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NURS 6053- Week 1 Discussion Review of Current Healthcare Issues

NURS 6053- Week 1 Discussion Review of Current Healthcare Issues

NURS 6053- Week 1 Discussion Review of Current Healthcare Issues

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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 large number of unfunded and undocumented patients; some of these patients are homeless, and others live in living conditions that are hazardous to their health. This exposes my work environment to a high volume and high acuity of critically ill patients, resulting in a high volume and high acuity workplace. The majority of our patients cannot afford preventive care and therefore present in critical conditions. The majority of these patients come from other states, neighboring communities, and not always from the two communities we serve. As a result, my workplace frequently experiences total diversion status. Any nurse working at my workplace is regarded as a super nurse by the community. Most nurses from my workplace are specifically hired when they transfer to other hospitals because it is assumed that if you can care for Grady patients, you can care for any patient anywhere.

NURS 6053- Week 1 Discussion Review of Current Healthcare IssuesMethods by which my Healthcare Setting has responded to the aforementioned Concern

My healthcare facility is a non-profit organization that provides the highest quality of care, prompting the slogan “Atlanta cannot live without Grady.” According to a recent study, the United States’ health-care spending is higher than that of other countries, most likely due to higher prices and possibly more easily accessible technology, rather than higher income or an abundance of hospitals and doctors. Norbeck (2013) My healthcare setting implemented a cost-cutting policy in which uninsured or low-income patients can obtain a “Grady Card” if they meet the essential criteria. Patients must, however, be residents of one of the two communities we serve.

We have physician advisors, case managers, and utilization review personnel who review patients’ clinical information and follow up as needed to ensure proper diagnosis documentation for billing purposes and the ordering of only medically necessary procedures to avoid overbilling (Jackson et al., 2015).

Finally, case managers are constantly reviewing charts to ensure that physicians place Medicare patients who meet inpatient criteria on appropriate status, as this significantly reduces or eliminates the burden of healthcare costs on patients. The hospital ensures that discharge follow-up calls are made within 2-3 days of discharge. All arrangements, including transportation, were made to ensure patients’ compliance with follow-up visits, lowering the likelihood of readmission and ER utilization. Reducing readmissions is a current priority for my health-care system, and timely outpatient follow-up is emphasized as an essential component of transitional care models (Jackson et al., 2015).

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

Review the Resources and select one current national healthcare issue/stressor to focus on.

Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

Also Check Out: NURS 6053- Week 3 Discussion Organizational Policies and Practices to Support Healthcare Issues

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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

Rubric Detail

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You have extensively responded to healthcare stressors in your organization. I would like to add how Covid-19 has affected healthcare systems and reimbursement.  The COVID-19 pandemic has had a significant impact on healthcare costs, insurance, and reimbursement systems worldwide. The unprecedented challenges posed by the pandemic have led to increased healthcare expenses, changes in insurance coverage, and shifts in reimbursement policies.

Firstly, the costs associated with COVID-19 have been substantial. Hospitals and healthcare facilities faced significant financial burdens due to the surge in patient volume, increased demand for personal protective equipment (PPE), testing supplies, and the need for additional staff and equipment. The costs of COVID-19 testing, treatment, and vaccination efforts have also contributed to rising healthcare expenses. These increased costs have put strains on healthcare systems and have been reflected in higher healthcare premiums and out-of-pocket expenses for individuals and employers (Waitzberg et al., 2021).

Secondly, the pandemic has brought about changes in insurance coverage. Many insurers expanded coverage to include COVID-19-related services, such as testing, treatment, and telehealth visits. Some insurers waived cost-sharing for COVID-19 treatment to alleviate financial burdens on patients. However, the pandemic has also highlighted gaps in coverage, especially for those without insurance or with limited coverage. The loss of jobs and subsequent loss of employer-sponsored health insurance further exacerbated the issue (Waitzberg et al., 2021).

Thirdly, reimbursement policies underwent modifications to adapt to the unique circumstances of the pandemic. Telehealth services, for instance, saw increased utilization as a means to provide care while minimizing in-person contact. Reimbursement policies were revised to accommodate and encourage telehealth visits, ensuring healthcare providers were adequately reimbursed for virtual consultations. Additionally, government programs, such as the Coronavirus Aid, Relief, and Economic Security (CARES) Act in the United States, introduced financial relief measures and additional funding to support healthcare providers and ensure timely reimbursement for COVID-19-related services (Cutler, 2020).

