Value-Based System
In the value-based healthcare model of delivery of healthcare, providers, incorporating physicians and hospitals, are enumerated depending on the health outcomes of the patient. In this type of care system, the reward that the providers receive is dependent is based on a number of factors (Catalyst, 2017). These include decreasing the incidence and effects of chronic diseases in patients, improving the health of patients, and enabling the patients to live lives more healthily. Unlike the fee-for-service system, value-based care does not reward providers based on the amount of work that they do. In vale-based practice, yearly value expectations and incentive payment percentages, for every patient discharged, are set by insurers, for example, Medicare. Those who purchase health care have a provision of making informed decisions that consider quality, price, access, incentives alignment, and efficiency. Value-based is a type of reimbursement that links the payments for the delivery of care to the care quality being provided and offers rewards for both effectiveness and efficiency. This reimbursement form has provided a potential and alternative replacement for paying a fee for the services being delivered.
Transformation of Current Practice
Value-based care has transformed the nursing practice immensely. First, the nurses to patient ratio has dramatically decreased. Hence, there has been a reduction in the number of hours which patient works, therefore, a decrease in workouts and stress levels. Thus this has resulted in many nurses focusing on more on their patients, especially during the vital procedures. Moreover, this has resulted in improved patient care and an increase in the mental health of the patients since they are experiencing less mental strain (Catalyst, 2017). This care system has also improved the salary of many nurses. This is because, as opposed to the fee-for-service system, the outcome of the nurses, which usually goes unnoticed, especially in the hospital setting, is recognized. Also, this care system has led to alleviation of the frustration and hardships which are experienced by the nurses as a result of the discontinuity of care when the specialists are either unavailable or inaccessible. However, there has a breakdown in the usage of electronic health records by the majority of the nurses. This is because, for example, in a twelve-hour shift, a nurse might be required to perform a service such as the removal of a catheter. Most of the time, since the focus is based on output, nurses tend to focus on patient care and forge the electronic documentation. Also, at certain times, the nurses often tend to focus on the documentation and forget on the desired quality.
Value-based care results in the improvement of the overall health of the patients as compared to the management of acute episodes of care. This is because, in value-based care, the providers of health care do not only focus on the symptoms of the patients but also other comorbidities and pre-existing conditions (Hillary et al., 2016). This results in reducing the costs which are associated with the management of chronic diseases hence saving some funds up for the installation of telehealth technologies in a health institution.
Value-based care has adversely affected many physicians. First, it has resulted in too many bureaucratic tasks for the physicians. These include tasks such as documentation, paperwork, and chatting. Moreover, this system has resulted in doctors spending more hours at work. This results from doctors strictly following patient-centered care. In this approach, doctors focus on the needs of each patient, and this may result in them spending more time on a patient hence long working hours. Moreover, the value-based system has resulted in many patients feeling that the doctors are offering poor quality services. This is because doctors spend most of their time documenting, collecting data, and analyzing, which may compromise the doctor-patient relationship.
The distinction between fee-for-service and Value-Based Care.
In the fee-for-service system, the providers of healthcare do not have the necessary technologies and incentives which are required to coordinate the provision of care continuum hence hindering the quality of care which the patients receive. In most cases, the fee-for-service model promotes the siloing of physicians since they work independently, and ultimately this results in a drastic increase in the health care costs which the patents incur (Hillary et al., 2016). The fee-for-service model sensitized the providers of healthcare to order more tests and procedures. Besides, this has enhanced the mismanagement of patients since physicians may hospitalize patients over minor conditions or symptoms to ensure they are paid more. In value-based care, the physicians engage more with the patients, provided care that was specific to each patient and availed equipment and technologies important in the diagnosis and management of various conditions (Hillary et al., 2016). The value-based model also enables documentation, data analysis, and reporting of patient information hence offering patient history and evidence-based practices evident. This system also allows a healthcare continuum where the health practitioners can link and provide quality healthcare services.
The reimbursements in the value-based model are calculated via many quality measures determinants of the general population health. As opposed to the fee-for-service system, this system is based on data since the providers have to make reports of specific aspects of health and illustrate improvements. It necessitates the providers of health care to follow-up and report readmissions into hospitals, population health, adverse events, and engagement of patients. In this new model, the providers of health care are encouraged to be more information technology compliant and learn to apply what telehealth in patient care. The value-based system has more positive patient outcomes as compared to the fee-for-service model.
Physicians and Nurses sharing power
The power-sharing between the nurses and physicians has shifted over time. In the past, the physicians used to view the nurses as their subordinates. The physicians used to give the nurses orders with the notion that the nurses were expected to implement them. In most cases, these negatively impacted the quality of health care being delivered to the patients. This is because, in case of errors, the nurses were scared or felt inferior to point them out to the physicians hence negatively impacting the patient outcomes.
Currently, in our healthcare system, the nurses recognize that nurses are vital people in health care provision. Physicians respect the nurses. They understand the roles which the nurses play the provision of care. In the current practice, the physicians involve the nurses in making decisions affecting the care of patients (Hillary et al., 2016). Physicians discuss the patient history of patients, management plans, and follow-up plans with the nurses. In most scenarios, once the doctors draw samples from the patients for laboratory examination, the nurses follow-up on the results from the laboratory. They, therefore, discuss the results of the tests and hence determine the diagnosis of the patients and the approaches to use.
However, some physicians still have a superiority complex hence find it difficult to share power with the nurses. Some doctors do not involve the nurses in the decision-making process, and they make patient care decisions independently. They do so since they feel that the nurses may be able to expose their faults of malpractices concerning patient care (Catalyst, 2017). This dominance by physicians often results in the imbalance in power in the health care firm. This also results in physicians not embracing the role which the other members of the health care personnel play in healthcare. This leads to physicians overlooking specific health care processes hence not offering holistic care to the patients, therefore, leading to poor health outcomes.
In specific scenarios, in our setting, some doctors have previously worked with nurses who were incompetent or lacked enough clinical experience. This impacted on their view of the role and competency of nurses regarding the care of patients. Hence, they feel that the nurses are not their equals about the patient care, thus making them feel powerful over the nurses. This results in doctors overlooking the input from the nurses, which may influence the quality of patient care hence negatively impacting the care of patients.
Conclusion
The shift from fee-for-service to value-based care has had a significant impact on the care of patients. Initially, physicians were paid based on the number of patients they saw and the duration of care provision that they put into practice. Moreover, the patients had to spend more time and funds to access care, especially for chronic conditions such as hypertension and diabetes. Also, few technological resources were available for the advancement of quality care provision and provision of a continuum of healthcare. In the value-based care model, physicians are paid based on the quality of the healthcare output they provide. This ensures that the holistic needs of the patient are made.
Moreover, this system has led to the adoption of various technological advancements aimed at improving the quality of care. Patients spend more time with the physicians, and they acquire a complete check-up, which saves on the cost of booking appointments with specialists. However, the value-based system has negatively impacted on the health care providers also since they work for a long duration, and spend most of the time feeding data into the electronic health records and reducing.
References
Catalyst, N. E. J. M. (2017). What Is Value-Based Healthcare?. NEJM Catalyst, 3(1).
Hillary, W., Justin, G., Bharat, M., & Jitendra, M. (2016). Value based healthcare. Advances in Management, 9(1), 1.