how can nurses reduce healthcare costs scholarly articles
The ACA goals have realized some successes but challenges continue. The nurse attorney, prepared with a Juris Doctorate, acts at the local, state, and national level to inform policy makers, lawmakers, and administrators regarding the support of legislation needed to improve healthcare systems and patient outcomes. (2018, September 6). Medicares evolving approach to paying for primary care. Healthcare transformation and changing roles for nursing. Health Care Industry Insights: Why the Use of Preventive Services Is Insurance type and access to health care providers and appointments under the affordable care act. Nurses at every level of practice have assisted in the implementation of medical homes. The affordable care act reduced socioeconomic disparities in health care access. Increasing the level of education for practicing nurses addresses the ACA requirement for improved quality. The average energy bill will drop when Ofgem cuts its price cap on Saturday amid falling . Reducing Health Care Spending: What Tools Can States Leverage? The cost of this method of implementation, however, is cited as a barrier to use. Burlington, MA: Jones & Bartlett. Center to Champion Nursing in America. The Role of Nurses in Improving Health Care Access and Quality - The . When this was not feasible, providers considered venues that remained cost-based, such as long term acute care hospitals and sub-acute centers to care for chronically critically ill patients. Healthcare price transparency is becoming a policy in many hospitals. The DNP-prepared nurse systematically applies scientific findings in practice and gathers outcome data to inform policy. Among states that have expanded Medicaid coverage since the implementation of the ACA, studies have shown that children remain vulnerable; there remains difficulty with access to specialty care regardless of the type of insurance coverage (Kreider et al., 2016). The DRG is a patient classification system that standardizes the cost of healthcare treatments and length of stay (Hawaii Medical Service Association [HMSA], 2018). Additionally, nurses must work collaboratively across disciplines to heighten the impact of HIT and increase use of big data in research. Practicing to the Full Extent of Our Ability: The Role of Nurses in Healthcare Reform. Dunham-Taylor, J. Retrieved from http://www.hret-hiin.org/Resources/clabsi/17/central-line-associated-bloodstream-infection-clabsi-change-package.pdf, Hollenbeak, C.S., Schilling, A.L. Nursing: Essential to healthcare value. We piloted this approach in seven primary care practices and found that it . Kim is licensed to practice law in the state of Ohio and the United States Supreme Court and is a PhD student at Kent State University. 482 and 485. Patient Advice Health Can Nurse Practitioners Help Ease the Growing Physician Shortage? Health care finance: Basic tools for nonfinancial managers (5th ed.). Health & Parenting Guide - Your Guide to Raising a Happy - WebMD Pay for Performance (P4P) is a reimbursement method for providers that gives incentive payments to those providers meeting certain predetermined quality and patient satisfaction outcomes (Baker et al., 2018). How Collaboration Can Drastically Improve U.S. Health Care Performance-based care demonstrates the important role of nurses as part of the healthcare team. Physician consolidation and employment results in more physicians employed by healthcare agencies. Journal of Nursing Administration, 48(6), 293-295. doi: 10.1097/NNA.0000000000000615, Burton, R., Berenson, R. A., & Zuckerman, S. (2017). Worked to fostered development state-level groups call action coalitions to implement recommendations from the IOMs Future of Nursing report (RWJF, 2012). The cost of hospital acquired infections remains high. The direction for organizations to provide cost effective, quality care that is accessible to all stakeholders is enhanced by a governing board that is diverse in composition, with members who possess extensive knowledge of healthcare. The VBP model applies four domains of assessment: safety; clinical care; efficiency and cost reduction; and person and community engagement to determine the healthcare agency performance level (CMS, 2017; Salmond & Eschevaria, 2017). There has never been a time quite as compelling as the present to inspire nurses to earn DNP and PhD degrees. (2016, December 14). Evidence-Based Practice and the Bottom Line: An Issue of Cost - HFMA June 3rd, 2021 With U.S. health care costs skyrocketing, medical establishments are looking for new strategies to lower expenses while maintaining patient satisfaction and treatment success rates. The result has been an explosion of nurses in leadership positions across health organizations and insurance companies; on governing boards of both health related and non-health related companies, healthcare systems, and community programs; and in government roles. Current Quality InitiativesFinancial links to quality are now regulated through CMS and operationalized through transformational healthcare teams that utilize contemporary, provider-quality reporting. Key areas of expertise for nurses include quality, safety, and patient-centered care (Hassmiller, 2011; IOM, 2010; Patton, Zalon, & Ludwick, 2015; Prybil, 2009); patient and population advocacy; problem-solving innovation; and