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Discussion: Review of Current Healthcare Issues

Discussion: Review of Current Healthcare Issues

NURS 6053 Discussion: Review of Current Healthcare Issues

Rapidly rising cost of care in developed countries; continue to be a significant national healthcare issue of concern, especially here in the United States. Insurance coverage is among the strongest predictors of access to care and better health outcomes. The uninsured are less likely to receive preventive services and are more likely to delay or forgo care because of cost.  They are more likely to have emergency department visits which are less cost-effective, also are more likely to experience potentially avoidable hospitalization than their counterparts with health insurance coverage (Yabroff et al., 2021).  While healthcare economics is complex, technological innovation and costs associated with the adoption and use of health technology have become the primary driver of healthcare cost inflation. In the United States, health technology (H.T.) enables the scope and quality of care patients receive. Unfortunately, patients pursue expensive H.T. in response to information asymmetry, which leads them to associate high-tech care with quality and, of course, inefficient or no insurance coverage that shelters them from the actual cost of care. Research has shown lots of evidence relating to ineffective and inappropriate use of H.T. with resultant cost inflation and variable healthcare quality (Hofmann, 2009).

With the escalating cost of healthcare and the rise of high deductible health plans, patients are becoming increasingly responsible for significant portions of their bills. The average income of families with employee health insurance rose from $76,000 in 1999 to $99,000 in 2009 but increased spending on health care largely offset this gain. Families’ health insurance premiums rose from $490 to $1115, and out-of-pocket healthcare spending almost doubled. It is no wonder that so many admitted patients pay attention to the bill they will receive on discharge instead of their recovery (Simone, 2011).

Impact of the Increased Healthcare Cost on my Work Setting

            I currently work at a hospital that serves a more significant number of unfunded and undocumented patients; some of these patients are homeless, with some in a living situation that is very unconducive for health. This exposes my work setting to a high flow of critically ill patients, leading to a high volume and high acuity workplace. Most of our patients cannot afford preventive care but present mainly in critical conditions. Most of these patients come from different states, neighboring communities, and not necessarily, the two communities we serve. This leads to my workplace experiencing frequent total diversion status. The community looks at any nurse working at my workplace as a super nurse. Most times, nurses from my workplace are expressly hired when they go to other hospitals because of the notion that if you can handle Grady patients, you can care for any patient anywhere.

Ways by which my Healthcare Setting has responded to the above Issue of Concern

My healthcare setting is a not-for-profit organization that provides the highest quality of care, leading to the slogan “Atlanta cannot live without Grady.” A recent study found that U.S. health care spending is higher than that of other countries, most likely because of higher prices and perhaps more readily accessible technology; rather than higher-income or an excellent supply of utilization of hospitals and doctors. (Norbeck, 2013). My healthcare setting established a cost-saving policy where unfunded or low-income patients can obtain a “Grady Card” on meeting the essential criteria. However, the patients must be residents of the two communities that we serve.

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We have physician advisors, case managers, and utilization review personnel who review patients’ clinical information and follow up appropriately to ensure proper documentation of diagnoses for billing purposes and order of only medically necessary procedures to prevent overbilling (Jackson et al., 2015).

In conclusion, case managers are consistently reviewing charts to ensure that physicians place Medicare patients who meet inpatient criteria on appropriate status, as that would significantly take away or reduce the burden of healthcare costs on patients. The hospital ensures making discharge follow-up calls 2-3 days post-discharge. All arrangements, including transport, were made to ensure patients’ compliance with follow-up visits, reducing the chance of readmission and emergency department utilization. Reducing readmission is a current priority for my health care system, timely outpatient follow-up is promoted as a critical component of transitional care models (Jackson et al., 2015). 

