Health Care Improvement Act of 2021 and Pay-for-Performance Reforms

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

1. Outline a current or emerging health care law or federal regulation introduced within the last 5 years to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse's role and responsibility.

1. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.

1. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.

1. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years in response to upcoming trends or predicted issues in health care.

Introduction

The healthcare delivery system in the United States as revolutionized in the past few years. There have been introduction of policies and laws that are necessary in improving the care delivered. This paper discusses an emerging law in healthcare and its effects on nursing practice, describes the pay for performance and quality measures that affect patient outcomes, professional nursing leadership and management roles and the emerging trends in healthcare and how they will transform nursing.

Current or Emerging Health Care Law or Federal Regulation and Effect on Nursing Practice, Role and Responsibility

One of the emerging healthcare laws is Health Care Improvement Act of 2021. The bill seeks to make significant changes in healthcare market place such as encouraging states to expand their Medicaid, expanding the premium assistance and establishing an option for public health insurance. In doing so, the bill starts by expanding the premium tax credit that helps people based in the household income. It provides funding for state reinsurance payments and insurance-related costs for individuals enrolled to the plans through individual marketplace. The bill will issue a seven years period for federal assistance for all the states to expand their Medicaid coverage and it makes changes in respect to rural health providers' payments and it permits market plans for small groups. This will bill give Department of Health and Human Services the authority to negotiate with the manufacturers the prices of drugs provided through Medicare (Congress.GOV, 2021). Additionally, the bill establishes guidelines for employees to follow regarding health coverage and requires the Government Accountability office to evaluate the process of employer notification. This bill will have an effect of the nursing practice as it increases the population that is covered by Medicaid. It will put pressure on nurses resulting in to shortage of nurses due to the increase in the demand of healthcare services. Also, the employers will also suffer the consequence of nurse shortage as now; they will have to utilize these services with other forms of capital inputs and healthcare labor.\

Quality Measures, Pay for Performance, Patient Outcomes And Effects On Nursing Practice

Pay for performance programs and other quality measures affect patient outcomes. The program emphasizes on quality over quantity healthcare services. This allows the healthcare payers to redirect the funds to promote positive health outcomes and best clinical practices. These programs foster transparency utilizing metrics that are reported publicly and this strengthens the reputation of healthcare organizations and encourages accountability through consumer-informed choice. The pay for performance programs utilized the Fee-for-service (FFS) that allowed transition to value-based care and gives time for the healthcare providers to develop the broader value-based policies, systems and mindsets (NEJM Catalyst, 2018). The pay-for-performance program reduces the healthcare costs incurred by the patients as it reimburses quality and not quantity. It has proved to be effective in reducing the rate of patient readmission within 30 days of hospital stay. In this program, the nurses must always adhere to the principles of non-maleficence and beneficence in care provisions. This means that, the care they provide yield positive outcomes while at the same time minimizing negative effects derived. The program allows nurses to be the advocates for the patients' best interests and encourage admission of all the patients to avoid patient dumping.

Professional Nursing Leadership and Management Roles

Some of the professional management and leadership roles that have arisen are Director of Nursing and Chief Nursing Officer. The roles of the Director of nursing are a step-up from clinical nurse managers. It requires more educational and clinical accomplishments and this requires years of leadership and nursing experience. They often lead the team managers and nurses and steer the strategy of the entire nursing department. The top priority of the director of nursing is to achieve excellent patient care and safety through being effective leaders in the healthcare facilities, nursing departments and units. They ensure that all the team members comply with federal and state regulations (WGU, 2020). On the other hand, Chief Nursing Officer (CNO) occupies a key leadership position and they budget for all the nursing-related items and ensure that the safety of the patients is enforced through the relevant procedures and policies. The CNOs ensure that all the new nurses meet the training requirements and they devote their tome to seek, develop and refine the appropriate training opportunities. For one to become a CNO, the baseline credential is a Master's Degree in Nursing. This is because, the roles of CNOs has evolved to include technical knowledge of the organizational systems and sophisticated strategies for leading people and managing finances. CNOs promote patient safety and provide quality care by allocating enough resources for providing high quality care that does not result in to any adverse outcomes and reduces medical errors (WGU, 2020).

Predict Changes in Nursing Roles and Nursing Practice

Some of the emerging trends in healthcare are remote patient monitoring and telehealth and integrated advanced technology. Telehealth is a transformative trend in healthcare and it allows nurses to remotely provide care services. It enables nurses to engage in virtual assessment, telephonic consultation and monitor the vital signs of the patients remotely (Bitar & Alismail, 2021). The nursing practice will transform due to the trend as it improves patient access to care services, facilitates timely implementation of interventions, reduces readmissions to the hospitals and enhances the patients' engagement in care delivery. There has been an increase use of advanced technologies such as smart devices, Electronic Health Records (EHR) and wearable health trackers in care delivery. These technologies enhances delivery of healthcare as they streamline documentation, improves accuracy in care and enables nurses to effectively track the progress of the patients (Bitar & Alismail, 2021). Additionally, nurses have embraced the use of mobile apps application for communication, medication management and as a reference material. This contributes to more efficient and safe patient care.

Conclusion

Healthcare laws are necessary in ensuring that the patients have access to high quality care services. One of the emerging laws in the United States that fosters care improvement is the Health Care Improvement Act of 2021. This bill aims at significant changes in healthcare by expanding Medicaid, premium assistance and establishing options for public health insurance. The pay for performance programs yields better patient outcomes through provision of high quality care and elimination of any unnecessary costs. With emerging trends such as integrated advanced technology and telehealth, new professional roles of nurses such as Director of Nursing and Chief Nursing Officer have emerged.

References

Bitar, H., & Alismail, S. (2021). The role of eHealth, telehealth, and telemedicine for chronic disease patients during COVID-19 pandemic: A rapid systematic review. Digital health, 7, 20552076211009396. https://journals.sagepub.com/doi/abs/10.1177/20552076211009396

Congress.GOV. (2021). S.352 - Health Care Improvement Act of 2021. https://www.congress.gov/bill/117th-congress/senate-bill/352

NEJM Catalyst. (2018). What Is Pay for Performance in Healthcare? NEJM. https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0245#:~:text=P4P%20in%20healthcare%20stresses%20quality,and%20promote%20positive%20health%20outcomes

WGU. (2020). The top 4 nursing leadership roles. Western Governors University. https://www.wgu.edu/blog/top-4-nursing-leadership-roles2001.html