabetes. And we’re working with states to set up a new insurance marketplace in 2014 that will allow us to say for the first time in our history, that all Americans have access to affordable health coverage.

How you care for your patients should not be determined by private insurance companies, and we’re going to keep working to put these decisions in the hands of patients and their nurses and doctors where they belong.

But as nurse practitioners, you know that the problems in our health care system don’t end with a broken health insurance market. America’s health care providers have the best training in the world. You work in the most advanced hospitals and clinics and have access to the latest equipment and medications. Your commitment to your patients is unquestionable.

And yet, by almost any measure, Americans live sicker and die sooner than people in similar countries around the world. Far too many Americans pass away before they ever get to hold a grandchild. Far too many suffer chronic pain or sickness that could have been prevented. Far too many families have to sell their homes or empty their college savings to pay their astronomical medical bills.

The fact that our overall outcomes fall short in spite of your heroic efforts is a result of deep, systematic flaws in the way we deliver care.

These are flaws you see every day. You see it when one of your patients is readmitted to the hospital because no one checked to make sure they were taking their medication correctly. You see it in children who have already developed type 2 diabetes because they have no access to healthy foods or safe places to exercise. You see it in the people who go without primary care altogether because there are so few providers in their community.

But you also know that each one of these flaws is an opportunity to improve care and health. And that’s what I want to focus on today.

A lot of attention has been focused on the insurance reforms in the health care law. And they’re long overdue. But the second part of last year’s health care law – the part that generates less discussion, but may be even more important in the long run – are a set of reforms that will help improve the way we deliver care in this country.

And there’s no one I’d rather be talking to about these reforms than you because when it comes to the changes we need to make – from putting a greater focus on prevention and primary care, to promoting better coordination between providers, to adopting best practices to reduce medical harms – nurse practitioners are at the center of every one of them.

Let me give you a few examples.

We know that the best way to keep people healthy is by preventing illnesses before they happen and catching small problems before they turn into big ones. That’s why the health care law eliminates co-pays and deductibles in Medicare and all new health plans for key preventive care from BMI screenings to mammograms to Pap tests.

But Americans won’t take advantage of these benefits unless they know about them. And that’s where you come in. As the clinicians who often provide this care, we need you to make sure your patients know that these services are now available at no additional cost. The health care law has opened a door, but we need you to show people the way through.

We also know that cost isn’t the only barrier to preventive care. Too many Americans today don’t get critical screenings and checkups for the simple reason that we don’t have enough primary care providers, especially in our smallest towns and biggest cities.

That’s why we’ve made a historic investment in our primary care workforce, whether it’s doubling the size of the National Health Service Corps or providing new funding to help health centers to serve nearly three and a half million new patients. And the health care law makes special investments in our nursing workforce, from educating more nursing professors, to helping more minority students fulfill their nursing dreams, to creating more nurse-managed health clinics.

But we can’t meet the demand for primary care in this country without your help. Today, nurse practitioners are the fastest growing category of primary care providers. If we’re going to make sure every American has access to a primary care provider, we are going to need you to work with us to make it happen.

That said, you also know that no single provider can meet patients’ complex needs today. Consider that in Medicare, the one fifth of beneficiaries with five or more chronic conditions account for two thirds of total spending. On average, these beneficiaries see 14 different doctors a year, without even counting nurse practitioners, pharmacists, nutritionists, counselors, and other health professionals. To deliver the best care, these providers need to be talking to each other. But in a system in which there’s no billing code for coordinating care, you know that doesn’t always happen.

That’s why the health care law invests in promising models like health homes in which providers work together in teams. But it’s going to be up to you to put these models into practice. We can change the payment incentives and provide technical support, but it’s going to be you, in your hospitals and clinics, who create and hone these models.

This is the same message I’ve been carrying around the country as part of a new national campaign to reduce medical errors we call the Partnership for Patients.

We started this partnership because of two facts. First, we know that as many as one out of three patients are harmed by the care they receive in the hospital. Second, we know that for almost every one of these harms, there are health systems across the country that have reduced or even eliminated them.

Our goal is to help these best practices spread. In just two months, we’ve already had thousands of partners join us, including Fortune 500 companies, some of the country’s largest health insurers, and more than 1,500 hospitals. And it was no surprise to any of us that one of the first organizations to join was the American Academy of Nurse Practitioners.

Nurse practitioners have been leaders on improving health care quality in your own hospitals and clinics, long before this became a national issue. In fact, the story I hear over and over again when I visit model health systems is that big improvements in quality started when nurses and nurses practitioners got involved.

So we need you to be involved. We know that the most successful health systems are those in which everyone is empowered to improve the quality of care from nurses to doctors to administrators to support staff. Wherever you work, whatever your duties, we need you to be crusaders for quality.

Now, think about the ideal health care system we just described – one in which the focus is on keeping people healthy not just treating illnesses, in which patients are cared for by a team led by their primary care provider, in which best practices are consistently applied to improve outcomes. That doesn’t sound a lot like the health care system you see on TV hospital shows. But it does sound a lot like what you do every day.

That’s why we need you to be leaders in implementing the health care law just like you were leaders in passing it. We need you to devote yourself as you always have, not just to providing the best care to your patients, but also to improving care for all patients.

It won’t be easy. But nurse practitioners have never shied away from these challenges. You didn’t listen when skeptics said you couldn’t run your own clinics or questioned your new roles in hospitals. You didn’t listen to the cynics who said that health reform would never pass. And you’ve stood tall against those who want to roll back the law, take back the investments in our primary care workforce, and return to the days of denying children coverage because of their pre-existing conditions.

The attitude of the nurse practitioners I’ve met is summed up by the words of Clara Barton. “I have an almost complete disregard of precedent,” she once said “and a faith in the possibility of something better. It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past.”

For years, you have fought for your patients, whether it’s for better care in a hospital or clinic or better health policies on the national stage. Now that health reform has passed, we need your help more than ever – to defend the law’s benefits against repeal, but also to make sure those benefits reach the patients you care for every day. When it comes to health care in America, I share your faith that in the “possibility of something better.” And I look forward to continuing to work with you to achieve it.

Thank you.