The Role of the RN/APRN in Policy Evaluation

 The Role of the RN/APRN in Policy Evaluation

The Medicare Shared Savings Program (MSSP), which was implemented in 2012 as part of the Affordable Care Act. The MSSP is a value-based payment program that incentivizes healthcare providers to form accountable care organizations (ACOs) to coordinate care for Medicare beneficiaries. The goal of the program is to improve the quality of care while reducing costs. The evaluation of the MSSP demonstrates the potential for value-based payment programs to improve the quality of care while reducing costs. By continuing to evaluate and refine the program, policymakers can work to ensure that Medicare beneficiaries receive high-quality, coordinated care that is also cost-effective. The article “Data‐Led Policy Design Using Medicare Shared Savings Program (MSSP) Health Care Cost Trajectories” by Rudisill et al. (2021) explores the use of health care cost trajectories in the Medicare Shared Savings Program (MSSP) to inform policy design. The authors argue that analyzing cost trajectories can provide insights into the effectiveness of the MSSP in reducing healthcare costs and improving quality of care.

The Medicare Shared Savings Program (MSSP) is a federal program aimed at improving healthcare quality and reducing healthcare costs by promoting coordinated, patient-centered care. Under the program, healthcare providers form accountable care organizations (ACOs) and are incentivized to improve patient outcomes and reduce costs. The study by Huang et al. (2023) examines the impact of Medicare Shared Savings Program (MSSP) participation on hospital financial performance. The researchers used an event-study analysis to examine hospital financial performance before and after MSSP participation.

The evaluation of the MSSP focuses on several criteria to measure the program’s effectiveness. These include:

Healthcare cost savings: One of the primary goals of the MSSP is to reduce healthcare costs while maintaining or improving quality of care. Therefore, the program’s success is often measured by its ability to reduce the total cost of care for beneficiaries, as well as the cost of specific services such as hospitalizations, emergency department visits, and outpatient procedures.

Quality of care: Another important criterion for evaluating the effectiveness of the MSSP is the quality of care provided to beneficiaries. Quality measures may include patient satisfaction, clinical outcomes, care coordination, and preventive care.

 Provider participation and engagement: The success of the MSSP also depends on the number and engagement of participating healthcare providers. Therefore, program evaluators may assess the number of ACOs formed, the number of providers participating in the program, and the level of engagement and collaboration among providers.

Beneficiary outcomes: The ultimate goal of the MSSP is to improve the health and well-being of Medicare beneficiaries. Therefore, program evaluators may measure beneficiary outcomes such as health status, functional status, and mortality rates.

Program sustainability: Finally, the long-term sustainability of the MSSP is an important criterion for program evaluation. Evaluators may assess the financial viability of ACOs, the cost-effectiveness of program interventions, and the program’s ability to adapt to changing healthcare environments.

One evaluation of the MSSP found that it has been successful in achieving cost savings, with participating accountable care organizations generating $739.4 million in net savings over a four-year period (2013-2016). Another evaluation found that the program has also led to improvements in quality of care, with participating accountable care organizations performing better than non-participating providers on several measures, including preventive care and patient satisfaction.

Social Determinants

Social determinants of health can impact the effectiveness of the MSSP. For example, socioeconomic status can affect a patient’s ability to access and afford healthcare, leading to higher rates of preventable hospitalizations and emergency department visits. Additionally, factors such as race and ethnicity can also impact health outcomes and utilization of healthcare services. Furthermore, social determinants of health such as race and ethnicity can influence health outcomes and patient satisfaction, with racial and ethnic disparities observed in the quality of care and health outcomes for Medicare beneficiaries (McCarthy et al., 2019).

A study published in the Journal of General Internal Medicine found that ACOs participating in the MSSP had a greater impact on reducing hospital readmissions and improving quality of care for patients with higher levels of social risk, such as those living in low-income areas or with limited English proficiency.

References

Huang, H., Zhu, X., Ullrich, F., MacKinney, A. C., & Mueller, K. (2023, February 1). The impact of Medicare shared savings program participation on hospital financial performance: An event-study analysis. Health Services Research, 58(1), 116. https://doi.org/10.1111/1475-6773.14085Links to an external site.

McCarthy, E. P., Mueller, K., & Joynt Maddox, K. E. (2019). Medicare’s next generation accountable care organization model: Generating promising early results. JAMA, 321(4), 339-340.

Rudisill, C., Chapman, C., Qin, F., & Xiao, F. (2021). Data‐Led Policy Design Using Medicare Shared Savings Program (MSSP) Health Care Cost Trajectories. Health Services Research, 56, 67. https://doi.org/10.1111/1475-6773.13791

The first opportunity that exists for RNs and APRNs to actively participate in policy review is the workplace. These professionals have the ability to influence the available and prospective health care delivery initiatives. The fundamental role of RNs and APRNs is to facilitate quality health. Therefore, they have a good opportunity to influence policy review in their workplaces by ensuring promotion of effective policies that enhances quality care. However, if a given policy fails to promote quality care, RNs and APRNs may decline the policy and request for its review. The other opportunity is through professional organizations such as the American Nurses Association and the American Academy of Nursing. These professional organizations can be used by the RNs and APRNs to review some policies. Professional organizations play crucial roles in ensuring that effective policies are adopted by the organizations (Miyamoto & Cook, 2019).

