Healthcare Delivery Models and Nursing Practice
An emerging health care law or federal regulation introduced to reform the health care delivery system and its effect on nursing practice and the nurse’s role and responsibility
The U.S. healthcare delivery system is undergoing extensive, far-reaching, and profound reorganization directed towards reducing cost and enhancing healthcare value. The Affordable Care Act signed into law by President Obama in March 2010 is one of the latest restructuring processes put into place to better the health care delivery system that aims to: improve accessibility and affordability of healthcare to Americans, expand consumer protections, and improve administrative efficiency (Department For Professional Employees, 2016). An essential stipulation of the ACA was the innovation of health insurance marketplace interchanges where people that cannot access employer-provided insurance schemes such as Medicaid/Medicare can shop for health insurance. The Affordable Care Act also includes schemes now led by the Centers for Medicare and Medicaid Services, whose objectives are the enhancement of quality and cost control. This is done by encouraging more team-work, coordination, and synergy of care across different backgrounds and amongst various healthcare providers.
The anticipated outcomes are the enhancement of the quality of care, and decrements of unnecessary expenditures (accredited to unnecessary hospital admissions, unwarranted use/misuse of emergency department resources, repeated/unjustified use of imaging modalities and diagnostic testing, and innumerable prescriptions) (Echevarria, 2017). The overall effect of this has been remarkably reduced the number of Americans not covered by insurance and an increase in health-seeking behavior, which translates to a scarcity of medical professionals, particularly nurses.
These transformational repositions require a new, intensified, and accentuated expertise, knowledge, and positive attitudes centered around general wellness, patient and family-centered care, care coordination, data analytics, and quality enhancement. Nurses are well situated to promote and advance the restructuring happening in the healthcare sector, albeit with small modifications of their roles and responsibilities, by being wholly contributing constituents of the integrated multi-disciplinary team as the focus is repositioned from a periodical, provider-based, fee-for-service care to interprofessional, integrative, multi-disciplinary, patient-centered care across the consecution that promises to deliver flawless, irreproachable, accessible, and quality care (Echevarria, 2017).
Focusing on wellness, preventive medicine, health awareness schemes, and initiatives to tackle environmental and social predispositions to illness should be addressed by the whole nursing faculty from the chief nursing officer to the staff nurse proactively and ardently to take equal precedence of focus as the illness-focused healthcare delivery system currently in place (Echevarria, 2017).
Patient and family-centered care require the involvement of patients and their families in the delivery of healthcare. Nurses are perfectly suited for this role since nursing, in general, encompasses a comprehensive, holistic, patient, and family-centered approach that encourages their participation in the delivery of healthcare. This creates a mutual comprehension of expectations, joint decision making, organization, and mapping out of treatment plans, and harmonization of preventive and post-discharge/follow up care, which creates an avenue for the provision of the necessary information to subsequent healthcare providers thus eliminating duplicative ordering (Echevarria, 2017).
Care coordination is an essential requirement for better quality, service, and cost optimization per unit of service. It incorporates consolidative exercises of communication and the marshaling of befitting resources and personnel, which consolidates the fragmented healthcare delivery system making it amenable. The ACA has set out objectives to reduce the fragmentation of care that has been associated with unnecessary hospital admissions, unwarranted use/misuse of emergency department resources, repeated/unwarranted use of imaging modalities and diagnostic testing, and innumerable prescriptions which all inflate the cost of healthcare provision. Nurses possess the clinical and management adeptness required to: facilitate coordinated care processes and execute rapid-cycle enhancements in response to clinical data, which makes them ideally suited for helming care across the continuum (Echevarria, 2017).
