Feb 23, 2024 Assignment 1: Issues in Health Care Reform (Interview) NURS 8100
A Sample Answer For the Assignment: Assignment 1: Issues in Health Care Reform (Interview) NURS 8100
Basis for Formation and Potential Positives
ACO’s were developed as a part of the Medicare Shared Saving Program (MSSP) around 2012. Conceptually, the goals were referred to as the “triple aim” which included improved patient experience, improved health outcomes (based on Medicare population) and cost reduction. Incentives for ACO’s would include reimbursement based on shared savings as goals of their development (benchmark based) and include efficient utilization of resources and improvement of quality and outcomes of care (Chukmaitov, et. al., 2019).
Unintended Consequences
Unfortunately, in the first three years of the ACO development, less than half of the organizations were able to attain reimbursement for shared shavings as benchmarks were not met. Additionally, contributing factors included a mix of primary care and specialist providers, ultimately causing misaligned goals especially in relation to preventative care. (Mikhailitchenko, et. al., 2020). Many organizations decided not to continue in the program due to these outcomes.
Personal/Organizational Consideration
My organization is currently one of 5 ACO’s in the state of Massachusetts. Our Medicare brand “Steward Health Choice” services a large population of the state. As with other commercial payer goals, preventative care, meeting quality metrics and managing chronic conditions are priorities. In 2018, there were 17 ACO’s in the state (Goff, et. al., 2021). It does seem that unless the system is well organized and prioritizes benchmark and outcomes, the profitability is significantly reduced. So far, my organization has fared relatively well.
References
Chukmaitov, A. S., Harless, D. W., Bazzoli, G. J., & Yangyang Deng. (2019). Factors associated with hospital participation in Centers for Medicare and Medicaid Services’ Accountable Care Organization programs. Health Care Management Review, 44(2), 104–114.
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Goff, S. L., Gurewich, D., Alcusky, M., Kachoria, A. G., Nicholson, J., & Himmelstein, J. (2021). Barriers and Facilitators to Implementation of Value-Based Care Models in New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol. Frontiers in Public Health, 9, 645665. https://doi.org/10.3389/fpubh.2021.645665
Mikhailitchenko, A., & Pforsich, H. (2020). An Empirical Insight: Accountable Care Organizations’ Profitability and Quality Drivers. International Journal of Medicine & Public Health, 10(4), 155–159. https://doi.org/10.5530/ijmedph.2020.4.34
This paper looks into an accountable care organization (ACO) in California and ways that it impacts population health. Accountable health care organizations play vital roles in promoting coordinated efforts between clinicians and medical practitioners while at the same time reducing costs and unnecessary treatments (McWilliams, 2016).
Accountable care organizations are a representation of changing health dynamics in the American care system. Accountable care organizations are formed when medical providers, for instance, doctors, nurses, health organizations and non-physician providers collectively agree to be responsible for financial and quality of care in a defined population.
Accountable Care Organization
In California, one of the common ACOs is the Shared Savings Programs (SSP) which is a voluntary program that is formed to encourage hospitals, doctors and other health providers in the country to come together as accountable care organizations. The organization gives coordinated and high-quality care to members who are beneficiaries of Medicare. The SSP was formed wit the intention of moving the payment system of Medicare from a volume perspective to outcome and value-based (Lipa, 2020).
SSP has significantly impacted population health in California. By coming together, SSP has improved the quality of care to patients who could not have afforded such care. The SSP ensures that patients from different areas in the state get the correct care at the right time. Quality care also means that patients do not go for unnecessary tests.
Another way that SSP has impacted population health in California is by focusing on preventative care through coordination of services across the different levels of care (Milwee, 2020).
The concept of bundled care.
Bundled care is a concept that entails Medicare implementing voluntary episode of payment models. Medicare used to make individual payments to individual services offered to patients. In Bundled care, all payments are combined in a single payment for physicians and hospital facilities. Bundled care increases the incentives for providers to work together to deliver patient care.
