Policy, Politics and Global Trends Essay

In 2012, the ACA found an excessive amount of readmissions of patients that were hospitalized within 30 days for the same medical conditions. This factor viewed under the ACA as a quality issue and CMS implemented value-based incentive payments based on performance in a set of quality measures. The plan is to implement a pay for performance (P4P) in formulas used by Medicare to reimbursement providers. “The objective is to link reimbursement to quality and efficiency as an incentive to improve the quality of health care, as well as reduce system-wide costs” (Shi and Singh, 2015). In addition to the P4P, nonprofit hospitals also focus on continual improvement, data and cost containment throughout the organization (Adamopoulos,

Under payment, an ideal healthcare system will have the challenge of delivering higher quality for lower costs. The system’s payment reform will involve a transition from fee-for-service to global from systems that are value-based important for the achievement of the overall healthcare goals. An ideal healthcare payment system will give a great deal of support to value-driven system of healthcare delivery (Kent, 2013). The fee-for-service payment system will be of great importance to the healthcare system as it will help control the costs of health care.

Over the last five years, the United States has implemented a new policy in which Americans will receive their health care benefits. This policy is known as the Patient Protection and Affordable Health Care Act which was implemented in 2010 through United States federal statue and signed into law by President Barack Obama. The intentions of the reform is to insure that all Americans have affordable access to health care benefits without struggling to afford the cost associated. The reform is broken down into nine title sections that affect all aspects of health care and changes that will be associated. In this paper, I will be discussing each of the title sections and how the changes will affect the field of nursing.

“The purpose of public policy is to direct problems to government and secure government’s response, while politics is the use of influence to direct the responses toward goals” (Milstead, 2013, p. 12). Policies are used as guidelines to reach a common goal. In healthcare, policies can affect and have an impact on how we provide care for our patients’. For this reason, it is important for nurses to be knowledgeable and involved in important healthcare decisions. “Knowledgeable nurses in advanced practice must demonstrate their commitment to action by being a part of relevant decisions that will ensure the delivery of quality health care by appropriate providers in a cost-effective manner” (Milstead, 2013, p. 1).

Healthcare has been around for many decades. It has always been a problem for many Americans. Whether it be too expensive or individuals do not qualify to be covered under medical insurance. Many Americans have spent years trying to get some type of medical coverage. This can be a frustrating task because it is not easy. In 2010 the Affordable Care Act was signed into law by congress. This law made healthcare affordable and accessible to all Americans. While it is a good attempt at changing previous healthcare rules, many Americans still go uninsured. In this paper I will look at two components the American Nursing Association feel need to be reformed.

Through the history of health care, the standard of care changed from protecting our patient from injury and illness to a systemic entity to make money for insurance companies. Access to services and clinical outcomes are dependent on what health insurance providers will “pay” for in a clinical or community setting; as a result, patient safety, care and satisfaction has been negatively impacted.

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.

There is a growing trend in the United States called pay-for-performance. Pay-for-performance is a system that is used where providers are compensated by payers for meeting certain pre-established measures for quality and efficiency (What is Pay-for-Performance, n.a.). We are going to be discussing what pay-for-performance is. There are different aspects of pay-for-performance which include; the effects of reimbursement by this approach, the impact cost reductions has on quality and efficiency of health care, the affects to the providers and patients, and the effects on the future of health care.

The service-based pay structure provides significant motivation for healthcare providers to deliver as many services as possible, with little to no consideration of patient outcomes. Furthermore, this structure provides no incentive for certain key elements of healthcare such as patient education and care coordination, both of which have led to diminished costs and better outcomes for patients. I am of the opinion that very little quality improvement will take place if this pay-for-service model persists. The current transition from service-based pay to quality-based pay is definitely a move in the right

For anyone who has kept up with the news, the US healthcare system has undergone major changes in recent years. Insurance providers are no longer able to deny someone coverage based on pre-existing conditions. The advent of healthcare marketplaces has changed the way people purchase health insurance. Children can stay on their parents' health insurance plans until 26. Leading the healthcare revolution is InnovaCare Health. This organization is a leading provider of Medicaid and Medicare Advantage plans. InnovaCare Health recently announced it would partner with the Health Care Payment Learning and Action Network. This is a significant private-public partnership that seeks to change compensation models to reflect the quality of care instead of quantity. This new partnership reflects InnovaCare Health's to affect change in compensation sooner rather than later. The current healthcare model focuses on reimbursing physicians based on the number of patients seen or procedures performed. This encourages "treadmill medicine," or a model that focuses on rapid turnover. This can often lead to detrimental effects on patient health. The new quality model would reward physicians based on practice targets. Potential goals include HbA1c goals for patients with diabetes, the percentage of patients who smoke, and hospital stay after surgical procedures.

The author of this paper is a registered nurse, a graduate student of Maryville University who lives in San Mateo, California with zip code 94403. The author has conducted a search of her state and federal legislators. In this paper, committees of federal representatives and senators are discussed. Main focus is given to the legislators’ involvement in health care policy. The paper also discusses how California Action Coalition implements the recommendations of the Future of Nursing. Additionally, the relevance of selected websites (http://www.hhs.gov, http://www.house,gov, http://www.senate.gov, and http://www.thefutureofnursing.gov) to the author’s current practice and practice in the near future

Besides, the financial incentives for hospitals and physicians that belong to ACOs, Jaffery & Golden 2013, asked and then answered the question “why would providers join this program? One reason is to prepare for the future”. Fee-for-service reimbursement, which has been how hospitals get paid for their services rely solely on the volume of patient seen without taking into consideration the quality of care provided. Payers today, such as government, commercial insurers, employers, and individual consumers are now requesting on value -based-payment, which consist of delivering the highest level of care at a lower cost. The volume based system even though the traditional way of how payments are made is not a viable long-term option (Jaffery and Golden, 2013, p.98).

Mason, D. J., Gardner, D. B., Outlaw, F. H, & O’Grady, E. T. (2016). Policy & Politics in Nursing and Healthcare, 7th ed. Elsevier.

Since 1992, health cares like Medicare have reimbursed physicians on a fee-for-service basis that weighs their service and expenses and then converts the weights to money (Wilensky, 8). According to Gail Wilensky, “Congress replaced an existing spending constraint with the Sustainable Growth Rate (SGR) to reduce reimbursements if overall physician spending exceeded the growth in the economy” (Wilensky, 8). Physicians and PAs are having a hard time with health-care reimbursement. It is causing many problems and Congress needs to come up with a solution. ¨This article states several promising models, including patient-centered medical homes, accountable care organizations, and various payment bundling pilots, that could offer lessons for a larger reform

The positive outcomes that have resulted due to value base programs have caused the model to gain traction and ignite one of the largest changes in history in the health care marketplace. By linking reimbursements to service quality, insurers such as the Centers for Medicare and Medicaid Services have facilitated a massive leap forward in the performance of United States health care providers. This achievement is a considerable accomplishment in the face of an institution that has received reimbursement from insurers via a fee-for-service model during the last 75 years. Soon, valued based payment models will represent the norm as more insurers support initiatives such as shared savings program, integrated clinical care, and accountable care payment models.