The Future of Nursing: Patient Care Delivery Models

Although the largest profession in the health care industry is nursing, a larger number of people are getting older and living longer. This means that more people will need nursing care, whether it’s in a hospital, a long-term care facility or at home. It is projected that long-term care facilities will need 66% more RNs by 2020 (Addressing the Nursing). The increase in life expectancy has amplified the complexity of health care because more people are living with chronic conditions. The American Nurses Association reported that “a large cross-sectional study of over 1,000,000 adults revealed that 82% had one or more chronic conditions” and we are seeing an increase of those age 65 and older living with multiple chronic conditions (Mion). Now, more than ever, there is a high demand for the best delivery of medical care.

Nursing is a dynamic profession and life long learning is essential for nurses to stay current with the increased complexity of the healthcare needs of today and into the future. In other words, the needs of our patients are changing, as we must change in order to be prepared to better serve that need.

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

The Accountable Care Organization (ACO) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients (McCarty, B., 2016). For example, Medicare Shared Savings Program was created by The Center for Medicare & Medicaid Services to monitor and establish that all ACO’s are meeting the quality performance benchmarks and reduce Medicare spending by certain percentages (H., 2017). The growth of ACO’s from 2011 to 2016 is astonishing, in 2011 there was 64 ACO’s and by 2016 they have risen to 838 in the U.S. (H., 2017).

Pioneering an Accountable Care Organization Model which is a program which goes hand in hand with the Medicaid Shared Savings Program. They are focused on providing highly coordinated care for Medicare fee-for-service-beneficiaries.

Hospitals should be encouraged to participate because improving hospital care is likely to be essential to success (McClellan et al, 2010). Accountable care organizations can be implemented through different payment models. These could include opportunities to share in demonstrated savings within a fee-for-service environment, in which providers took on no new financial risk. They could also include limited or substantial capitation arrangements, in which payments were unrelated to the volume of services provided, to the intensity of service use, or to the frequency of face-to-face meetings, and in which providers took on some financial risk for poor-quality results or failure to control costs (McClellan et al,

The accountable care organization I researched is called the Physician Organization of Michigan ACO (POM ACO). The POM ACO is a joint venture of the U-M Health System and physician groups around the state, with the aim of improving care for 81,000 Michiganders enrolled in traditional Medicare and slowing the growth of health care costs, according to the announcement by the U-M Health System (Daly, 2013). The group was launched on January 1, 2013 under the Medicare Shared Savings Program. 12 physician organizations from around Michigan came together to take part in a Medicare-sponsored program that strives to improve on the quality of care for traditional Medicare recipients, while also containing cost growth. In 2014, POM ACO expanded to include all the University of Michigan faculty physicians and thousands of other providers from the University of Michigan Health System. The POM ACO is now one of the largest accountable care organizations nationwide. More than 5,700 physicians and other providers are now involved in the POM ACO. Therefore, the POM ACO is organized as a physician-hospital organization. Hence, the patient has more flexibility in where and how their care is delivered. The patient can still use any doctor or hospital that accepts Medicare at any time.

​Kaiser Health News recently published an article on a new trend in healthcare. This trend introduces the Accountable Care Organization (ACO). The Centers for Medicare and Medicaid services defines it as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (“Accountable Care Organization,” 2015). According to the Affordable Care Act (ACA), the goal of the ACO is to be able to share health cost-savings with providers who are able to save money by eliminating unnecessary procedures and reduce health costs while increasing quality of care. ACOs make health professionals become more accountable in maintaining good-quality, coordinated healthcare for a patient through a value-based system that is evaluated through a number of criteria and benchmarks (Ronai, 2011).

The Affordable Care Act (ACA) legislated in 2010, has changed the United States health care industry. In addition to universal healthcare, one of the principles of the ACA is the ideal of accountable care. Specifically, adopting an Accountable Care organization (ACO) for Medicare beneficiaries under the fee for service program. An ACO seeks to hold providers and health organizations accountable for not only the quality of health care they provide to a population, but also keeping the cost of care down (1). This is accomplished by offering financial incentives to the healthcare providers that cooperate in, circumventing avoidable tests and procedures. The ACO model, seeks to remove present obstacles to refining the value of care, including a payment system that rewards the volume and intensity of provided services instead of quality and cost performance and commonly held assumptions that more medical care is equivalent to higher quality care (2) .A successful ACO model, will have developed quality clinical work and continual improvement while effectively managing costs, however this is contingent upon its ability to encourage hospitals, physicians, post-acute care facilities, and other providers involved to form connections that aid in coordination of care delivery throughout different settings and groups, and evaluate data on costs and outcomes(3). This establishes the ACO will need to have organizational aptitude to institute an administrative body to manage patient care,

Even although, the cost of the health care system and the care it offers my not allow the national debt to decline to a level that will or would enhance the economy forward the cost of running a system that is backed by the government is too costly, and it will not help the deficit. , the legal responsibility of the organization is that every patron should have the same treatment for the same ailment. There are no predetermined dispositions; everyone is eligible as a government-backed facility. The funds are to assure those who have no insurance are covered. The accountable care

The American health care system has been victim to an escalation in the prices of health care services juxtaposed with inefficiency in delivery of care services. There has even been cases where State spending on the actual health care increased dramatically in the United States and one of the key components of curbing this problem which has been prevalent over the mass media and has been a major discussion among physicians is the advent of Accountable Care Organizations. Accountable Care Organizations (ACOs) is structured with the goal of trying to improve health care delivery and aid in the reduction of the overall cost of services (Weissert & Weissert, 2012). If there is insufficient coordination of high quality care delivery in the health care industry, this will have a negative impact on patient safety and diminish affordable care for patients. Hence, the development of ACOs is envisioned to be the savior of medical practices and can improve the overall fabric of the American society (Bresnick, 2013). ACOs serves as one of the answers for curbing the problem of high costs, low quality care and possible segmented delivery and as much as it serve as the major determinant for improvement in patient satisfaction, there are minor

Changes in the Health Care System and the Practice of Nursing have become complex. Technological changes, complicated client needs, short hospital length of stay, and departure from acute care to community based care, all these changes have underscore the need for professional nurses to think critically in order to provide safe and effective client care. A better educated nursing workforce can provide good health education to patients and their families. The affordable care of 2010 has required the need for nurses to expand their role of practice to meet complicated patient demands. This has prompted the Institute Of Medicine to review the “Future of Nursing, Leading change and Advancing Health”. {Creasia & Fribery,2011}

Ongoing development and changes in healthcare delivery enable nurses to maintain standards of nursing and develop their competence and performance. Through this the patients well-being is maintained, respecting them through accessing up to date knowledge and skills that are essential in an ever changing environment.

After reading The Future of Nursing: Leading Change, Advancing Health article by the Institute of Medicine, I gained a clearer view of the overall goal for nursing. Although there are many diverse parties that need to be associated in perfecting the continuously changing health care system, nurses vital to the contribution. Nurses provide direct patient care, deal with the health care system and health care policies, as well as interact with the interdisciplinary team. So the Institute of Medicine has a great nursing blueprint for help nurses make a different for not only the future of the health care system

Upon considering the past and future of nursing, many changes have already taken place, and even larger changes are expected. With the recent rate of technological development, the heath care system is certain to follow in its advances at nearly the same pace. Many predictions for the future of medicine are based on computerized technology. The use of telemonitoring, video and “smart houses” are already being used by some companies today, and will be utilized more frequently in the future. This will enable one nurse to care for many more patients than he/she is capable of safely caring for currently. This is very important due to the baby-boomer generation growing older and the