Health Care Delivery Models and Nursing Practice Essay Paper

Federal and state laws reform the healthcare system. These healthcare laws improve the quality of care by regulating nursing practice at state or national levels. However, a law is formulated and adopted based on the practice area that needs improvement. Others are introduced to amend existing policies, enhancing clinical practice. While several federal healthcare laws are in existence, this paper focuses on “The Sustaining Excellence in Medicaid Act” of 2019 (HR 3253), including the impact of pay for performance (P4P) and quality measures on patient outcomes, nursing managerial and leadership roles arising from this law, and emerging trends. Health Care Delivery Models and Nursing Practice Essay Paper

A Current Health Care Law and its Impact on Nursing Practice and Responsibility and Roles of Nurses

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A recent law that the federal government implemented is “The Sustaining Excellence in Medicaid Act” of 2019 (HR 3253). Debbie Dingell, the Michigan representative, introduced HR 3253 into Congress on June 13, 2020, and sponsored it (CONGRESS. GOV, 2020). Later, on August 6, 2020, the bill was signed into law after passing through all stages. HR 3253 primarily aimed at restructuring the Medicaid program (CONGRESS. GOV, 2020). The new federal law would modify some provisions of the Medicaid program to make it more effective in meeting beneficiaries’ needs. In particular, the reform would support Medicaid appropriations through the 2024 fiscal year. Additionally, the bill would allow the state fraud units in the Medicaid program to evaluate complaints presented by non-institutionalized patients, eliminating potential complaints from these patients.

Additionally, this bill extended Medicaid eligibility to protect individuals from poverty or spousal impoverishment. In some cases, Medicaid coverage is not extended to spouses with low socioeconomic status. Such populations would be covered in this bill. For instance, the bill would specify persons qualifying for community- and home-based medical services. Moreover, this bill repeals drug manufacturers’ requirements that require them to always capture generic drug prices when setting the price. Besides, the bill exempts drug manufacturers from the drug wholesalers’ definition, supporting rebate calculations. Health Care Delivery Models and Nursing Practice Essay Paper

HR 3253 affects the nursing practice by modifying the responsibilities and roles of nursing staff. For instance, this bill defines persons qualifying for community- and home-based medical services. Studies show that home- or community-based care improves health outcomes in persons with chronic or terminal illnesses (Saunders et al., 2019). Therefore, nurses would provide nursing care services to these individuals to optimize their healthcare outcomes. Providing healthcare services to patients in these settings would increase nurses’ workload. Additionally, this health care policy extends Medicaid coverage to spouses, protecting them from current impoverishment. Hence, nurses would provide care services to spouses based on provisions of the amended Medicaid program, increasing their workload and working hours. In addition to providing care services to individuals and groups covered by the modified Medicaid program, nurses will be involved in educating the community about changes in the Medicaid program initiated by HR 3253. Lastly, nurses will perform an advocacy role to ensure that patients access services included in the refined Medicaid program.

The Impact of Quality Measures and P4P on Patient Outcomes

In the healthcare system, P4P and quality measures impact patient outcomes. P4P is a reimbursement model in which healthcare providers are compensated based on the efficiency and quality of healthcare services delivered to patients (Kyeremanteng et al., 2019). This model promotes quality of patient care since it does not focus on the volume of services offered but rather on outcomes. Therefore, P4P leads to optimal patient care since healthcare providers focus on providing quality care to maximize their financial rewards and income. On the other hand, the P4P model punishes practitioners for poor quality care through penalties. However, the P4P model affects nursing practice adversely. In most cases, nurses are unwilling to provide care services to patients with more complicated medical issues since they might be punished for the patient’s poor results, which might not be their fault. Thus, poor patient outcomes in the P4P reward system encourage patient dumping, which leads to adverse outcomes, including death. Health Care Delivery Models and Nursing Practice Essay Paper

Professional Nursing Leadership and Managerial Duties and their Response to Emerging Trends and Promoting Quality Care and Patient Safety

The most significant emerging nursing leadership and managerial positions and roles is nursing informatics. According to Forman et al. (2020), nurse informatics use their technology skills to enhance nursing practice by collecting, organizing, and documenting data needed to enhance nursing and clinical practice. Incorporating health information technology (HIT) into clinical practice is one of the emerging trends in the healthcare industry (Okolo et al., 2021). This change requires nurses to advance their technology knowledge and skills to enhance their nursing practice. For instance, nurses rely on patients’ electronic health record (EHR) data when making clinical decisions. This nursing role is supported by nurse informatics, who ensure access to electronic data by multidisciplinary teams involved in patient care, allowing them to provide safe and quality patient care to patients with diverse healthcare needs.

