NUR 514 Topic 1 Discussion 1
DQ Discuss The Shift To Value-Based Health Care And Its Impact On The Roles And Responsibilities Of Advanced Registered Nurses
Value-based health care implies that payment for medical care is dependent on positive patient outcomes. The goal is to contain the cost of medical care while reducing complications for patients (Huffman, 2021). The total joint replacement bundles are an example of value-based health care (Schardt et al., 2020). The orthopedic surgeon provides surgical intervention for an elective joint replacement that follows surgical pathways for optimal outcomes. The advanced practice nurse may then follow up with the patient in an acute setting or office setting to monitor and provide early intervention to achieve optimal recovery. This reduces cost and leads to better patient outcomes and payment. The joint center advanced registered nurse leader participates in a collaborative team that develops protocols based on evidence to produce positive outcomes. The leader ensures protocols are followed by staff for beneficial patient outcomes. The advanced practice nurse educator is responsible for teaching direct care nurses the clinical pathways necessary for optimal outcomes. The acute care center of current employment has a Joint Center that performs in this manner to maintain cost-effective, efficient, quality care with the patient in mind. Huffman (2021) describes these elements in detail in her article. The suggestion is that nurse leaders assume a collaborative, innovative role to establish and maintain value-based care in their areas of practice.
Health care reform is restructuring the health care system to improve patient outcomes. With such reforms, the undeserved and remote communities can now get access to affordable health care. ECHO health is one example of such initiatives that has brought specialty health care services to communities in remote areas. The ECHO health
model started by decentralizing the treatment of Hepatitis. Primary care providers were enhanced in knowledge and skills to treat the complex Hepatitis infection (Osei-Twum et al., 2022). Later on, ECHO health extended to include the treatment of other chronic conditions within remote communities. This is good for the disadvantaged poor communities who cannot afford travelling to hospitals because health care services are brought to their door steps. There have also been laws such as the Affordable Care Act that were enforced in order to provide affordable health care to the United States populace. This law makes sure that the uninsured are insured.
In the next 3-5 years, many more patients will go home after surgeries. In the past, many spinal cases stayed overnight in the hospital. In the current environment, postop cervical spinal fusions and discectomies who meet the criteria for discharge go home the day of surgery with follow-up from a nurse practitioner. Total joints that are relatively low risk go home the day of surgery after meeting all discharge criteria. The health care system is moving towards home care with continued follow-up in the office with advanced practice registered nurses. Advanced practice registered nurses in various roles within the acute and community setting deliver cost-effective, quality care. This will continue into the foreseeable future to contain costs while providing safe, reliable, quality care to patients. The hope is that advanced practice nurses can continue to grow and expand their skills to provide care that encompasses the full extent of their education and skills.
References
Huffman, M. (2021). Value-based care: An executive briefing. Nurse Leader, 19(1), 82–86. https://doi.org/10.1016/j.mnl.2020.07.014
Schardt, K., Hutzler, L., Bosco, J., Humbyrd, C., & DeCamp, M. (2020). Increase in Healthcare Disparities: The Unintended Consequences of Value-Based Medicine, Lessons from the Total Joint Bundled Payments for Care Improvement. Bulletin of the Hospital for Joint Diseases, 78(2), 93–94.
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Value based healthcare is defined as the hospital or physician being paid based on the outcome of the patient care (NEJM Catalyst, 2017). This bases the “value” that a doctor or hospital is paid by the insurance company or Medicare on outcome-based practice. There are many positive things that can come from value-based healthcare. One example is the fact that the patient pays less money for better care (NEJM Catalyst, 2017). This allows the patient to have less out of pocket expenses related to healthcare for better care. If
the provider must show outcomes of patient care, it also forces the providers to provide better care to the patient. This will eventually lead to better patient outcomes and better health promotion (NEJM Catalyst, 2017). The advanced practice registered nurse will provide care to the patient if they are working in a nurse practitioner role that requires billing to take place. This will affect the care that they give in the same way it affects other providers because it will be outcome based. This will allow for better care for the patient with the responsibility for care being on the practitioner. Initiatives have been created for the advanced practice registered nurse to provide better care for patient, therefore increasing positive outcomes for patients and reducing the amount of money that is required to be paid by the insurance company or the patient directly (Nilsson, Bååthe, Andersson, & Sandoff, 2017). Advanced practice registered nurses influence the way healthcare is going in a positive direction. Nurse practitioners are said to be more compassionate than some doctors because they have worked directly with patients over a series of steps of becoming an advanced practice registered nurse. This allows the practitioner to allow experience with direct patient care to guide their services that they are providing to patients in a practitioner role. With healthcare moving towards value-based healthcare, the advanced practice registered nurse will need to move with it and allow for better patient outcomes to drive their care.
References
NEJM Catalyst. (2017). What Is Value-Based Healthcare? Innovations in Care Delivery, https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558.
Nilsson, K., Bååthe, F., Andersson, A. E., & Sandoff, M. (2017). Value-based healthcare as a trigger for improvement initiatives. Leadership in Health Services, https://www.emerald.com/insight/content/doi/10.1108/LHS-09-2016-0045/full/html.
