As An Advanced Nurse Practitioner ( N-5

Pay-for-performance payment model – healthcare payment systems that offer financial rewards to providers who achieve, improve or excel their performance on specified quality of care and cost measures (HealthCare Incentives Improvement Institute, N.D.)

First implemented in 1985 by Aetna (previously U.S. Healthcare), P4P programs were used to reward top performers and improve outcomes (Bruno, 2012). The incentives were meant to improve the quality of patient care by basing incentives on patient outcomes. Conversely, fee-for-service reimbursements are based on the treatments and set limits on the amount reimbursed for services. Because of these limits, incentives for use of pharmaceuticals and non-invasive procedures can impact how physicians practice.

I want to be an Advanced Practice Nurse. I complete similar work every day so I thought to myself, why not get the certification for it? As I called medical doctors and physicians assistants about sick patients, I found myself suggesting and telling them what orders the patient needs. I was struck with a sudden realization; I needed to go back to school.

It is commonly believed that the method of physician remunerations affects their professional behavior. As a result, payment systems are therefore manipulated in attempts to achieve policy objectives with the primary aim to improve quality of care, contain cost and maintain recruitment of human resources in underserved areas. (2,1)

Like what was stated previously, the cost of having Nurse Practitioners in place of doctors is lower. This is because their salaries are much less and the cost structure is lower. Evidence of this can be seen with Medicare and Medicaid. These government sponsored programs will pay for 85% of these services in comparison with doctors. This is important, because it is showing how the lower cost structure is one reason why Nurse Practitioners are playing a major role inside a health care environment. (Pickert, 2009)

by a nurse equivalent is equivalent to care provided by a physician.. In addition, the

There have been concerns regarding the identification and credentialing of advanced practiced registered nurses (APRNs). A APRN is a registered nurse who has successfully completed an accredited graduate-level education program, in which the individual is well prepared and successfully passed the nationwide certification examination (APRN Consensus Model, 2008). However, there are still debating issues of who would fall under the APRN category. The National Council of State Boards of Nursing (NCSBN) has identified four APRNs who are deem fit to be called ARPNs; however, only two will be named. They would be certified registered nurse anesthetists (CRNAs) and certified nurse practitioners (CNPs). Whereas, the nurse informatics and the nurse administrations are not considered to be APRNs; although, they are still license registered nurses but they do not provide direct patient care and are not required to take the national certification examination (ARPN Consensus Model, 2008).

With the passing of the Affordable Care Act in 2010 approximately 32 million more people will be insured throughout the United States. The need for healthcare workers and providers will be in drastic demand to provide care to these insured Americans. The 2010 IOM report details out how the advanced practice nurse can be a valuable asset in primary, chronic and transitional care and their skill set should be used to promote better healthcare across the nation (IOM, 2010). This impact of this report should help progress advanced practice nurse’s ability to practice without individual state regulation and be governed under one body to server in and outside of the hospital setting

The Texas Nurses Association is a strong proponent of permitting APRN’s to practice with full authority using their clinical skills and education to their fullest potential (Cates, 2017, p. 2)l. The TNA is a member of the APRN Alliance, which encompasses four statewide associations (Cates, 2017, p. 2). The APRN Alliance joined forces with the Coalition for Health Care Access (CHCA). This coalition is comprised of “over 20 business, consumer-advocacy, and health care stakeholder groups” (Cusack, 2017, p. 2). Currently, APRN’s barriers include expenses associated with partnering physicians (Holmes & Kinsey-Weathers, 2016). Granting APRN’s full practice authority would results in a monetary loss to these physicians. The AMA and AAFP oppose the passing of HB 1415 (Hooker & Muchow, 2015, p. 89). The pushback from these organizations stands regardless of strong evidence of the positive outcomes with allowing APRN’s full practice authority.

Advanced Practice nursing (APN) is considered the usage of a broader scope of constructive, logical and research-based expertise related to the health and well-being of patients, within a varying disciplines (DeNisco & Barker, 2013). What is the future position of APNs in the progression of our healthcare system? What role will this writer assume, educator, practitioner, population health coach, or all three? The use of theory, primarily Sister Callista Roy’s Adaptation Model, and EBP give this writer a firm foundation to develop and modify her own practice framework.

Reimbursement for the advanced practice nurse (APN) is improving but how they fit into reimbursement systems is vey important. One question that arises is if the APN should be paid the same fee for service as a physician or should only a percentage of the payment be received. Most third-party reimburses, which include a few large insurance companies are now reimbursing APNs and more states are getting on board with reimbursements by developing reimbursement models for APNs (Hamric, 2009). For example, Aetna US Healthcare, Anthem Blue Cross and Blue Shield of Kentucky, Medicare and Medicate all credential NPs as primary care providers and pay at 85% of the physician rate. Tricare of Kentucky credentials NPs and pays 100%.

One major trend in the healthcare environment is the shift from volume based reimbursement towards value based reimbursement. Many provider practices remain on a volume based or fee for service reimbursement plan. This system tends to reward high quantity of services with less regard for the quality or performance of the service. However, with a renewed focus on value, reimbursement plans

Many Americans use Advance Practice Nurse Practitioners (APRN) for a number of their health care needs. For more than fifty years, APRN’s have provided a great amount of services in primary care and acute settings, making their presence in the health care system important. Likewise, expectations are that APRN’s will become even more crucial to the delivery of healthcare as more Americans gain access to providers through the new tax reform. With this being said, it is imperative that the APRN be able to practice to his or her full practice authority. “Full practice authority is comprised of state practice and licensure laws that allow advanced practice registered nurses to practice fully in the four domains of practice, under the exclusive licensure

Going back to when I was a novice nurse, I was nervous, scared, afraid of making medication error, charting errors or fail to recognized patients worsening symptoms. These fears, made me vigilant, focused and kept me on my toes at all times. No matter which part of nursing I ended up as I grew up the from medical surgical nursing to stepdown unit nursing to intensive care nursing, I felt those fears in every step of my growth and they helped me be a better nurse for my pateints. Today, I am in the advanced practitioner program to become a nurse practitioner who is responsible for: interviewing, assessing, diagnosing, counseling and treating patients. To provide safe and quality healthcare, I am expected to have good critical thinking and decision making abilities (Maten-Speksnijder, Grypdonck, Pool, & Streumer, 2012). while I can recognize clinically deteriorating patients and recommend treatments, I am now responsible for providing treatments. I am now recognizing that facts about being not only responsible for the patient, but also to provide safe care that keeps the patient out of the hospital and out of the ICU. Knowing these facts, I am yet again, faced with the fears of my limited clinical practice knowledge as a practitioner. The amount of information that I have received and learned during this clinical rotation was both exciting and overwhelming at the same time, because I realized as a novice student nurse practitioner (NP), the limited depth of

Pay for performance is indeed a popular system of reimbursement to hospitals and providers, with adjustable financial incentive rates or a bonus. That said, I like that you reminded us there is a difference in the goals and process of the pay for performance and those of utilization management department, however, it is possible for providers or hospitals to use the result of a utilization management process such as retrospective reviews to improve their patients’ health care services in the health care arena, consequently, enhancing their incentive from their respective insurer. I like that you enumerated in details the activities covered under the pay for performance quality improvement reviews, as it is important to for health care managers to be cognizant of the various segments of the