Health Care Delivery Models and Nursing Practice
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.
Outline a current or emerging health care law or federal regulation introduced within the last 5 years 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 in response 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.
Sample Solution
The U.S. health care delivery system has undergone major changes in recent decades to reform and restructure the industry for both providers and patients. The Affordable Care Act, commonly known as Obamacare, was enacted in 2010 by President Obama to expand access to health insurance coverage across the country (Werner-Wilson, 2017). This included providing subsidies for individuals that otherwise could not afford it and allowing dependents to stay on their parents’ plan until they were 26 years old (U.S. Department of Health & Human Services [HHS], 2020). Insurance companies were also mandated to cover essential benefits such as preventive services with no copayment or coinsurance (HHS, 2020).
In addition, healthcare organizations have implemented new payment structures based on value rather than volume that are designed to improve quality while reducing costs (Werner-Wilson, 2017). These programs include bundling payments that are centered around episodes of care where a single payment is provided regardless of how many services are needed during that time period (Kane et al., 2019) . To assist in these initiatives some organizations have switched from a traditional fee-for service model which reimburses providers for each task performed during patient visits, instead using Accountable Care Organizations (ACOs) which incentivize coordination between multiple providers and improved outcomes through shared savings agreements with health insurers or Medicare Advantage Plans (Kane et al., 2019).
Nurses play an integral role within this changing environment as they provide direct patient care and help coordinate efforts among physicians and other providers along the continuum of care. Nurses must be proactive when advocating for their patients under new models such as bundled payments since this can lead to potential gaps in needed care if resources are not allocated appropriately by administrators at the organizational level (Smartt & Bellissimo, 2016). Nurses also need to be mindful when documenting patient encounters throughout these changes since ACOs now demand accurate reporting data in order track outcomes more effectively across multiple settings including hospitals outpatient clinics primary care physician offices etc.. Finally, nurses should take advantage of educational opportunities available related to new models so they can accurately explain them patients who may be unfamiliar with these concepts or concerned about how they may affect their treatment going forward (Smartt & Bellissimo, 2016).