Health Care Delivery Models and Nursing Practice Essay Paper
Health Care Delivery Models and Nursing Practice Essay Paper
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Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.
Include the following:
Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse\’s role and responsibility.
Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.
You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Health Care Delivery Models and Nursing Practice
Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse\’s role and responsibility.
A current health care law introduced to reform and restructure health care delivery is the Affordable Care Act (ACA), also dubbed Obamacare and PPACA. This is a comprehensive law enacted in March of 2010 with the intention of reforming the US health care system through three approaches. The first approach is to reform the insurance industry and health care access by making insurance more affordable and available to more Americans. Health Care Delivery Models and Nursing Practice Essay Paper Through the legislation, Americans are offered subsidies in the form of premium task credits that reduce the cost of health insurance for households whose incomes do not exceed the federal poverty level by 400%. The second approach is to expand the Medicaid program so that it now covers all adults whose incomes do not exceed the federal poverty level by 138%. The third approach is to support innovative medical care delivery techniques that are shown to generally lower health care costs. Overall, ACA has enabled more US citizens and legal residents to have health insurance (HealthCare.gov, 2020; The Henry J. Kaiser Family Foundation, 2017).
ACA has allowed more Americans to gain access to health coverage, and this has resulted in the seemingly inevitable shortage of health care personnel, particularly primary care providers. In fact, the shortage has become more acute over time. To address this concern, the health care industry has largely focused on increasing the number of nurse practitioners. However, this approach has been faulted for significantly increasing the cost of health care and eroding the gains made by the ACA. In a bid to develop a more acceptable solution, attention has shifted towards expanding the role of nurses so that they are allowed to provide patients with a much wider range of health care services. This moves allows advanced practice registered nurses (APRN) to provide primary care services that were previously exclusively provided by physicians. With at least a Master’s degree qualification, APRN are now able to provide a broader range of medical services to meet the health care needs of the increasing number of patients. These services include initial patients’ evaluations and extend to ongoing care for chronic conditions while also offering preventive services such as screenings and immunizations. Besides that, nurses are increasingly being allowed to practice independently to meet the increasing demand for health care so that Americans who rely on ACA are benefiting from increased access to health care. While nurse autonomy is yet to be achieved, ACA has provided opportunities for nurses to practice independently (Kongstvedt, 2016).
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Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
Pay for performance is a policy approach that ties reimbursement for health care costs to metric-driven patient satisfaction, best practice and outcomes. It is a value-based payment policy that links provider performance to financial incentives and disincentives. The intention is to ensure that payment for medical services is aligned with care quality and value (NEJM Catalyst, 2018). The policy has had a positive effect on patient outcomes. It has helped to drive the behavior of health care systems and medical personnel towards improving patient health outcomes, reducing the unnecessary use of expensive medical services when cheaper alternative services are available, and improving the quality of health care services delivered. To be more precise, the policy incentivizes primary care practices to achieve the quality indicators that support the goals of public health and clinical care. In addition, the policy has caused the health care industry to increasingly adopt integrated health information technology that deliver decision support and automated prompts thereby improving health care delivery and outcomes. These benefits are most apparent in areas that initially had poor baseline performance whereby hospital utilization rates have been reduced as patients report better care outcomes with reduced need for re-hospitalization (Mendelson et al., 2017).
The pay for performance policy seeks to improve health care quality by aligning reimbursement with the desired health care outcomes and processes. The policy seeks to address concerns of health care quality and safety in the face of growing nurse personnel shortages. The care provided by nurses is central to the policy in terms of ensuring optimal care outcomes and preventing poor outcomes. The policy requires that nurses not only provide care of excellent quality, but that they perform a wider range of health care acts. This is targeted at enabling nurses to leverage to leverage their knowledge, experiences and competence to provide competent care that makes use of the available resources and tools. In addition, nurses are now required to have closer collaborations with other medical personnel and professionals, and exercise judgment on behalf of their patients (Kongstvedt, 2016).
Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
An emerging trend is nurses becoming full partners with physicians and other medical professions thereby redesigning the health care system. There is a recognition that strong leadership and management skills among nurses is important for transforming health care towards promoting patient safety and quality care in diverse health care systems. This is important because there is an existing shortage of medical personnel, and nurses can help to alleviate the effects of the shortage by taking on more responsibilities in the primary care setting, to include leadership and management roles from the boardroom to the bedside. In serving as partners in health care, nurses become more accountable for their contributions towards the delivery of safe and high quality care while working collaboratively with other health professions. Although nurses have not traditionally been perceived as leaders and managers in health care systems, they must be leaders in designing, implementing, evaluating and advocating for the ongoing reforms in the different health care settings (Black, 2020).
In addition, they will need leadership and management competencies and skills in order to act as full partners with other health professions in the system reform and redesign efforts. Besides that, nursing practice and research continue to identify and develop evidence-based care improvements. It is only as leaders and managers that nurses gain the capacity to test and adopt these improvements across the different health care settings. As leaders and managers, nurses take on the responsibility of translating new research findings to the nursing education and practice environments, and into policy and practice. Additionally, nurses have taken on the role of patient advocates, and being strong in this role requires them to be involved in decision making on how to improve care delivery. Also, the new roles involve nurses taking the responsibility of identify areas of waste and problems, devising and implementing improvement plans, tracking the improvements over time, and making necessary changes to the improvements in order to realize established objectives (Ellis & Bach, 2015).
Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.
An emerging trend is the increasing adoption and use of virtual health technologies such as telehealth. It is clear that we are directionally headed towards a significant shift in the manner in which health care is delivered with outpatient services being increasingly virtualized. Covid-19 has helped to highlight and increase the shift as virtual care capacity is up scaled and telehealth as well as other digital health tools become mainstream in response to the need for social distancing (Padmanabhan, 2020). Nurses are professionally and educationally prepared to offer a broad range of medical services and skills across the health care continuum. With the shift towards virtual health technologies, nursing roles and practices will similarly transform. The presence of virtual health technologies creates a need for nurses to initiate timely and appropriate use of these technologies to ensure that the public receives the needed care. In addition, they will take on the role of collaborating with other stakeholders to develop new care delivery models and pathways to address reimbursement, safety and quality requirements, delegate tasks to broaden the caregivers’ spectrum, and strength clinical practice infrastructure. There will be a greater need for nurses to engage in collaborative health care delivery while building effective health care teams in order to optimize health care efficiencies, and improve patients’ experiences and care delivery via virtual technologies. As frontline health care providers who are consistently present in communities, it is critical for nurses to be positioned to support to support all aspects virtual health continuum. As transformational leaders, policy advocates, researchers, educators and clinicians, nurses must be included in the design and delivery of virtual health to ensure that care delivery is not compromised (Lau & Kuziemsky, 2016).
References
Black, B. (2020). Professional Nursing: Concepts & Challenges (9th ed.). Elsevier.
Ellis, P., & Bach, S. (2015). Leadership, Management and Team Working in Nursing (2nd ed.). SAGE Publications.
HealthCare.gov (2020). Affordable Care Act (ACA). https://www.healthcare.gov/glossary/affordable-care-act/
Kongstvedt, P. (2016). Health Insurance and Managed Care: What They are and how They Work (4th ed.). Jones & Bartlett Learning, LLC.
Lau, F. & Kuziemsky, C. (2016). Handbook of EHealth Evaluation: An Evidence-Based Approach. University of Victoria.
Mendelson, A., Kondo, K., Damberg, C., Low, A., Motuapuaka, M., Freeman, M., O’Neil, M., … & Kansagara, D. (2017). The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care. A Systematic Review. Annals of Internal Medicine, 166(5), 341-353. https://doi.org/10.7326/M16-1881
NEJM Catalyst (2018). What is Pay for Performance in Healthcare? https://catalyst.nejm.org/pay-for-performance-in-healthcare/
Padmanabhan, P. (2020). Beyond telehealth: the virtual care technology trends that will transform healthcare. https://www.healthcareitnews.com/blog/beyond-telehealth-virtual-care-technology-trends-will-transform-healthcare
The Henry J. Kaiser Family Foundation (2017). Summary of the Affordable Care Act. http://files.kff.org/attachment/Summary-of-the-Affordable-Care-Act . Health Care Delivery Models and Nursing Practice Essay Paper