Potential Changes in Nursing Practice and Nursing Roles

The use of medical robots in performing various operations in healthcare settings has increased tremendously. For instance, robots distribute medicines and other supplies, such as devices and implants, within healthcare settings (Awad et al., 2021). Nurse assistants and registered nurses initially performed these duties. Therefore, increasing the use of robots in healthcare settings will render a significantly high number of nurses jobless in the next five years. Besides, a few nurses who will be serving in various healthcare organizations will be required to upgrade their technology skills and learn how to operate technological devices to enhance their clinical operations within hospital settings. Moreover, the use of telemedicine in the healthcare industry is an emerging trend (Sahoo et al., 2023). Integrating nursing practice with telemedicine will transform nurses’ roles. Therefore, nurses must acquire technology and communication skills to enable them to communicate with patients via telehealth systems if need be. Timely communication will allow nurses to address patient’s needs, improving health outcomes. Health Care Delivery Models and Nursing Practice Essay Paper

Conclusion

HR 3253 was enacted to restructure the original Medicaid program. Including new provisions, such as covering spouses with low incomes and provision of community-based care, would make the program more effective in meeting beneficiaries’ health needs. This bill would impact nurses’ roles. It would increase their workload since nurses would be involved in providing healthcare services to new groups included in the bill. Nurses would also educate individuals and the community about changes in the Medicaid program. An emerging role in the nursing profession aligning with trends in the healthcare sector is nurse informaticists. These nurse practitioners ensure that EHR data needed in making clinical decisions is accessible to team members involved in the patient’s care process.

References

Awad, A., Trenfield, S. J., Pollard, T. D., Ong, J. J., Elbadawi, M., McCoubrey, L. E., … & Basit, A. W. (2021). Connected healthcare: Improving patient care using digital health technologies. Advanced Drug Delivery Reviews, 178, 113958. https://doi.org/10.1016/j.addr.2021.113958

CONGRESS. GOV. (2020). H.R.3253 – Sustaining Excellence in Medicaid Act of 2019. CONGRESS. GOV. https://www.congress.gov/bill/116th-congress/house-bill/3253/text/eas

Forman, T. M., Armor, D. A., & Miller, A. S. (2020). A review of clinical informatics competencies in nursing to inform best practices in education and nurse faculty development. Nursing Education Perspectives, 41(1), E3-E7. DOI: 10.1097/01.NEP.0000000000000588

Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., & Neilipovitz, 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, 2019(1), 8943972. https://doi.org/10.1155/2019/8943972

Okolo, C. A., Ijeh, S., Arowoogun, J. O., Adeniyi, A. O., & Omotayo, O. (2024). Reviewing the impact of health information technology on healthcare management efficiency. International Medical Science Research Journal, 4(4), 420-440. DOI: https://doi.org/10.51594/imsrj.v4i4.1000

Sahoo, S., Sahoo, J., Kumar, S., Lim, W. M., & Ameen, N. (2023). Distance is no longer a barrier to healthcare services: current state and future trends of telehealth research. Internet Research, 33(3), 890-944. https://www.emerald.com/insight/content/doi/10.1108/INTR-10-2021-0774/full/html

Saunders, S., Killackey, T., Kurahashi, A., Walsh, C., Wentlandt, K., Lovrics, E., … & Wong, S. (2019). Palliative care transitions from acute care to community-based care—a systematic review. Journal of Pain and Symptom Management, 58(4), 721-734. https://doi.org/10.1016/j.jpainsymman.2019.06.005

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. Health Care Delivery Models and Nursing Practice Essay Paper

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Include the following:

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. Health Care Delivery Models and Nursing Practice Essay Paper