Health Care Delivery Models and Nursing Practice Paper
Health Care Delivery Models and Nursing Practice
There have been several changes in the United States healthcare system. These changes have been effected to improve the safety and quality of health care services. The purpose of this paper is to explore a health care reform introduced recently, its effects on the roles and responsibilities of nurses, and the impact on nursing practice, and describe how pay for performance and quality measures affect patient outcomes, arising management and leadership roles for the professional nurses.
Health Care Law Reforms
The Sustaining Excellence in Medicaid Act of 2019 (HR 3253) is a recent federal law that reforms the health care system in the United States. Debbie Dingell, the Michigan representative, introduced the bill to the 116th Congress on 13th June 2019. It was signed into law on 6th August 2020. The bill was intended to provide some extensions in some provisions to restructure the Medicaid program (Dingell, 2019). The bill allowed Medicaid appropriations through to the 2024 fiscal year. The bill also authorized the state to enablefraud units to examine and consider complaints launched by non-institutionalized patients. This is a vital reform as it removes disparities arising from ignoring complaints from such patients who legally qualify for cover under the Medicaid program.
Sections II and III of the bill discuss the extension of the community health services demonstration program and extension of protection for Medicaid recipients ofhome and community-based services against spousal impoverishment, respectively. At times, Medicaid denies cover to spouses from low socioeconomic backgrounds. The bill extends cover to such people, including those receiving community-based and home-based medical services. Besides these reforms, the bill requires drug manufacturers always to include the cost of generic drugs in the determination of prices. This is intended to reduce the wholesale acquisition cost for new drugs and biologicals. Furthermore, the bill allows rebate calculations by excluding drug manufacturers from the definition of wholesalers dealing with drugs.
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The bill affects nursing practice and the roles and responsibilities of nurses. For instance, the bill extends Medicaid coverage to spouses and protects them from impoverishment. This reform extends the roles and responsibilities of nurses. The nurse should identify patients affected by spousal poverty, limiting their access to quality care and educating them on the changes. By doing so, the nurse would assist impoverished individuals in accessing safe and quality health care services. The bill also adds to the role of nursing advocacy. Cleveland et al. (2019) note that nurses contribute to stronger health care delivery systems through patient advocacy. The nurse should assist non-institutionalized patients in lodging complaints and assist them in appealing if the latter are denied services. In this way, nurses would help many patients to get social justice.
Quality Measures and Pay for Performance and the Effects on Patient Outcomes
Pay for performance (P4P) has been introduced in several health care systems. P4P is a model that offers financial incentives to health professionals and medical groups to meet specific performance measures(Kyeremanteng et al., 2019). This compensation approach is performance-based and aims at improving the delivery and quality of health services to patients. Failing to meet a particular result implies that a health practitioner does not receive the incentives associated with meeting the set target. Some penalty-based P4P incentivesprovide financial penalties to hospitals when medical complications arise following failure to institute the appropriate preventative measures(Kyeremanteng et al., 2019). The P4P model motivates nurses, physicians, and other health care professionals to offer high-quality services to their clients to meet specific performance criteria to receive the tied financial benefits. However, Kyeremanteng et al. (2019) observe there is a risk for poor patient outcomes associated with this model when it encourages patient dumping. This means that health professionals may concentrate more on patients with less complex health issues and with a higher likelihood of faster recovery while relegating patients with complex health issues to the periphery. This would lead to poor health outcomes for the neglected patients as they would lack timely and sufficient medical attention and services.
When such situations confront a nurse, they should apply the ethical principles in their practice. These include non-maleficence (to not harm), beneficence (to do good), justice, and autonomy (Varkey, 2020). The nurse should also encourage other health professionals and practitioners of the Hippocratic Oath, which binds them to the duty of saving patient lives. By adhering to the ethical principles, nurses would give all patients the necessary medical attention they require, irrespective of the complexity of their situations, and not based solely on motivation to attain specific set performance standards to achieve the financial incentives tied to them.
Professional Nursing Leadership and Management Roles
The emerging trends and diverse health care needs of the population have necessitated nursing roles to continue arising and evolving to continue responding to the trends. One of the emerging roles is the use of nursing informatics and technology in nursing. In health care settings, the use of technology has become ubiquitous. This has increasingly necessitated nurses to equip themselves with the knowledge and skills in technological advancements. For instance, the use of surgical robots in surgeries is a trend observed in some advanced health care settings. For the nurses to have fulfilling experiences and roles in such operations, they must be conversant with the use and operation of such robots.
Another advancement in technology is the use of bedside alert systems which alert nurses when patients leave their beds unattended. The patients also use them to notify nurses that the former needs urgent attention. Therefore, these bedside alert systems improve timely medical interventions and reduce the incidence of falls. The nurse leaders and managers are responsible for ensuring their nursing staff are technologically well-informed as part of their nursing roles. Additionally, nurses must also be aware of using electrical medical records, which have revolutionized clinical documentation. They must use the EMRs appropriately and comply with the provisions and regulations of the HIPAA.
One of the emerging trends is the use of robots in surgeries. Robot-assisted surgeries have been driven by robotic proliferation, machine and AI learning growth, and the rollout of 5G connectivity.Medical practitioners must know how these robots are set up and recognize situations where they malfunction. Therefore, nurses will be required to learn how these robots work, how they affect nursing roles and duties, and how to respond in an emergency, which can be life-saving.
Another trend observed in the health care settings is the increased use of telemedicine. Hyder and Razzak (2020) define telemedicine as the use of information technology and telecommunications to provide health services in a situation where a considerable physical distance exists between patients and health providers. Telemedicine will continue to enhance the nurses’ roles as communicators, reaching out to clients upon request through different telehealth systems. Nurses should communicate timely with patients, within the shortest time possible, and use simple messages. Therefore, nurses will be required to enhance their knowledge and skills on technology and the use of various platforms to communicate with patients. It is vital that nurses appropriately use devices used in telemedicine to avoid mistakes that could have adverse health outcomes.
Health care reforms have changed health policies that have improved the health care systems, seeing the provision of safer, more affordable, and higher-quality health services. The trends in the current health settings have necessitated nurses and other health professionals to update their knowledge and skills in various areas to keep up with those trends. Nurses should continue embracing technological advancements in health settings. Teaching institutions should also prepare students technologically to be well competent to provide safe and quality health services in increasingly complex technological health settings.
Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable Care: Harnessing the Power of Nurses. Ojin.nursingworld.org. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-24-2019/No2-May-2019/Affordable-Care.html
Dalton, J. (2021). EMERGING HEALTHCARE INDUSTRY TRENDS #11: The Increasing Prevalence of Robot-Assisted Surgery. Thrive. https://thrivethinking.com/2021/08/10/robot-assisted-surgery/
Dingell, D. (2019, August 6). Text – H.R.3253 – 116th Congress (2019-2020): Sustaining Excellence in Medicaid Act of 2019. Www.congress.gov. https://www.congress.gov/bill/116th-congress/house-bill/3253/text
Hyder, M. A., & Razzak, J. (2020). Telemedicine in the United States: An Introduction for Students and Residents. Journal of Medical Internet Research, 22(11). https://doi.org/10.2196/20839
Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., &Neilipovitz, D. (2019). An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients. Critical Care Research and Practice, 2019, 1–7. https://doi.org/10.1155/2019/8943972
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119
Health Care Delivery Models and Nursing Practice
Jan 24, 2022, 12:00 AM
Jan 30, 2022, 11:59 PM
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 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, 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.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.