Health Care Delivery Models and Nursing Practice
Emerging Health Care Law and Effect on Nurses Roles
Enacted in 2011, the Affordable Care Act (ACA) is still among the top emerging federal laws set to reform the U.S. health care system. Since March 2011, ACA has reformed the U.S. health care system by expanding coverage to over 20 million citizens and saving millions of lives. The provisions found in the ACA purpose to improve patient protection, expand access to health insurance, improve quality and system performance, advance prevention and wellness, lower increasing health care costs, and expand the health care workforce (Keegan, 2018). The introduction of the ACA has contributed to far-reaching benefits for health systems and patients across America. According to (Cleveland, Motter, & Smith, 2019), the ACA provides nurses, doctors, and other healthcare practitioners with the opportunity to participate and contribute to shaping the delivery of care services to patients.
Since its enactment, the Affordable Care Act has continued to impact nursing practice, particularly on nurses’ role and responsibility for its successful implementation (Korenstein, et al., 2016). This federal health care regulation compels nurses to enhance transformational leadership, innovation, and care coordination as key stakeholders in providing the upcoming generation of quality advances, cost containment, and improved patient access to health care services. While under nurses’ care, the ACA has ensured that patients have a champion, a health care practitioner working to assure valid and reliable tests, assessments, and rehabilitative activities that foster faster and better recovery (Cleveland, Motter, & Smith, 2019). The ACA has also impacted nurses’ roles as professionals by compelling them to improve patient care quality and reduce care costs. Besides, nurses’ role in steering preventive care, patient communication, and patient wellness have been bolstered under the Affordable Care Act.
Effects of Quality Measures and Pay-for-Performance on Patient Outcomes
In the U.S., quality health care is a top priority for the government, the Centres for Medicaid and Medicare Services (CMS), and the Department of Health and Human Services (HHS) (Tinker, 2018). The HHS and CMS implement quality initiatives to assure Americans with quality care. The common quality measures used by CMS and the HHS include pay for reporting, quality improvement, patient safety, timely care, public reporting, and high-quality care. Pay-for-performance entails the quality measures/initiatives that improve quality, safety, efficiency, and timely care. With the Affordable Care Act, the use of pay-for-performance has expanded in Medicare and Medicaid. According to (Kyeremanteng, et al., 2019), pay-for-performance initiatives offer financial incentives to nurses, doctors, physicians, hospitals, and other health care practitioners. As a result, nurses and other health care providers carry out such improvements and register optimal care outcomes for patients.
Research done by (Kyeremanteng, et al., 2019) indicates that quality measures and pay-for-performance positively impact patient outcomes. Pay-for-performance motivates nurses’ performance, improves nurses’ engagement in patient care, and contributes to nurses’ retention. This implies that pay-for-performance measures help resolve nursing issues that adversely affect patient outcomes, for example, nurses’ turnover (Tinker, 2018). For quality measures and pay-for-performance initiatives to thrive, nurses are entitled to oversee a set of roles and responsibilities, failure to which the whole system collapses. Since nurses are the primary caregivers in health care settings, they play a major role in influencing the quality of care offered to patients, and, ultimately, treatment and patient outcomes (Kyeremanteng, et al., 2019). Also, the pay-for-performance initiative has tasked nurses with the responsibility to monitor and assess patients, perform immediate interventions to prevent medical complications or reduce risk, and perform performance analysis through which the merit payment plans are based.
Professional Nursing Leadership and Management Roles
According to (Cleveland, Motter, & Smith, 2019), the top health care trends include the Affordable Care Act, Medicaid expansion, and prescription drug/medicine prices. To respond to these trends, the role of nursing leadership and management has gained interest:
Improving quality of care and patient safety: Nurse Leaders and managers play the role of ensuring safe delivery of care by nurses to the patients. As per (Keegan, 2018) study, nurse leaders and managers should intimately familiarize themselves with the safety protocols and standards of the nursing profession and health care institution. In the context of the Affordable Care Act, for example, nursing leaders are mandated to supervise the nursing team members to guarantee all patients with quality care, safety, prevention of further harm, and wellness.
Monitoring patient care: Nurse Leaders and managers monitor patients’ care by their health care workforce/nurses to ensure that the nursing team is providing optimal quality care. With respect to the Medicaid expansion trend, nursing leaders and managers have been compelled to prepare care for the increasing influx of patients seeking care without compromising quality (Cleveland, Motter, & Smith, 2019). Nursing leaders and managers are also responsible for ensuring the health systems prepared meet the CMS standards of care.
Implementing change: To implement change, nursing leaders are required to be up to date and well-versed about health care trends, nursing operations, and medical practices. Before implementing change, nurses have to carry out evidence-based research on patient health matters, which must inform quality patient care (Korenstein, et al., 2016). Given the diverse nature and constantly changing patient needs, nursing leaders and managers must understand this change. For example, health care costs are prescribed in the Affordable Care Act and the prescription drug prices trends. Through this role, they are better prepared for success in their leadership and management role position.
Emerging Health Care Trends and Future of Nursing
Among the top emerging trends in nursing include movement to community-based care, telehealth’s continued growth, nursing turnover, nurses’ advocacy and action groups, expansion of entrepreneurial activities, the rise of nurse navigators, and more (Kyeremanteng, et al., 2019). These trends have impacted and will continue to impact the practice of the nursing role in the future. To predict the impact of these emerging trends in health care, two trends can be used (1) movement to community-based care, and (2) continued growth of telehealth.
A continued movement to community-based care: According to (Keegan, 2018), increasing numbers of registered nurses (RNs) are in public and community health and practicing care coordination in the community. Nurses are increasingly shifting their health care services from inpatient to outpatient settings. By 2025, approximately 30 percent of the U.S. RNs will have moved into the community outpatient setting. By then, the outpatient revenue would be 95 percent of inpatient revenue, helping close the gap between the two. This shift would be aligned to the Affordable Care Act’s goal of controlling health care costs and the need to establish new and advanced health care technologies.
Advanced growth of telehealth: In the next five (5) years, at least 95 percent of the U.S. health care centers would have embraced telehealth. With telehealth, patients will have increased access to nurses, physicians, and doctors through remote monitoring, video call consults, and other electronic modes of communication (Tinker, 2018). Currently, 76 percent of the U.S. health care centers and hospitals connect with patients and consulting RNs via technology. In areas such as critical care, telehealth will allow nurses to provide quality care virtually. In the area of wellness, hospitals and outpatient settings will be able to integrate personal health information from wearable devises into the records of their patients.
References
Cleveland, K. A., Motter, T., & Smith, Y. (2019, May 31). Affordable Care: Harnessing the Power of Nurses. OJIN: The Online Journal of Issues in Nursing, 24(2). doi:10.3912/OJIN.Vol24No02Man02
Keegan, W. (2018). Restructuring the U.S. healthcare delivery system. Medica; Economics, 1(1), 9-24. Retrieved from https://www.medicaleconomics.com/view/restructuring-us-healthcare-delivery-system
Korenstein, D., Duan, K., Diaz, M. J., Ahn, R., Keyhani, S., & Kevin, J. (2016). Do health care delivery system reforms improve value? The jury is still out. Medical Care, 54(1), 55-66. doi:10.1097/MLR.0000000000000445
Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., Neilipovitz, D., & Gianni, D. (2019). An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients. Critical Care Research and Practice. doi:10.1155/2019/8943972
Tinker, A. (2018). The Top Seven Healthcare Outcome Measures and Three Measurement Essentials. Health Catalyst, 10-30.