Healthcare Delivery Models and Nursing Practice Assignment

There is no single-payer health insurance system in place in the United States. The cost of healthcare is likewise among the highest in the world in the US (Sultz & Kroth, 2018). According to Cai et al. (2020), a system with only one payer would have looked something similar to Medicare for all. For the very first occasion in terms of legislative strategy and coverage, the American healthcare system underwent significant improvements in 2010. This took the shape of healthcare legislative policy that was enacted to reorganize the payer and delivery systems for healthcare services. The official name of the legislation is the Patient Protection and Affordable Care Act 2010. It is otherwise simply known as the ACA 2010 or Obamacare (Kominski et al., 2017). The purpose of this paper is to discuss the ACA 2010 as a federal healthcare regulation and its impact on nursing practice. Healthcare Delivery Models and Nursing Practice Assignment

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The Current Federal Healthcare Regulation in Force: The Patient Protection and Affordable Care Act of 2010

The 2010 ACA was created to lower the cost of healthcare for mostly the underprivileged and to bring about some degree of equality in healthcare access. It introduced the “individual mandate” rule, which forced every individual to enrol for the health coverage by only paying a little cost, in order to take advantage of economies of scale. The option to purchase health insurance belongs to the employer for individuals who are working. The individual obligation carries a penalty for noncompliance (Kominski et al., 2017). The ACA of 2010 also included a beneficial and ground-breaking clause that gave payers monetary rewards for covering even pre-existing diseases including heart disease, diabetes mellitus, and hypertension. Such existing illnesses were not covered by payers prior to the ACA of 2010. Healthcare Delivery Models and Nursing Practice Assignment

The practice of providers focusing on volume production at the cost of value or excellence was also ended by the ACA of 2010. Pay-for-performance is a notion that was developed by it (Holmström, 2017). This clause stipulates that the practitioner must have given the person receiving treatment the best care possible, regardless of the patient’s socioeconomic standing, in order for payment to be respected. This has a significant impact on the practice of nursing as well as the role and accountability of the nurse.

Effect on Nursing Practice, Role and Responsibilities

Nurses would first need to educate and enlighten their clients about the need to demand the best treatment possible from all healthcare providers. They now have legal protection for this right, which is theirs. Additionally, nurses would have to provide only top-notch nursing care. This would particularly apply to advanced practice nurses who are also clinicians in their own right, such as nurse practitioners. The advanced practice nurses would need to solely apply evidence-based practice (EBP) that is certain to utilize effective interventions supported by scientific research because of the necessity for value over volume and the pay-for-performance mandate (Melnyk & Fineout-Overholt, 2019; Spath, 2018). This would be ideal behavior and the benchmark for performance. Healthcare Delivery Models and Nursing Practice Assignment

Quality Measures, Pay-for-Performance, and Effect on Nursing Practice

The pay-for-performance option and other quality standards introduced by the Affordable Care Act of 2010 (ACA) have a direct bearing on patient outcomes. This is due to the fact that it is now against the law for clinicians to utilize any interventions unless they are certain that they would be successful in treating the patient. If you don’t do this, you’ll miss out on reimbursement and fall short of the pay-for-performance standard.

Evidence-based practice (EBP) is the only type of practice that can ensure such types of successful treatments. EBP is an effort to improve quality that will allow healthcare professionals to give patients care that is efficient and effective. In other words, EBP makes it possible to provide care that is secure, prompt, efficient, effective, fair, and patient-centered. According to the Institute of Medicine (IOM), these are the six dimensions of quality care (AHRQ, 2018). These categories are all met by EBP. Healthcare Delivery Models and Nursing Practice Assignment

The impact on the outcomes of patients is such that the EBP-required quality metrics result in a scenario where the patient’s length of hospitalization is decreased. Because of EBP and high-quality treatment, they recover more quickly and can leave the hospital sooner. This indicates that they are currently spending fewer dollars on healthcare than they were. In addition, there will be reduced hospital-acquired illnesses including ventilator-associated pneumonia (VAP), fewer return visits, and ultimately fewer deaths and morbidity.

In these circumstances, the nurse’s duty as a nurse includes responsibilities and expectations that make them the guardian of the patient’s interests. Then, they must make sure the patient receives the care that is required by law. They must take the lead in providing high-quality care exclusively through EBP going forward. It is anticipated that medical outcomes would become better and satisfaction among patients will dramatically rise. Healthcare Delivery Models and Nursing Practice Assignment

Professional Nursing Leadership and Management Roles

According to the aforementioned advancements, professional nursing leadership and management roles are beginning to emerge. These roles increasingly favor transformational nurse leaders who can inspire, encourage, and elevate the nurses who report to them (Robbins & Davidhizar, 2020). In this way, the nurses are psychologically safe at work and aren’t stressed out or anxious about being taken advantage of by the nurse leaders. The nurses are so at ease in such a setting with transformative nurse leadership that they make less mistakes.

Additionally, even if they make a mistake, they are willing and prepared to tell their transformational nurse leader because they are certain that they won’t criticize or victimize them but rather use the principles of just cause. As a result, patient satisfaction and safety are consistently promoted in a variety of healthcare settings, and patients get the finest care possible. Additionally, nurses’ intentions to leave their jobs decrease, and job satisfaction rises. A content nurse will take pleasure in their work and only provide the highest caliber of care. Less mistakes and improved patient safety are the end results.  Healthcare Delivery Models and Nursing Practice Assignment

Predicted Change in Nursing Roles and Nursing Practice

Regarding new trends, I can say that nursing will take advantage of innovation increasingly more than it has in the past, and that nurses will also seek out higher education than they have in the past to improve. The problem of mistakes within the healthcare sector has been attributed to the absence of technology, which has been hailed as a remedy and solution. The nurses who have utilized and are familiar with the value of computerized clinical decision support systems integrated into electronic health record (EHR) systems can speak to the truth of this. Nurses that receive more training will also be better at providing evidence-based treatment.

Conclusion

The 2010 Affordable Care Act (ACA 2010) completely changed American healthcare landscape. It also brought with it the obligation for pay-for-performance and the option for prioritizing quality over quantity. Apart from that, the individual mandate rule ensures that everybody enrols and economies of scale are used fully. These regulations have resulted in higher-quality treatments and overall improved results for patients. Indeed, this is the closest the US has come to having Universal Healthcare. Healthcare Delivery Models and Nursing Practice Assignment

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References

Agency for Healthcare Research and Quality [AHRQ] (2018). Six domains of health care quality. https://www.ahrq.gov/talkingquality/measures/six-domains.html

Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., Bertozzi, S., White, J.S., & Kahn, J.G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLOS Medicine, 17(1), 1-18. https://doi.og/10.1371/journal.pmed.1003013

Holmström, B. (2017). Pay for performance and beyond. American Economic Review, 107(7), 1753–1777. https://doi.org/10.1257/aer.107.7.1753

Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. https://doi.org/10.1146/annurev-publhealth-031816-044555

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Robbins, B., & Davidhizar, R. (2020). Transformational leadership in health care today. The Health Care Manager, 39(3), 117–121. http://dx.doi.org/10.1097/HCM.0000000000000296

Spath, P.L. (2018). Introduction to healthcare quality management, 3^rd ed. Health Administration Press.

Sultz, H.A., & Kroth, P.J. (2018). Sultz and Young’s health care USA: Understanding its organization and delivery, 9^th ed. Jones & Bartlett Learning. Healthcare Delivery Models and Nursing Practice Assignment