References

Hofmann, B.R. (2009). Health care costs. [Electronic resource] : Causes, effects, and control. Nova Science Publishers.

https://eds.a.ebscohost.com/eds/detail/detail?vid=7&sid=019852ef-04cc-4b96-bd64-4af538e363df%40sdc-v-sessmgr02&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1lZHMtbGl2ZSZzY29wZT1zaXRl#AN=wal.EBC3020814&db=cat06423a

Jackson, C., Shahsahebi, M., Wedlake, T., & DuBard, C. (2015). Timeliness of outpatient follow-up: An evidence-based approach for planning after hospital discharge. Annals of family medicine, 13(2), 115–122.

https://doi.org/10.1370/afm.1753

Norbeck T. B. (2013). Drivers of health care costs. A physician’s foundation white paper – second of a three-part series. Missouri medicine, 110(2), 113–118.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179664/

Simone, J. V. (2011). An analysis of the effects and causes of the high cost of health care. Oncology Times, 33(19), 23-24.

https://journals.lww.com/oncology-times/Fulltext/2011/10100/Simone_s_OncOpinion__An_Analysis_of_the_Effects.12.aspx

Squires, D.A. (2012). Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality. The issue brief, (Commonwealth Fund), 10, 1-14. 

https://eds.a.ebscohost.com/eds/detail/detail?vid=15&sid=019852ef-04cc-4b96-bd64-4af538e363df%40sdc-v-sessmgr02&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1lZHMtbGl2ZSZzY29wZT1zaXRl#AN=22582452&db=mnh

Yabroff, K., Zhao, J., Halpern, M., Fedewa, S., Han, X., Nogueira, L., Zheng, Z., & Jemal, A. (2021). Health insurance disruptions and care access and affordability in the U.S. American Journal of Preventive Medicine, 61(1), 3–12.

https://eds.a.ebscohost.com/eds/detail/detail?vid=12&sid=019852ef-04cc-4b96-bd64-4af538e363df%40sdc-v-sessmgr02&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1lZHMtbGl2ZSZzY29wZT1zaXRl#AN=2021-59241-002&db=psyh

RE: Main Post – Week 1- Response 2

Blessing,

Thank you for your post. I agree that the rapidly rising cost of healthcare is a serious issue in our country. I too see the impact on the patients seen in the emergency department. Uninsured patients will come in for toothaches or sore throats because they cannot be turned away for inability to pay and no payment is required at the time of service. They have no primary doctor willing to see them. In researching this issue I found information on the proposal of universal healthcare. Though controversial, it has been introduced as one solution to this problem.

According to Galvani et. al. (2020), the provision of universal healthcare would entail expanded utilization of health services by those who are currently uninsured and those who are insured but for whom cost still imposes a barrier to health care. As you mentioned, the uninsured and underinsured tend to forgo necessary treatments and preventative measures. According to Galvani et. al. (2020), individuals without any insurance utilize healthcare at 50.1% of the rate of adequately insured individuals. There are also 41 million underinsured Americans who have insurance plans with prohibitively high deductibles and/or copays. Underinsured individuals utilize healthcare 86% less than adequately insured individuals. With universal healthcare coverage, it is presumed that healthcare utilization by both uninsured and underinsured individuals would rise to the level of adequately insured individuals for whom cost does not discourage healthcare utilization (Galvani et. al., 2020).  As you pointed out, healthcare access and affordability are not the same. Having health insurance does not automatically grant patients financial access to needed care. Health insurance is a financial mechanism for paying for health care, while access refers to the process of actually obtaining that health care (Manchikanti et. al., 2017). The gap between providing patients the mechanism of paying for healthcare and actually receiving it needs to be addressed.

References

Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. Lancet (London, England), 395(10223), 524–533. https://doi.org/10.1016/S0140-6736(19)33019-3

Manchikanti, L., Helm Ii, S., Benyamin, R. M., & Hirsch, J. A. (2017). A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?. Pain physician, 20(3), 111–138.

 

Global healthcare systems are facing unprecedented times and uncertain future based on the current situation of Covid-19 pandemic. This has prompted quick adoption of technology in healthcare systems from booking of appointments to billing. Therefore, I believe one of the major current healthcare issues is on technology disruption. Much questions have been raised on the big data usage, incorporation of telehealth, synchronization of the national health data systems and on the confidentiality and security of the patient’s health records as cases of cybersecurity have soared with increased adoption of information technology in healthcare (Sittig et al., 2018).

Big data in healthcare systems refers to the accumulation of large sets of digital information about the patients’ biodata, medical history, clinical interventions, current and past medical concerns of the patients. This data is accumulated overtime rather than that which is received in small amounts and not stored for future references (Thew, 2016). This prompts the healthcare nurse informatics to employ the use of data analytics and data mining tools so that they can extract meaningful patterns, study the correlation and develop predictions (McGonigle & Mastrian, 2018). Use big data has proved to be essential in healthcare management especially when analyzed and used to inform critical decision-making points and even guide future evidence-based change projects (Byrd et al, 2018).  This information is used by managers and administrators to identify patterns and areas of strength and weakness within the system and help plan in resource allocation.