There are challenges associated with opportunity at the workplace. The first challenge is poor leadership, which does not provide opportunity for nurses to develop their leadership skills. This challenge can be addressed by enabling all RNs and APRNs opportunity to expand their leadership aptitude and inspire confidence in them to query policies adopted (Brunt & Bogdan, 2018). Another challenge is failure to update all nurses on the proposed policies and the need for their review. This can be addressed by informing all nurses on the policy changes and the need to review them before implementation. There is also a challenge of disunity among nurses, which can be addressed uniting nurses to focus on a common goal. Concerning the opportunity in relation to professional organizations, the major challenge is intricate process of membership. This challenge can be overcome by creating a straightforward and clearly understood process that nurses should follow to join the professional organizations.

The strategies to advocate for the existence of these opportunities include provision of training to equip them in understanding their work environment and roles. The other strategy is ensuring good leadership that can provide opportunity for nurses to voice their perceptions about a given policy (Bleich et al., 2020). These two strategies are crucial tools of informed nursing team.

References

Bleich, M. R., Smith, S., & McDougle, R. (2020). Public policy in a pandemic: a call for leadership action. The Journal of Continuing Education in Nursing, 51(6), 250-252. https://doi.org/10.3928/00220124-20200514-03

Brunt, B. A., & Bogdan, B. A. (2018). Nursing Professional Development (NPD) Leadership. Treasure Island, FL: StatPearls Publishing.

Miyamoto, S., & Cook, E. (2019). The procurement of the UN sustainable development goals and the American national policy agenda of nurses. Nursing outlook, 67(6), 658-663. https://doi.org/10.1016/j.outlook.2019.09.004

To Prepare:

• In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
• Review the Resources and reflect on the role of professional nurses in policy evaluation.

• Grid View

		Excellent	Good	Fair	Poor
Main Posting		45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.   Supported by at least three current, credible sources.   Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.   At least 75% of post has exceptional depth and breadth.   Supported by at least three credible sources.   Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	35 (35%) – 39 (39%) Responds to some of the discussion question(s).   One or two criteria are not addressed or are superficially addressed.   Is somewhat lacking reflection and critical analysis and synthesis.   Somewhat represents knowledge gained from the course readings for the module.   Post is cited with two credible sources.   Written somewhat concisely; may contain more than two spelling or grammatical errors.   Contains some APA formatting errors.	0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately.   Lacks depth or superficially addresses criteria.   Lacks reflection and critical analysis and synthesis.   Does not represent knowledge gained from the course readings for the module.   Contains only one or no credible sources.   Not written clearly or concisely.   Contains more than two spelling or grammatical errors.   Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness		10 (10%) – 10 (10%) Posts main post by day 3.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not post by day 3.
First Response		17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings.   Responds fully to questions posed by faculty.   Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.   Demonstrates synthesis and understanding of learning objectives.   Communication is professional and respectful to colleagues.   Responses to faculty questions are fully answered, if posed.   Response is effectively written in standard, edited English.	15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings.   Communication is professional and respectful to colleagues.   Responses to faculty questions are answered, if posed.   Provides clear, concise opinions and ideas that are supported by two or more credible sources.   Response is effectively written in standard, edited English.	13 (13%) – 14 (14%) Response is on topic and may have some depth.   Responses posted in the discussion may lack effective professional communication.   Responses to faculty questions are somewhat answered, if posed.   Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 12 (12%) Response may not be on topic and lacks depth.   Responses posted in the discussion lack effective professional communication.   Responses to faculty questions are missing.   No credible sources are cited.
Second Response		16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings.   Responds fully to questions posed by faculty.   Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.   Demonstrates synthesis and understanding of learning objectives.   Communication is professional and respectful to colleagues.   Responses to faculty questions are fully answered, if posed.   Response is effectively written in standard, edited English.	14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings.   Communication is professional and respectful to colleagues.   Responses to faculty questions are answered, if posed.   Provides clear, concise opinions and ideas that are supported by two or more credible sources.   Response is effectively written in standard, edited English.	12 (12%) – 13 (13%) Response is on topic and may have some depth.   Responses posted in the discussion may lack effective professional communication.   Responses to faculty questions are somewhat answered, if posed.   Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 11 (11%) Response may not be on topic and lacks depth.   Responses posted in the discussion lack effective professional communication.   Responses to faculty questions are missing.   No credible sources are cited.
Participation		5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.
Total Points: 100

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For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

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Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource