How quality measures and pay for performance affect patient outcomes

How quality measures and pay for performance affect patient outcomes Essay Assignment Paper

NRS-440VN Health Care Delivery Models and Nursing Practice

Federal Healthcare Law Reform

A recent federal law that reforms healthcare in the United States would be the Sustaining Excellence in Medicaid Act of 2019 (HR 3253). This bill was introduced into Congress on June 13 2020 and signed into law on August 6 2020. The Michigan representative, Debbie Dingell, introduced and sponsored this bill. The bill seeks to restructure the Medicaid program by providing for some extensions in some of its provisions (KDP LLP, 2019). One of the changes made was allowing the appropriations of Medicaid through to the fiscal year 2024. Another reform in Medicaid authorized in this bill is allowing the state fraud units within the program to consider and examine complaints from the non-institutionalized patients. This reform is important because it eliminates some of the disparities that arise from the ignoring of the complaints from such patients, yet, legally, they qualify for cover under the Medicaid program.

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Another reform introduced by this bill is extending the Medicaid eligibility for individuals to protect them from spousal impoverishment or poverty. Sometimes, spouses from the lower socioeconomic backgrounds are denied cover given that Medicaid does not extend to them. This bill extends cover to such populations, including those who receive home-based and community-based medical services. In addition to these reforms, this bill repeals the requirements placed for the drug manufacturers to always include the prices for generic drugs when determining the price. It also excludes drug manufacturers from the definition of drug wholesalers to allow rebate calculations.

This bill affects the nursing practice by adjusting the nurse’s role and responsibility. For instance, since the bill extends Medicaid to cover the spouses and protect them from impoverishment, the nurse should ensure that they educate all patients about the new changes to this bill. A patient may be suffering from spousal poverty which limits their access to quality medical care. The nurse should be able to identify such patients, and educate them about the new changes to help them access quality medical care. Another way this bill affects the nurse’s role and responsibility is that it adds to the role of advocacy in nursing. The nurse should advocate for the non-institutionalized patients whenever they have complaints, and help them appeal to Medicaid in the event of denial of services. The new bill covers the patients and enables them to have their complaints reviewed, hence, increasing their chances of getting social justice. The nurse should be an advocate and help the patients access social justice by helping them lodge complaints.

How Quality Measures and Pay for Performance Affect Patient Outcomes

Pay for performance is a reward system that rewards practitioners financially for their performance based on certain criteria in medical practice. It is a performance-based compensation approach that aims to improve the quality and delivery of healthcare services to patients. As such, this model also punishes the practitioners for achieving poor results. For instance, a psychologist whose patient fails to quit smoking at the end of their sessions does not receive the financial rewards associated with her role. In some ways, this model improves patient outcomes because it motivates the physicians and nurses to offer high quality services to their patients to ensure that they receive the financial rewards associated with their roles and criteria used for performance analysis. However, there is a risk to poor patient outcomes associated with this reward system, where it encourages patient dumping. This concept means that those patients with more complicated healthcare issues that have high risks tend to be relegated to the periphery, because the physicians prefer to focus on cases that are likely to be successful, so that they receive their rewards and bonuses (Kyeremateng et al., 2019). This practice leads to negative patient outcomes because those in the periphery suffer from lack of sufficient and timely medical attention.

A nurse who finds him/herself in such situations should consider applying ethical principles such as non-maleficence, which means to cause least harm. By applying this principle, the nurse would encourage the physicians to admit and attend to patients with complex medical issues. Additionally, the nurse should remind the rest of the practitioners about the Hippocratic Oath, which binds them to the duty to save lives. Patient dumping is a severe violation of this oath and the nurses’ responsibility should be to remind the colleagues about these ethical applications.

Professional Nursing Leadership and Management Roles

An emerging nursing leadership role that addresses emerging trends would be knowledge on nursing informatics and the use of technology in nursing (Harris et al., 2019). An emerging trend in healthcare is the use of technology in the practices, which are increasingly requiring nurses to learn and equip themselves with skills in technology. For instance, there are surgical robots used in surgery, and surgical nurses should be conversant with the machines, so that their role in the surgical room is fulfilling. Another example is the use of bedside alert systems which notify the practitioners when a patient leaves their bed unattended, hence, reducing the incidence of patient falls. Therefore, the nurse leaders are tasked with the responsibility of ensuring that the nursing teams are technologically savvy as part of their nursing roles. The nurse leader and manager will ensure the availability of trainings in technology to enhance the nursing team’s professionalism. By doing so, the nurses promote patient health and safety. For instance, the bedside alert systems reduce the incidence of patient falls, and learning how to manage the electronic health records promotes patient health and enhances their professionalism levels since they comply with the HIPAA rules.

Emerging Trends

An emerging trend in healthcare is the use of medical robots in operations such as surgeries. This practice requires that the medical practitioners learn how to operate the robots in the event the surgeon is unable to continue operating because of an emergency. The nurse also needs to learn how to setup the machine and recognize situations in which the machine malfunctions. Therefore, given this change, the nurses’ roles will change to include technological operations in the healthcare setting. The nurses will be tasked with the responsibility of learning how technological devices work in a hospital because in some emergency situations, the nurse may save a life.

Another emerging trend in healthcare is the application of telemedicine. Telemedicine is on the rise, given the technological advent in today’s era. Incorporating telemedicine practices in nursing will transform their roles. Telemedicine will enhance the role of the nurse as a communicator because the nurse should be reachable to their client upon request, through the telehealth systems. Since the interaction with the patient is no longer in person, the nurse should enhance their role as a communicator by using clear language, providing timely communication to their patient, and communicating within the shortest time possible, to allow them to tend to other patients.

Another nursing role that is influenced by telemedicine is the use of technology to deliver nursing care to patients. Just like the medical and surgical robots, nurses will be required to enhance their knowledge on technology and the use of the internet platforms to communicate with patients. It remains critical that the nurse avoids challenges using the devices applied in telemedicine, which could have serious adverse health outcomes for the patients. Therefore, the nurse’s role changes to include those that require the heavy use of technology.