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Today’s healthcare is in a state of complex constant change. With the passing of the Affordable Care Act in 2010, changes in healthcare have occurred that directly impact a patient’s ability to receive healthcare and preventative care. New healthcare delivery models have emerged in the hopes of providing quality care at the greats value to the patient (McNiff, 2018).
Economic changes are necessary for health care in the United States to be sustainable while providing quality patient care. With health care costs skyrocketing, methods were developed by the Centers for Medicare and Medicaid Services (CMS) to help reign in these costs. Pay for performance was developed to reward healthcare organizations and providers that are able to provide quality care and improve patient outcomes. Through data collection of quality measures established in collaboration with the Agency for Healthcare Research and Quality (AHRQ), providers and organizations are rewarded for improving patient care and lowering costs and holding organizations and providers who do not accountable for these shortcomings (McNiff, 2018). This value-based system is based on patient satisfaction and proven best practices. Quality metrics are reported to the public through the Hospital Consumer Assessment of Health Plan Survey (HCAHPS), care quality and delivery, and quality measures related to falls, infections, morbidity, and mortality, in the inpatient setting, and the Healthcare Effectiveness Data and Information Set (HEDIS), for outpatient settings (McNiff, 2018). All nurses, including Advanced Practice Registered Nurses (APRN’s) and administrators have a direct impact on quality initiatives and patient outcomes. With this, APRNs must be aware of current concepts on quality including selection of quality measures, data collection, data measurement and data reporting, and evaluation. Nurses will need to understand and promote their role and the impact they have on high quality patient care through advocating for the necessary resources, fostering a culture of safety, participation in decision-making regarding best practices, and leading and implementing quality initiatives.
The nursing profession is in a key position to transition health care reform and patient care models. The advent of these new care models that focus on preventative measures and health promotion across the continuum has brought about the emergence of new roles for nurses (Salmond & Echevarria, 2017). These new positions include, care coordinators, patient navigator, health coaches, virtual care nurses, bundled care coordinators, and nurse-managed care centers. All these roles are necessary as patient care becomes more complex and extends beyond the acute care hospital. Nurse managed health centers are run by nurse practitioners, nurse midwives, and public health nurses. Within these centers, nurses coordinating the care of patients along their health continuum, as patient care is transitioning away from acute hospital settings and into the communities, the patient is better assured of receiving the best evidence-based care resulting in optimal patient outcomes.
Future trends see a decrease in primary and specialty care physicians. To allow for patient coverage in this gap, healthcare delivery will shift to APRN’s and RNs to maintain public health coverage and access to care. Another trend occurring across the country is the development of Patient centered Medical Homes (PCMH). Many hospital systems are building these patient medical homes in rural areas to allow patients better access to care and many of these will be staffed and run by APRN’s and RN’s.
References
McNiff, P. (2018). Current trends in nursing practice. In Grand Canyon University (Ed.), Trends in health care: A Nursing perspective (1 ed). Retrieved from https://lc.gcumedia.com/nrs440vn/trends-in-health-care-a-nursing-perspective/v1.1/#/chapter/2
Salmond, S.W., &Echevarria, M. (2017, January). Healthcare transformation and changing roles for nursing. Orthopedic nursing, 36(1), 12-25. https://doi.org/10.1097/NOR.0000000000000308
Turner, C. (2018, April 3). How new nursing roles are shaping the future of healthcare [Blog post]. Retrieved from https://blog.meditech.com/how-the-newest-roles-in-nursing-are-shaping-the-the-future-of-healthcare
According to DeNisco (2021), a major feature of the U.S. healthcare system is its fragmented nature, as different people obtain health care through different means. The system has continued to undergo changes, due to concerns related to costs, access to care, and quality outcomes.
As health care expenditures continue to rise due to aging populations and managing chronic diseases, providers, payers, and policymakers must shift their focus from traditional fee-for-service models to value-based care programs. Value-based healthcare is a healthcare delivery model in which providers are paid based on patients’ health outcomes. Under value-based care, providers are paid and rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. This model promotes high-value health care, with the best possible outcomes per dollar spent (Agba, et al., 2022).
As the US health care system continues to evolve into value-based healthcare, and providers are incentivized based on patients’ health care outcomes, the demand for mid-level health care practitioners will continue to increase. We are also seeing more healthcare legislation directed towards expanding the scope of practice and roles of advanced practice nurses to be able to practice independently, without direct supervision from a physician, in order to provide much-needed medical care in areas and communities that need them most.
References:
Agba, C. O., Snowden-Bahr, J. D., Kadakia, K., Chaker, S. A., Young, J. B., Forystek A. G., (2022). Global horizons for value-based care: Lessons learned from the Cleveland clinic, NEJM Catalyst 3 (5) https://catalyst.nejm.org/doi/pdf/10.1056/CAT.22.0123
DeNisco, S. (Ed). (2021). Advanced practice nursing: Essential knowledge for the profession (4th Ed.). Jones and Bartlett Learning