Clinical Nurse Specialists

Leaders in Managing Patients With Chronic Conditions

Mary P. Hansen; Mitzi M. Saunders; Cynthia R. Kollauf; Ludmila Santiago-Rotchford


Nurs Econ. 2019;37(2):103-109. 

In This Article

CNS Impact on the Triple aim

The Triple Aim represents the simultaneous pursuit of improving population health, enhancing patient satisfaction, and reducing healthcare costs (Berwick, Nolan, & Whittington, 2008). The Centers for Medicare & Medicaid Services (CMS) created new challenges for systems when it began to shift from a volume to a value-based purchasing (VBP) model. This swing from volume to VBP focused on quality metrics with specific requirements for decreased emergency department utilization and hospital readmissions (Tompkins, Higgins, & Ritter, 2009). By 2018, the HHS planned to transition 90% of Medicare reimbursement to VBP (CMS, 2016). The demands of achieving the outcomes of the Triple Aim associated with a rapidly changing healthcare environment create increased stress for healthcare providers (HCPs) that fuel burnout and undermine its achievement.

Attention has recently been drawn toward a Quadruple Aim focus which embraces the three legs of the Triple Aim (cost, quality, and satisfaction) and also addresses the work life of the HCP. An unfavorable work life leads to burnout and threatens the Triple Aim. Allowing full scope of practice to every HCP reduces burnout and improves care (Bodenheimer & Sinsky, 2014). Systems that accommodate a structure allowing the CNS to influence nurse, patient, and system spheres of care are positioned more readily to achieve, not only the Triple Aim, but the Quadruple Aim. Ongoing healthcare reform continues to highlight the added value a CNS brings to the treatment team (NACNS, 2013). HHS recognized a cost savings of $330 million per year for hospitals that aligned privileges of non-physician providers, which includes APRNs, with state laws and scope of practice acts (HHS, 2012). Evidence within the literature supports the positive impact of CNSs on the Triple Aim.