Resource Management Essay Discussion Paper
Resource Management Essay Discussion Paper
Using the conditions listed in box 11.1 ( see attachment) in the Joel textbook, identify and discuss two different conditions that may have a significant impact on revenue in the care setttings, in the Family Practice.
Describe how these conditions might affect how Advance Practice Nurses provide care in these settings? Resource Management Essay Discussion Paper
Resource Management
Identify and discuss two different conditions that may have a significant impact on revenue in the care settings, in the Family Practice.
Foreign object retained after surgery and blood incompatibility are two different conditions under hospital-acquired conditions (HAC) that may have a significant impact on revenue in the care setting. The two conditions have significant negative effects on revenue through placing payment at risk, financial fines, creating opportunities for malpractice claims, and negatively affecting reputation. Firstly, they place payment at risk as they are adverse events that should never occur so that Medicare is unlikely to pay for them. State Medicaid payment is also likely to be withheld for the two HACs. The Centers for Medicare and Medicaid (CMS) recognizes that the two events add significantly to the average total cost of caring for a patient, and has implemented a policy not to reimburse hospitals from the added costs brought about by the two conditions. This implies that any claims that a hospital makes for either one of the two conditions would be refused, so that the hospital has to absorb the cost of additional care rather than submitting a claim to Medicare. In addition to CMS, private insurers also refuse to pay for HACs. Secondly, the hospital is likely to be fined for the HACs. An example of this is seen in California State where hospitals have been fined for HACs since 2009 as they are fined $75,000 for the first event, $100,000 for the second event, and $125,000 for subsequent events within three years (Helming, Shields & Avino, 2020). Resource Management Essay Discussion Paper
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Thirdly, it creates opportunities for malpractice claims. When a patients become aware that either one of the two HACs occurred, then a lawsuit or settlement is likely to follow. In fact, many states allow plaintiffs to file for malpractice litigation for malpractice following a HAC occurrence even years after the event occurred. Many of these lawsuits rely on the doctrine of res ipsa loquitor (the thing speaks for itself) as there would be injuries that would otherwise not occur without negligence. This doctrine infers negligence while shifting the burden of proof to the defendant. The financial fallouts from HAC lawsuits end up costing the hospital a lot of money paid in legal representation, settlements, defense and cost containment (Milstead & Short, 2019). Finally, it has a negative effect on reputation so that the hospital loses some of its market share. With the occurrence of the two HACs, the hospital’s brand would be damaged from the publicity surrounding the cases. While the cost of lost reputation is difficult to accurately estimate in terms of dollar amounts, it is considerable as the media would typically pile on the case while citing and sensationalizing grim details so that other patients are less confident in receiving care from the hospital (Raingruber, 2017).
Describe how these conditions might affect how Advance Practice Nurses provide care in these settings?
An awareness of the two HACs and need to prevent their occurrence has resulted in Advanced Practice Nurses (APN) adopting deliberate prevention strategies. In this case, APN understand that they are the frontline defense for applying practices to prevent the HACs. This involves recognizing and applying evidence-based procedures to prevent the HACs. Also, they perform, monitor and assure compliance with prevention practices, provide knowledgeable collaborative oversight, and serve as the primary resource (Stanley, 2017).
Besides that, the APN provide leadership in the prevention efforts as they recognize that although HACs occur, many of them are attribute to system problems that impact processes used by medical personnel. The APN intervene by evaluating the professional impact of the surgical staff based on the outcomes that demonstrate that nursing and medical orders are properly completed, that sentinel events did not occur, clinical judgment was properly utilized to improve care, and that the patients leave in better or stable health than when they arrived (Schmidt & Brown, 2019).
In addition, they take the responsibility for risk reduction by collaborating with other medical personnel in communication, teamwork and safety strategies that are critical requirements to avoid HACs and provide reliable care. If evidence-based practice is not delivered as indicated, then the APN have a professional obligation to demonstrate leadership by developing methods to improve care through influencing standards cultures and expectations to implement best practices (Schmidt & Brown, 2019).
References
Helming, M., Shields, D., & Avino, K. (2020). Dossey & Keegan’s Holistic Nursing: A Handbook for Practice (8th ed.). Jones & Bartlett Learning, LLC.
Milstead, J. & Short, N. (2019). Health Policy and Politics: A Nurse’s Guide (6th ed.). Jones & Bartlett Learning.
Raingruber, B. (2017). Contemporary Health Promotion in Nursing Practice (2nd ed.). Jones & Bartlett Learning, LLC.
Schmidt, N., & Brown, J. (2019). Evidence-Based Practice for Nurses: Appraisal and Application of Research (4th ed.). Jones & Bartlett Learning, LLC.
Stanley, D. (2017). Clinical Leadership in Nursing and Healthcare: Values into Action (2nd ed.). John Wiley & Sons, Ltd.