However, big data faces one of the greatest security challenges especially on the confidentiality of the patient’s information. Cases of cyber insecurity have been rising since most healthcare facilities and organizations adopted use of technology to manage the spread of Covid-19 pandemic. The patient’s confidential data may be easily accessed if the systems security checks are not well enforced. In some of the online platforms like Amazon, for online shopping, the systems put in adequate security checks and user authentication and verification steps. The breech of patient’s confidential medical information could have adverse effects on the healthcare facility or organization hence incur a lot of expenses in terms of compensation and in the end the reputation of the organization will also be severely damaged.

Therefore, it is imperative for healthcare organizations and systems that procure any digital platform for managing healthcare records to invest heavily on ensuring the system is safe and secure from cyber security threats and phishing on patient’s data (Bibhuranjan, 2019). Moreover, there is need to improve the software technology to develop systems that are less susceptible to hacking. It is also essential to ensure that patients are well educated on ways of safely using the digital platforms and there should be readily accessible customer care agent to help patient’s carry out proper verification and maintain safety of their data.

Increased usage of digital platforms and information technology poses another safety threat to the patients as they are likely to seek for medical advice from online blogs and unverified media sources that could be misleading to the patients. This information collected on such blogs has no scientifically proven or evidence-based data to support the claims or the medical advice offered. Moreover, the information could be provided by individuals who have no professional training in the areas that they are providing the medical information. There has been rapid increase in blogs from unregistered dietician and fitness coaches whose methods are not scientifically viable to rely on as professional medical procedures. Many patients have fallen prey to such misleading information that even sometimes discourages the use of conventional medication and clinical intervention measures (Young, 2016).

In conclusion, it is imperative for the federal and state government to come up with strict measures, laws and policies that govern the use of information technology in healthcare. The guidelines should be clear and the regulations must be standardized to enhance security of the patients’ data and also safeguard them from unverified and unethical practices and information availed to them on social media platforms. Any digital platforms or media engaging in medical or clinical information must have passed the licensure criteria that would be guided by strict conformity to the ethical issues in healthcare and meets the set standards.

References

Bibhuranjan. (2019). Big data analytics – How beneficial is it for healthcare? Technofaq. https://technofaq.org/posts/2019/05/big-data-analytics-how-beneficial-is-it-for-healthcare/#:~:text=%20Big%20Data%20Analytics-%20Benefits%20in%20the%20Healthcare,is%20very%20important%20for%20any%20organization…%20More

Byrd, T.A., Kung, L., & Wang, Y. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3-13. doi:10. 1016/j.techfore.2015.12.019

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Sittig, D. F., Wright, A., Coiera, E., Magrabi, F., Ratwani, R., Bates, D. W., & Singh, H. (2018). Current challenges in health information technology–related patient safety. Health Informatics Journal, 26(1), 146045821881489. https://doi.org/10.1177/1460458218814893

Thew, J. (2016). Big data means big potential, changes for nurse execs. HealthLeaders. https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

Young, A. (2016). The pros and cons of big data in the healthcare industry. HealthCareZone. https://www.healthtechzone.com/topics/healthcare/articles/2016/11/18/427248-pros-cons-big-data-the-healthcare-industry.htm

 

Thank you for the informative discussion post on health equity and affordability in healthcare. As you pointed out, reaching out to the uninsured is one avenue to attaining a healthy populace. Affordable care act legislation was geared to address the inequalities of insured persons and their access to health care. It also encompassed the quadruple aim to assure quality, satisfaction, individualized care and cost containment on service delivery.

A value based reimbursement by CMS was adopted as an oversight to quality against the traditional service for fee system that neglected optimal care to maximize profits. As observed by Goldman & Sommers, “Medicaid enrollees and are associated with delayed health care access and reduced medication adherence. Little is known about the effect on churning of the expansion of eligibility for Medicaid under the Affordable Care Act (ACA), which had the potential to reduce coverage disruptions”, (Goldman, A. L., & Sommers, B. D., 2020). Addresses and attempts to bridge the gap and disruption of coverage in the continuum of care.

Equity in healthcare has been elusive in considerations to the many dynamics that play into it. With ACA legislation, Lipton, Decker & Sommers found out, “that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites”, (Lipton, B. J., Decker, S. L., & Sommers, B. D., 2019).

Affordability enhances access to care and improves larger population health and eases continuum of care.

Zao et al., in their article summarizes that, “The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end-of-life care than their counterparts with health insurance coverage”, (Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X., 2020). Affirming contribution to the discussion of needed policy implementation to ensure successful and optimal care delivery.

References

Goldman, A. L., & Sommers, B. D. (2020). Among Low-Income Adults Enrolled In Medicaid, Churning Decreased After The Affordable Care Act: This study examines whether the Affordable Care Act’s expansion of Medicaid eligibility had an impact on coverage disruptions–known as “churning”–among Medicaid enrollees. Health affairs39(1), 85-93.

Lipton, B. J., Decker, S. L., & Sommers, B. D. (2019). The Affordable Care Act appears to have narrowed racial and ethnic disparities in insurance coverage and access to care among young adults. Medical Care Research and Review76(1), 32-55.

Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X. (2020). The Affordable Care Act and access to care across the cancer control continuum: a review at 10 years. CA: a cancer journal for clinicians70(3), 165-181.

 

Patients should receive high-quality care in safe environments. However, multiple healthcare issues impede healthcare organizations’ ability to achieve this goal while increasing management costs, among other adverse outcomes. A national healthcare issue significantly affecting the work setting is a nursing shortage. In the United States, the nursing shortage is a multifaceted problem caused by the influx of patients in healthcare facilities, high nurse turnover, an aging population, and poor working conditions (Hamlin, 2023; Tamata et al., 2023). Potential impacts of the nursing shortage on the work setting include increased nurse burnout, patient dissatisfaction with care, overcrowding, and extended hospital stays. Understanding the complexity and multidimensional nature of the issue can help healthcare leaders implement sustainable solutions to mitigate its effects on patients, the nursing workforce, and healthcare organizations.

Social determinants of health (SDOH) affect the nursing shortage in various dimensions. For instance, problems increasing vulnerability to chronic diseases lead to a proportional increase in the number of patients seeking care in healthcare settings (Barrio-Cortes et al., 2021). Environments characterized by poor access to healthy foods and facilities that promote physical activities increase the risk of lifestyle diseases. Inadequate access to care increases the risk of hospitalization for preventable diseases. Education also influences health choices, including practices, behaviors, and decisions regarding when and where to seek healthcare support.

Healthcare settings respond differently to the nursing shortage. Broome and Marshall (2021) mentioned the practicality of telemedicine, collaborative care, and new models in response to the shortage of primary care providers. In the current workplace, nurse empowerment programs to prevent nurse turnover play a significant role in addressing the nursing shortage problem. Besides, there is an intensified effort to provide tech-based care to improve access to care and reduce physical patient visits in the facility. Supportive leadership also helps healthcare workers to understand and respond to work-related stress (Greco et al., 2022). More leadership support is among the changes needed to enable the current workforce to respond to stressors related to the nursing shortage and work optimally.

 

 

References

Barrio-Cortes, J., Soria-Ruiz-Ogarrio, M., Martínez-Cuevas, M., Castaño-Reguillo, A., Bandeira-de Oliveira, M., Beca-Martínez, M. T., … & Jaime-Sisó, M. Á. (2021). Use of primary and hospital care health services by chronic patients according to risk level by adjusted morbidity groups. BMC health services research21, 1-13. https://doi.org/10.1186/s12913-021-07020-z

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Greco, E., Graziano, E. A., Stella, G. P., Mastrodascio, M., & Cedrone, F. (2022). The impact of leadership on perceived work-related stress in healthcare facilities organizations. Journal of organizational change management35(4/5), 734-748. https://doi.org/10.1108/JOCM-07-2021-0201

Hamlin, K. (2023). Why is there a nursing shortage? Nurse Journal. https://nursejournal.org/articles/why-is-there-a-nursing-shortage/

Tamata, A. T., & Mohammadnezhad, M. (2023). A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nursing open10(3), 1247-1257. https://doi.org/10.1002/nop2.1434