Consider the evolution of the U.S. health care system. Discuss how the shift to value-based health care has impacted delivery of care and the role and responsibilities of the advanced registered nurse. Project what major evolving trends in the health care delivery system will affect nursing practice and how advanced registered nurses will influence the direction of health care.
NUR 514 Discuss how the shift to value-based health care has impacted delivery of care
Health care delivery is an evolving practice that must respond to the ever-evolving needs regarding patient experience, care quality, cost-effectiveness, and safety. Health statistics reveal that health care spending increased from 5% to 17.7% of the U.S Gross Domestic Product between 1960 and 2019 without a proportional increase in health care quality (Harrill & Melon, 2021). Such gaps have necessitated value-based health care to enhance patient experience and ensure patients receive health care services that match their needs.
Characteristically, value-based health care is a payment reform to improve the quality of care. Achieved primarily through the pay-for-performance (P4P) model, value-based health care entails incentivizing health care providers depending on the quality of services (Harrill & Melon, 2021; Teisberg et al., 2020). The model characterizes a shift from the fee-for-service model, where health care providers are reimbursed based on the quantity of services rendered to patients. The shift to value-based health care has impacted the role and responsibilities of the advanced registered nurse by increasing focus on care quality. Accordingly, the advanced registered nurse must be innovative and integrate approaches that reduce medical errors and optimize safety to achieve the desired care quality.
Besides value-based health care, other evolving trends will profoundly influence the nursing practice. For instance, Snoswell et al. (2020) projected increased use of telehealth and technology-driven practices to reduce health care spending, increase access to care, and enhance efficiency. These technologies will support remote patient monitoring and facilitate the absorption of self-help kiosks to reduce staffing. Amid these evolutions, advanced registered nurses will influence the direction of health care by promoting technology use in health care delivery and leading change. The implication is that advanced registered nurses will use their knowledge and skills to ensure health care organizations embrace evolution and invest in appropriate resources to accommodate practice changes.
References
Harrill, W. C., & Melon, D. E. (2021). A field guide to US healthcare reform: The evolution to value‐based healthcare. Laryngoscope Investigative Otolaryngology, 6(3), 590-599. https://doi.org/10.1002/lio2.575
Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if telehealth can reduce health system costs: Scoping review. Journal of Medical Internet Research, 22(10), e17298. https://doi.org/10.2196/17298
Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care: a strategic framework. Academic Medicine: Journal of the Association of American Medical Colleges, 95(5), 682–685. https://doi.org/10.1097/ACM.0000000000003122
Value-based healthcare is meant to be personalized medicine. VBH has the motto to “treat the right patient at the right time with the right treatment”. Treatments can be much more personalized, increase efficacy, reduced adverse events, improved quality of life and efficient use of healthcare expenditure (Steffen, J.A. & Lenz, C. 2013). Diagnostic testing for cancer care has drastically improved for cancer patients with use of single testing, parallel testing, and whole-genome sequencing which has led to wide range of diagnostic technologies that are available for use, the drawback is local and state regulations as well as reimbursement specifically if it is seen as value added (Steffen, J.A. & Lenz, C. 2013). This is a drastic change from value-based healthcare as care was delivered by a physician and was seen as the only truth to care and one-size fits all approach.
Introduction of value-based healthcare has allowed advanced practice registered nurses to expand responsibilities and there has been an increase in service and specialties. Examples of this is nurse practitioners moving into a variety of settings such as acute care and partnering with specialty providers, ability to perform initial hospital assessment and consultation, continued oversight of patients, development of treatment plans, discharge planning and follow up at clinics. Kocakulah, M.C. et al. (2021) states discharge clinics are being staffed more by nurse practitioners with access to other team members. Nurse practitioners are more cost effective, and use of NP’s has allowed providers to meet Medicare guidelines of a 7 day post-discharge follow-up. This can help patients and the primary providers meet this guideline when obtaining an appointment to see their primary is difficult to impossible. In my prior role nurse practitioners worked in various specialties including cardiology, orthopedic, oncology and palliative are. Each NP worked hand in hand with their physician(s) from admission to discharge and into the specialty clinics.
A healthcare setting that will likely see a change in home healthcare and home hospice. It is likely more NP’s will be allowed to prescribe for home health care and hospice services as well as NP’s work in these environments with the ability to provide necessary care for home bound patients. During the pandemic lifts on these regulations provided much needed relief for agencies, providers, patients and family members.
References:
Steffen, J.A, & Lenz, C. (2013). Technological evolution of diagnostic testing in oncology. Personalized Medicine, 10(3), 275-283. Doi:http://dx.doi.org/10.2217/pme.13.19
Kocakulah, M. C., Austill, D., & Henderson, E. (2021). Medicare cost reduction in the US: A case study of hospital readmissions and value-based purchasing. International Journal of Healthcare Management, 14(1), 203–218. https://doi.org/10.1080/20479700.2019.1637068