A discussion of how quality measures and to pay for performance affect patient outcomes, nursing practice and the expectations and responsibilities of the nursing role in these situations
The ACA, through the Centers for Medicare and Medicaid Services, is pioneering a value-based healthcare delivery system with an assortment of remittance models that comprise of several pays for performance systems (The Hospital Value-Based Purchasing Program (VBP), the Hospital Readmissions Reduction Program (HRRP), and the Hospital-Acquired Condition (HAC) Reduction Program) (NEJM Catalyst, 2018). Pay for Performance/value-based payment entails remittance models that affix economic incentives to healthcare provider performance. It forms a component of the broad-brush, comprehensive national program to restructure healthcare to a value-based delivery system that tallies remittance with value and quality (NEJM Catalyst, 2018). The pay for performance systems in healthcare delivery accentuates and advocate for quality over quantity by channeling resources towards efficient clinical procedures, which encourages constructive, incontrovertible health outcomes (NEJM Catalyst, 2018). The system also promotes transparency and accountability, motivating organizations to safeguard fortify their reputations by offering value for money and quality healthcare services (NEJM Catalyst, 2018). There has also been an overall reduction in the number and severity of adverse outcomes of treatment following the implementation of this system. The available literature suggests that overall, the pay for performance system ameliorates healthcare delivery, but the immensity and significance of this improvement is not lucid (Deborah Korenstein, 2016).
Nurses are crucial elements in this cross-sectional fragment of healthcare reform. The value-based remittance program advocates that the remuneration for Skilled Nursing Facilities is offered based on the quality of care that they offer. The Protecting Access to Medicare Act of 2014 (PAMA) added sections that required Skilled Nursing Facilities under the value-based remittance program to: undergo appraisals based on their performance on a hospital readmission measure, be awarded for enhancement and achievement, receive periodic (quarterly) personal recommendation reports regarding their performance and to earn incentive remuneration based on their performance (Medicare, 2020).
A discussion of 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
The U.S. healthcare delivery system is undergoing extensive, far-reaching, and profound reorganization directed towards the reduction of cost and enhancement of the healthcare value. Nurses are the sole biggest licensed consummate in the healthcare delivery system, practicing in just about every circumstance. In this contexture, they have been forced to undertake new crucial duties and responsibilities to enhance the quality of care, health, and value. These new roles require the nurses to be proficient at appreciating the influence of the community attributes on patients and populations, to formulate and execute care coordination programs (assuming the role of care coordinators), to influence clinical data and automation technology to enhance patient care (assuming the role of informatics experts), and to cooperate and affiliate efficiently with varied teams of healthcare providers (assuming the role of care managers) (ERIN FRAHER, 2015).
Emerging trends. 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
Nurses in improved and reconceptualized roles are going to be vital if the United States is to execute the requisite restructuring of its healthcare delivery systems where evolution in healthcare technology is happening at a breakneck pace. This means that nurses have to be alert and on their toes to make sure they can keep up with current trends. Remote monitoring devices, ultramodern contemporary patient simulators, various forms of electronic communication, and a general increase in technology utilization in the healthcare setting has come up as one of the essential emerging trends in telemedicine. The nursing staff must be amenable to learning about new systems and equipment. This will enable them to provide real-time patient care in response to varying physiological parameters based on scientifically valid protocols to enhance the quality of care offered.
Preventive care is another trend. Focusing on wellness, preventive medicine, health awareness schemes, and initiatives to tackle environmental and social predispositions to illness should be addressed by the whole nursing faculty from the chief nursing officer to the staff nurse proactively and ardently to take equal precedence of focus as the illness-focused healthcare delivery system currently in place. This means that nurses will experience an escalation in demand and collaboration with other healthcare providers, which will allow nurses to participate and own the decision-making process in regards to the provision of high quality interdisciplinary medical care.
References
Deborah Korenstein, K. D. (2016). Do health care delivery system reforms improve value? The jury is still out. History Of The Human Sciences, 55-66.
Department For Professional Employees. (2016, August 15). The U.S. Health Care System: An International Perspective. Retrieved June 2, 2020, from Department For Professional Employees: https://www.dpeaflcio.org/factsheets/the-us-health-care-system-an-international-perspective
Echevarria, S. W. (2017, February 7). Healthcare Transformation and Changing Roles for Nursing. Retrieved from Orthopedic Nursing: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266427/
ERIN FRAHER, J. S. (2015). Nursing in a Transformed Health Care System: New Roles, New Rules. Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative.
Medicare. (2020, April 8). Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program. Retrieved June 3, 2020, from Medicare.gov/NURSING HOME COMPARE: https://www.medicare.gov/nursinghomecompare/snfvbpdata.html
NEJM Catalyst. (2018). What Is Pay for Performance in Healthcare? New England Journal of Medicine.