Assignment 1 Issues in Health Care Reform (Interview) NURS 8100
Bundled care exposes healthcare facilities to certain risks and challenges. Some of the risks of bundled care include the fact that patients may have comorbidities (Agrwal, 2020). This is where some patients might require expensive treatment procedures that are uncontrollable by the provider. Another risk of bundled care in handling cases of uncompliant patients. When patients fail to comply with their care plan such as the medication regimen, health care providers will have difficulties in managing the costs.
Benefits of showing pricing for care.
One benefit of showing pricing of care is that it promotes price transparency. When there is access to price transparency, it helps them to choose accountable payment models that are implemented by different organizations to improve healthcare quality. Another benefit of showing care pricing is that it empowers patients to make informed decisions and get more involved in their care. Care pricing also ensures equitable prices for both insured and uninsured patients since in most cases the uninsured patients are often charged more (Mummadi & Mishra, 2020). Finally, showing care prices helps the patient to make decisions on which provider will be most effective at a low cost. Showing care prices increase competition in healthcare facilities thereby improving the quality of care provided.
In conclusion, the Shared Saving Program (SSP) is an accountable care organization (ACO) that is designed to improve population health as well as the quality of care to patients. Showing care pricing benefits healthcare in various ways. By showing care prices, patients can make an informed decision based on the pricing and quality of services offered.
References.
Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The Impact of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review: A systematic review of the impact on spending, utilization, and quality outcomes from three Centers for Medicare and Medicaid Services bundled payment programs. Health Affairs, 39(1), 50-57.
Lipa, S. A., Sturgeon, D. J., Blucher, J. A., Harris, M. B., & Schoenfeld, A. J. (2020). Do Medicare Accountable Care Organizations Reduce Disparities After Spinal Fracture?. Journal of Surgical Research, 246, 123-130.
McWilliams, J., Hatfield, L., Chernew, M., Landon, B., & Schwartz, A. (2016). Early Performance of Accountable Care Organizations in Medicare.
Millwee, B. (2020). Accountable Care Organizations in Medicaid. The Journal of ambulatory care management, 43(1), 11-14.
Mummadi, S. R., Mishra, R., & Mummadi, R. R. (2020). Price Transparency in the Electronic Health Record. Jama, 323(3), 281-281.
Health reform involves revamping a country’s or state’s health care system. It entails addressing the ever-rising costs of health care for individuals, families, and the government. Health reforms center on improving the benefits citizens receive from the country’s healthcare system and increasing access to health insurance. Healthcare reforms aim to lower the number of uninsured individuals, making healthcare more affordable and enhancing the quality of care. During this course, I met with a state legislator and discussed a healthcare reform issue that has caught my interest. The purpose of this paper is to give a summary and analysis of the interview and discuss the health care reform issues I presented.
Selected State Legislator
I planned to present my healthcare reform of interest to a legislator from my state Illinois. With the help of my colleagues, I was able to plan a meeting with Representative LaToya Greenwood through her personal assistant. Greenwood is a Democratic member of the Illinois House of Representatives. She has represented the 114th district since January 2017 and is the chairperson of the Health Care Availability and Access Committee (Illinois General Assembly, n.d.). She is also a member of several other committees such as Prescription Drug Affordability; Agriculture & Conservation; Approp-Elementary & Secondary Education (Vice-Chairperson); Data Analytics & IT; Appropriations-Human Services; Cybersecurity, Public Utilities; Museums, Arts, & Cultural Enhancement.
Rep. LaToya Greenwood was the legislator of choice due to her admirable track record. She has chiefly sponsored numerous bills as a Representative. She recently passed House Bill 4645 to strengthen minority representation in health care and stop the uneven quality of care across underserved communities (Illinois General Assembly, n.d.). The bill was founded on her belief that every citizen in Illinois deserves the highest quality of health care at an affordable cost. Furthermore, Rep. Greenwood is dedicated to fighting for affordable prescription drugs and increasing the workforce in public health.
Summary of the Interview
The PA scheduled a one-hour meeting on 15th April 2022 at the Representative’s office from 10 am to 12 pm. The Rep welcomed me to her office, and after establishing rapport, I explained my purpose for the meeting and the desired outcomes from the meeting. The health care reform of interest was the introduction of a bill on mandatory Nurse-to-Patient ratios in all healthcare settings across Illinois. I explained to the Rep that hospitals in Illinois do not observe the WHO-recommended nurse-to-patient staffing ratios, which are purposed to promote safe patient care and prevent nurse burnout. I gave an example of the California nurse-to-patient staffing ratios act. The bill was passed to address the increasing concern that patients’ safety is often compromised by inadequate staffing attributed to the increasing severity of health conditions and complexity of care (Livanos, 2018).
I explained the benefits of enacting a bill on mandate nursing ratios, including the challenges the state currently faces due to the lack of that reform. There is a connection between nurse workload and patient morbidity and mortality rates. Hospitals with unsafe nurse-to-patient ratios overwork their nurses, resulting in burnout. Features of hospitals with high nursing workloads include increased incidences of medical errors and missed nursing care. Various studies found a high prevalence of hospital-acquired infections, like urinary tract infections and pneumonia, and failure to perform CPR in facilities with a high nurses’ workload.
I informed Rep. Greenwood that the biggest benefits from a health reform on safe nurse-to-patient ratios would be improved patient outcomes, reduced morbidity and mortality rates, reduced nursing turnover, and increased patient and staff satisfaction (Griffiths et al., 2018). Safe staffing ratios are equivalent to greater job satisfaction and reduced nurse turnover, saving organizations from the costs spent in frequently hiring new nurses. nurse-to-patient ratios influence most patient outcomes, most noticeably in mortality rates. Nurse staffing ratios are linked to a higher likelihood of patient survival. Lee et al. (2018) found that patients were 95% more likely to stay alive when health facilities observed a hospital-mandated nurse-to-patient ratio. Besides, managing critically ill patients in settings with high nursing workloads and unsafe staffing ratios was associated with a significant decrease in the odds of survival.
Potential Challenges with the Health Reform
We discussed the potential challenges of enacting mandatory nurse staffing ratios and approaches to address them with Rep. Greenwood. I explained that the main shortcoming of the health reform is that health organizations will be mandated to increase the number of nurses without getting increased reimbursement for patient care. Besides, the costs of hiring additional nurses needed for the increased mandated ratios will not be compensated by additional payments to health organizations (de Cordova et al., 2019). This will lead to unfunded mandates. Fortunately, the challenge can be addressed by providing a market-based incentive to healthcare organizations to improve nurse staffing levels (de Cordova et al., 2019). This will separate nursing care from the current room and board charges and adjust healthcare payments for optimum nursing care.
Feedback from the Legislator
Rep. Greenwood was pleased with the presentation since she is devoted to increasing the workforce in Illinois public health. She agreed that the proposed reform would significantly improve nurses’ working environment and quality of patient care resulting in improved health outcomes. She requested that I leave her with the printed proposal so that she can through it and make amendments where necessary. She also stated that she would organize another meeting to discuss the amendments and the way forward.
Conclusion
Enacting mandatory staffing ratios is the healthcare reform of interest. I presented the reform to Rep. LaToya Greenwood of the Illinois House of Representatives representing the 114th district. I presented the reform to Rep. Greenwood and discussed the benefits of enacting the bill on patients’ health outcomes and nurses’ job satisfaction. We also discussed potential challenges and solutions.
References
de Cordova, P. B., Rogowski, J., Riman, K. A., & McHugh, M. D. (2019). Effects of Public Reporting Legislation of Nurse Staffing: A Trend Analysis. Policy, politics & nursing practice, 20(2), 92–104. https://doi.org/10.1177/1527154419832112
Griffiths, P., Maruotti, A., Recio Saucedo, A., & Redfern, O. C. (2018). Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ Qual Saf.. https://doi.org/10.1136/bmjqs-2018-008043
Illinois General Assembly. (n.d.). Representative Biography. https://www.ilga.gov/house/Rep.asp?MemberID=2902
Lee, A., Cheung, Y. S. L., Joynt, G. M., Leung, C. C. H., Wong, W. T., & Gomersall, C. D. (2018). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals of intensive care, 7(1), 1-9. https://doi.org/10.1186/s13613-018-0269-2
Livanos, N. (2018). A broadening coalition: Patient safety enters the Nurse-to-Patient ratio debate. Journal of Nursing Regulation, 9(1), 68-70. https://doi.org/10.1016/S2155-8256(18)30056-5
According to the AACN (2006), “Political activism and commitment to policy development are central elements of professional nursing practice” (p. 13). Throughout this course, you will hone the skills and competencies required for this type of involvement in policy.
Research is an essential step in the process of acquiring the skills and competencies, and interviews are one form of research that can serve as a valuable source of information. As such, this Assignment (which you will start this week, and submit by the end of Week 9) provides an opportunity for you to identify a health reform issue of interest and discuss the issue with a state or national politician (or their aide).
To prepare:
Identify a state or national politician (state representative or legislator, senator, congressman, governor, etc.), or aide, whom you would like to interview regarding current issues in health care reform.
As soon as possible, contact the individual’s office to request a meeting. Keep in mind that it may be difficult to get on their calendar, so plan accordingly. You may conduct the interview in person or by phone.
In advance of the interview, ask yourself:
What health care policy issue is important to me personally?
What issue do I want to bring to this person’s attention?
With this in mind, develop your list of questions for the interview around your selected health policy issue. In addition, you may wish to include questions related to health care reform:
What are your constituents most concerned about regarding health care reform?
What are the trade-offs associated with recent health care reform policy?
By Day 7 of Week 9
To complete:
Write a 3- to 4-page paper providing a summary and analysis of the interview and the health care reform issues you discussed.
Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate. Refer to the Publication Manual of the American Psychological Association to ensure that your in-text citations and reference list are correct. Due by Day 7 of Week 9.
Assignment 1: Issues in Health Care Reform (Interview) NURS 8100
List ViewExcellent Good Fair PoorRESPONSIVENESS TODISCUSSION QUESTIONDiscussion post minimumrequirements:
8 (26.67%) – 8 (26.67%)Discussion postings and responsesexceed the requirements of theDiscussion instructions. They:Respond to the question beingasked or the prompt provided; – Go
7 (23.33%) – 7 (23.33%)Discussion postings and responsesmeet the requirements of theDiscussion instructions. They: –Respond to the question beingasked or the prompt provided; -Are
6 (20%) – 6 (20%)Discussion postings and responsesare minimally responsive to therequirements of the Discussioninstructions. They: – do not clearlyaddress the objectives of the
0 (0%) – 5 (16.67%)Discussion postings and responsesare unresponsive to therequirements of the Discussioninstructions. They: – do not clearlyaddress the objectives of the
*The original posting must becompleted by Wednesday, Day 3,at 11:59pm MST. Two responsepostings to two different peeroriginal posts, on two differentdays, are required by Saturday,Day 6, at 11:59pm MST. Facultymember inquiries requireresponses, which are notincluded in the minimum numberof posts. Your Discussion Boardpostings should be written instandard edited English andfollow APA style for format andgrammar as closely as possiblegiven the constraints of the onlineplatform. Be sure to support thepostings with specific citationsfrom this week's LearningResources as well as resourcesavailable through the WaldenUniversity online databases. Referto the Essential Guide to APAStyle for Walden Students toensure your in-text citations andreference list are correct.
beyond what is required in somemeaningful way (e.g., the postcontributes a new dimension,unearths something unanticipated);-Are substantive, reflective, withcritical analysis and synthesisrepresentative of knowledge gainedfrom the course readings andcurrent credible evidence. –Demonstrate significant ability togeneralize and extend thinking andevaluate theories or concepts withinthe topic or context of thediscussion. -Demonstrate that thestudent has read, viewed, andconsidered the Learning –Resources as well as additionalresources and has read, viewed, orconsidered a sampling ofcolleagues' postings; -Exceed theminimum requirements fordiscussion posts*.
substantive, reflective, with criticalanalysis and synthesisrepresentative of knowledge gainedfrom the course readings andcurrent credible evidence.re –Demonstrate ability to generalizeand extend thinking and evaluatetheories or concepts within the topicor context of the discussion. –Demonstrate that the student hasread, viewed, and considered theLearning Resources and has read,viewed, or considered a sampling ofcolleagues' postings -Meet theminimum requirements fordiscussion posts*.
discussion or the question orprompt; and/or -May (lack) lack indepth, reflection, analysis, orsynthesis but rely more onanecdotal than scholarly evidence;and/or -Do not adequatelydemonstrate that the student hasread, viewed, and considered theLearning -Resources and/or asampling of colleagues' postings;and/or has posted by the due dateat least in part. – Lack ability togeneralize and extend thinking andevaluate theories or concepts withinthe topic or context of thediscussion. -Do not meet theminimum requirements fordiscussion posts*.
discussion or the question orprompt; and/or – Lack in substance,reflection, analysis, or synthesis butrely more on anecdotal thanscholarly evidence. – Lack ability togeneralize and extend thinking andevaluate theories or concepts withinthe topic or context of thediscussion. -Do not demonstratethat the student has read, viewed,and considered the LearningResources and/or a sampling ofcolleagues’ postings; and/or doesnot meet the minimum requirementsfor discussion posts*.
CONTENT KNOWLEDGE 8 (26.67%) – 8 (26.67%)
Discussion postings and responses:-demonstrate in-depthunderstanding and application ofconcepts and issues presented inthe course (e.g., insightfulinterpretations including analysis,synthesis and/or evaluation of topic;– are well supported by pertinentresearch/evidence from a variety ofand multiple peer- reviewed booksand journals, where appropriate; –Demonstrate significant masteryand thoughtful/accurate applicationof content, applicable skills orstrategies presented in the course.
7 (23.33%) – 7 (23.33%)Discussion postings and responses:-demonstrate understanding andapplication of the concepts andissues presented in the course,presented with some understandingand application of concepts andissues presented in the course(e.g., insightful interpretationsincluding analysis, synthesis and/orevaluation of topic; -are supportedby research/evidence from peer-reviewed books and journals, whereappropriate; and · demonstratesome mastery and application ofcontent, applicable skills, orstrategies presented in the course.
6 (20%) – 6 (20%)Discussion postings and responses:– demonstrate minimalunderstanding of concepts andissues presented in the course, and,although generally accurate, displaysome omissions and/or errors; –lacksupport by research/evidenceand/or the research/evidence isinappropriate or marginal in quality;and/or lack of analysis, synthesis orevaluation of topic – demonstrateminimal content, skills or strategiespresented in the course. ——-Contain numerous errors whenusing the skills or strategiespresented in the course
0 (0%) – 5 (16.67%)Discussion postings and responsesdemonstrate: -A lack ofunderstanding of the concepts andissues presented in the course;and/or are inaccurate, contain manyomissions and/or errors; and/or arenot supported byresearch/evidence; and/or lack ofanalysis, synthesis or evaluation oftopic -Many critical errors whendiscussing content, applicable skillsor strategies presented in thecourse.
CONTRIBUTION TO THEDISCUSSION
8 (26.67%) – 8 (26.67%)Discussion postings and responsessignificantly contribute to the qualityof the discussion/interaction andthinking and learning by: -providingRich and relevant examples;discerning and thought-provokingideas; and stimulating thoughts andprobes; – -demonstrating originalthinking, new perspectives, andextensive synthesis of ideassupported by the literature.
7 (23.33%) – 7 (23.33%)Discussion postings and responsescontribute to the quality of thediscussion/interaction and thinkingand learning by -providing relevantexamples; thought-provoking ideas– Demonstrating synthesis of ideassupported by the literature
6 (20%) – 6 (20%)Discussion postings and responsesminimally contribute to the quality ofdiscussion/interaction and thinkingand learning by: – providing fe
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