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. Healthcare Delivery models & Nursing Practice
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 a minimum of three sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide,
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Healthcare Delivery models & Nursing Practice
Rubric Criteria
Current or Emerging Health Care Law or Federal Regulation
33 points Quality Measures Pay for Performance, Patient Outcomes, and Effect on Nursing Practice
33 points Professional Nursing Leadership and Management Roles
33 points Predict Change in Nursing Roles and Nursing Practice
33 points Thesis Development and Purpose
8.25 point Argument Logic and Construction
8.25 points Mechanics of Writing (includes spelling, punctuation, grammar, language use)
8.25 points Paper Format (use of appropriate style for the major and assignment)
3.3 points
Healthcare Delivery models & Nursing Practice
The United States is one of the developed countries in the world with a lot of resources but that still does not have Universal Healthcare Coverage or UHC. What this means is that there is no single payer system for every citizen but disparate commercially run private healthcare insurance entities. This has made healthcare in the US to be one of the most expensive in the world (Sultz & Kroth, 2018). The system had for long required reform in terms of healthcare policy at the federal level but no administration dared to disrupt the status quo. A single payer system would have resembled what would have been known as “Medicare for All” or something close to that (Cai et al., 2020). It was not until the year 2010 when President Obama was in Office that he made one of the most audacious attempts at reforming the healthcare system and making it friendly to the common American citizen who has few means. This is the current federal law or healthcare legislative policy introduced to restructure the healthcare delivery system in 2010. It is referred to as the Patient Protection and Affordable Care Act 2010 in its long form. In short it is just the ACA 2010 or Obamacare (Kominski et al., 2017). The purpose of this paper is to look at the ACA 2010, its role in quality improvement and effects on nursing practice.
Current Federal Healthcare Regulation: The Patient Protection and Affordable Care Act of 2010
The ACA 2010 was introduced to make healthcare affordable to the poor and to bring some form of healthcare equity. To benefit from economies of scale, it brought the provision referred to as the individual mandate that required each and every person to take up the healthcare insurance by just paying a small premium. For those that are employed, it is the prerogative of the employer to take up the healthcare insurance. Failure to honor the individual mandate would attract a penalty (Kominski et al., 2017). The other provision that is favorable and revolutionary is that the ACA 2010 provided monetary incentives to payers to cover even pre-existing conditions such as diabetes mellitus, heart disease, and hypertension. Before the ACA 2010, payers would not cover such pre-existing conditions.
The ACA 2010 also brought an end to the practice whereby providers concentrated on producing volume at the expense of value or quality. It came up with the concept of pay-for-performance (Holmström, 2017). This is the provision that requires that for reimbursement to be honored, the provider must have provided care that is of the highest quality to the patient regardless of their socioeconomic status. The effect of this on nursing practice and the role and responsibility of the nurse is immense. To begin with, nurses would now have to educate and sensitize their patients that they should only expect the best care from any provider. This is their right and it is now protected by the law. Nurses would also be required to deliver only quality nursing care. This would especially apply to advanced practice nurses such as nurse practitioners who are also clinicians in their own right. With the requirement for value over volume and the pay-for-performance directive, the advanced practice nurses would need to only use evidence-based practice or EBP that is guaranteed to employ efficacious interventions backed by scholarly evidence (Melnyk & Fineout-Overholt, 2019; Spath, 2018). This would be best practice and the gold standard for practice. Healthcare Delivery models & Nursing Practice
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How Quality Measures and Pay-for-Performance Affect Patient Outcomes
The quality measures and requirements that the ACA 2010 brought including the provision for pay-for-performance have a direct impact on patient outcomes. This is because having been entrenched into law; the providers are now forced to only use those interventions that they are sure will be effective in treating the patient. Failure to do this would result in missing on reimbursement and also not meeting the pay-for-performance criterion. The only form of practice that can guarantee these kinds of efficacious interventions is evidence-based practice or EBP. EBP is a quality improvement drive which would enable the providers and nurses to deliver care that is efficacious and effective. In other words, EBP enables the delivery of care that is safe, timely, effective, efficient, equitable, and patient-centered. These are the six domains of quality care as advanced by the Institute of Medicine or IOM (AHRQ, 2018). EBP meets all these domains.
The effect on patient outcomes is such that the quality measures necessitating EBP lead to the situation in which the length of hospital stays is reduced for the patient. They get better quicker because of EBP and quality care and can go home earlier. This means that they now spend less on healthcare than previously. There will also be less re-admissions, fewer hospital-acquired infections such as ventilator-associated pneumonia (VAP), and generally reduced morbidity and mortality. The expectations and responsibilities of the nursing role in these situations is such that the nurse is the custodian of the rights of the patient. They must then ensure that the patient gets what the law says that they should get. They themselves must henceforth be in the forefront in delivering quality care through only EBP. The expectation is that patient outcomes would improve for the better and patient satisfaction would increase significantly.
Emerging Professional Nursing Leadership and Management Roles
The emerging professional nursing leadership and management roles that have emerged according to the above developments point towards the preference for transformational nurse leaders who can motivate, empower, inspire, and promote he nurses working under them (Choi et al., 2016). This way the nurses have psychological safety at the workplace and do not suffer from stress and anxiety of impending victimization from the nurse leaders. In such an environment with transformational nurse leadership, the nurses are so comfortable that they commit fewer errors. Moreover, even if they commit an error they are willing and ready to disclose it to their transformational nurse leader because they know they will not judge or victimize them but employ the tenets of just cause. The result is that patient safety is promoted in diverse healthcare settings and the patient receives the best care and satisfaction all the time. Turnover intention also drops among the nurses and job satisfaction increases. A nurse who is satisfied will enjoy their job and only deliver the best quality care they can. The net result is less errors and better patient safety. Healthcare Delivery models & Nursing Practice
Emerging Trends
The predictions that I can make with regard to emerging trends are that nursing will embrace technology more and more than before; and nurses will also seek better education than before to become better. Technology has been touted as a panacea and silver bullet for the problem of errors within the healthcare industry. This is true as can be attested to by those nurses who have used and know the usefulness of computerized clinical decision support systems embedded in electronic health record (EHR) systems. Better education will also make the nurses better in delivering evidence-based care.
Conclusion
The ACA 2010 revolutionized healthcare in the United States. With it came the provision for quality or value over volume and the requirement for pay-for-performance. These provisions have had the effect of better quality services that have improved patient outcomes across the board.
References
Agency for Healthcare Research and Quality [AHRQ] (2018). Six domains of health care quality. https://www.ahrq.gov/talkingquality/measures/six-domains.html
Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., Bertozzi, S., White, J.S., & Kahn, J.G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLOS Medicine, 17(1), 1-18. https://doi.og/10.1371/journal.pmed.1003013
Choi, S.L., Goh, C.F., Adam, M.B.H., & Tan, O.K. (2016). Transformational leadership, empowerment, and job satisfaction: The mediating role of employee empowerment. Human Resources for Health, 14(1), 73. https://doi.org/10.1186/s12960-016-0171-2
Holmström, B. (2017). Pay for performance and beyond. American Economic Review, 107(7), 1753–1777. https://doi.org/10.1257/aer.107.7.1753
Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. https://doi.org/10.1146/annurev-publhealth-031816-044555
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Spath, P.L. (2018). Introduction to healthcare quality management, 3rd ed. Health Administration Press.
Sultz, H.A., & Kroth, P.J. (2018). Sultz and Young’s health care USA: Understanding its organization and delivery, 9th ed. Jones & Bartlett Learning.
Healthcare Delivery models & Nursing Practice