In conclusion, the COVID-19 pandemic has had profound effects on healthcare costs, insurance coverage, and reimbursement systems. The increased expenses, changes in insurance coverage, and modified reimbursement policies have been necessary to address the unique challenges posed by the pandemic and ensure access to healthcare services during this unprecedented time.

References

Cutler, D. (2020). How will COVID-19 affect the health care economy?. In JAMA Health Forum, 1(4). e200419-e200419)  Doi:10.1001/jamahealthforum.2020.0419

Waitzberg, R., Quentin, W., Webb, E., & Glied, S. (2021). The Structure and Financing of Health Care Systems Affected How Providers Coped With COVID‐19. The Milbank Quarterly99(2), 542. Doi: 10.1111/1468-0009.12530

Content

Name: NURS_6053_Module01_Week02_Assignment_Rubric

  Excellent Good Fair Poor
Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing the selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

·   Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).

Points Range: 23 (23%) – 25 (25%)

The response accurately and thoroughly describes in detail the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate, clear, and detailed data to quantify the impact of the national healthcare issue/stressor selected.

Points Range: 20 (20%) – 22 (22%)

The response describes the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate data to quantify the impact of the national healthcare issue/stressor selected.

Points Range: 18 (18%) – 19 (19%)

The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague or inaccurate.

The response includes vague or inaccurate data to quantify the impact of the national healthcare issue/stressor selected.

Points Range: 0 (0%) – 17 (17%)

The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague and inaccurate, or is missing.

The response includes vague and inaccurate data to quantify the impact of the national healthcare issue/stressor selected, or is missing.

·   Provide a brief summary of the two articles you reviewed from outside resources, on the national healthcare issue/stressor and explain how the healthcare issue/stressor is being addressed in other organizations. Points Range: 27 (27%) – 30 (30%)

A complete, detailed, and specific synthesis of two outside resources reviewed on the national healthcare issue/stressor selected is provided. The response fully integrates at least 2 outside resources and 2 or 3 course-specific resources that fully support the summary provided.

The response accurately and thoroughly explains in detail how the healthcare issue/stressor is being addressed in other organizations.

Points Range: 24 (24%) – 26 (26%)

An accurate synthesis of at least one outside resource reviewed on the national healthcare issue/stressor selected is provided. The response integrates at least 1 outside resource and 2 or 3 course-specific resources that may support the summary provided.

The response explains how the healthcare issue/stressor is being addressed in other organizations.

Points Range: 21 (21%) – 23 (23%)

A vague or inaccurate summary of outside resources reviewed on the national healthcare issue/stressor selected is provided. The response minimally integrates resources that may support the summary provided.

The response explains how the healthcare issue/stressor is being addressed in other organizations that is vague or inaccurate.

Points Range: 0 (0%) – 20 (20%)

A vague and inaccurate summary of no outside resources reviewed on the national healthcare issue/stressor selected is provided, or is missing.

The response fails to integrate any resources to support the summary provided.

·   Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected and explain how they may impact your organization both positively and negatively. Be specific and provide examples. Points Range: 27 (27%) – 30 (30%)

A complete, detailed, and accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response accurately and thoroughly explains in detail how the strategies may impact an organization both positively and negatively, with specific and accurate examples.

Points Range: 24 (24%) – 26 (26%)

An accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response explains how the strategies may impact an organization both positively and negatively. May include some specific examples.

Points Range: 21 (21%) – 23 (23%)

A vague or inaccurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response explains how the strategies may impact an organization both positively and negatively that is vague or inaccurate. May include some vague or inaccurate examples.

Points Range: 0 (0%) – 20 (20%)

A vague and inaccurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided, or is missing.

The response explains how the strategies may impact an organization both positively and negatively that is vague and inaccurate, or is missing. Does not include any examples.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

Points Range: 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

Points Range: 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

Points Range: 3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

Points Range: 0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

Points Range: 5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

Points Range: 4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

Points Range: 3.5 (3.5%) – 3.5 (3.5%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

Points Range: 0 (0%) – 3 (3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. Points Range: 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

Points Range: 4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

Points Range: 3.5 (3.5%) – 3.5 (3.5%)

Contains several (3 or 4) APA format errors.

Points Range: 0 (0%) – 3 (3%)

Contains many (≥ 5) APA format errors.

Total Points: 100