outcome attainment through interdisciplinary collaboration (Hassmiller, 2012; Patton et al., 2015). Results associated with these roles exceed cost reduction by improving outcomes and challenging systems to push quality and safety initiatives further than previously envisioned by insurance payers or policy makers. Orthopaedic Nursing, 33(6), 305309. Health Affairs, 29(5), 893-899. doi:10.1377/hlthaff.2010.0440. (PwC, 2018). Improving Patient Experience and Reducing Cost by Measuring Outcomes ACA and MACRA: What they mean for you. Retrieved from https://hmsa.com/portal/provider/zav_pel.fh.DIA.htm, Health Research & Education Trust (2017). (2017). Their findings were published in the June 2019 issue of Health Affairs. The following are some ways nurses can play an instrumental role in the process: Producing, sending and keeping information such as patient records in electronic format. Nurses have historically led team based care. Nurse-Attorney Cleveland is an international and national speaker and consultant on health reform, health law, nursing leadership, and health policy. Care coordination: The game changer. Washington, DC: The National Academies Press. First, the importance of understanding the purpose of health care as improvement of health and its experience has been emphasized by two recent complementary re-definitions of health and disease. Burlington, MA: Jones & Bartlett. Performance-based care places value on nursing care and demonstrates the important role of nurses as part of the healthcare team. Navigating the path to value-based care. May 16, 2016 - As healthcare costs continue to rise, hospital revenue cycle management has become an important focal point for providers. Another may be to reduce the utilization of low-value care. The first attempt to control healthcare costs was introduced in 1989, when the Diagnosis Related Group (DRG) system replaced cost-based reimbursement. Taking the first steps to serving on a board. Retrieved from https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847, Warren, C., Lemieux, A. She is a co-investigator in funded research examining the role of nurses on governing boards. Tracey Motter is Associate Dean of Undergraduate Programs at Kent State University College of Nursing, in Kent, OH. Jo, who worked as a neonatal nurse and midwife for over 25 years, says she left her job at Sussex University hospitals as she did not want "to put my registration on the line due to staff . Integration of systems of care and efficient resources is a dynamic and complex process. This represents 17.9 percent of the GDP (CMS, 2018a). Nurses making policy: From bedside to boardroom. She serves in a number of volunteer roles within nursing organizations including The American Association of Nurse Attorneys, Nurses on Boards Coalition, National League for Nursing, and Sigma Theta Tau International. Affordable Care: Harnessing the Power of Nurses Matching registered nurse services with changing care demands: Study protocol of a natural experiment multi-centre study. "The lower costs in our study were driven primarily by a higher rate of hospitalization among physician patients," Morgan says. After running the model with these adjustments, we estimated that approximately 15,000 (8.4%) of lab orders could be changed to lower-cost facilities in Year One if we spent $259,995 on incentives . As full partners with physicians, nurses provide unique disciplinary expertise to assist financial stakeholdersRegulations subsequent to the ACA link quality to reimbursement. At the Masters level of nursing education, the clinical nurse leader (CNL) role was developed to address changing healthcare delivery systems. Nurses influence cost in healthcare organizations mainly because they are on the front lines. open access What is already known about this topic? As such, these nurses contribute to and develop solutions in an enhanced regulatory environment through the formation of health policy. The economic models underpinning today's healthcare - profit maximization - have shifted the focus away from its main purpose. Health Affairs. In A CEO Checklist for High-Value Health Care, we, as executives of eleven leading health care delivery institutions, outlined ten key strategies for reducing costs and waste while improving outcomes. The medical home provides a cohesive structure through which patients can access primary care with increased equity and decreased cost (Omolola et al., 2015; Tillett, 2011). What Are Some Ways Nurses Can Influence Healthcare Organization Costs? The Office of Government Affairs for universities with nursing programs is linked directly to AACN. While many nurses understand changes within their practice areas, they may not have had the opportunity to appreciate collective power across practice boundaries. & Etzioni, D. (2019) Value-based total hip and knee arthroplasty: A framework for understanding the literature. These principles have influenced nurses to become leaders in healthcare change. The Challenge of Understanding Health Care Costs and Charges The cost of hospital acquired infections remains high. . Nurses at every level of practice have assisted in the implementation of medical homes. This chapter from Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare explains how evidence-based practice improves healthcare quality and patient outcomes while reducing costs and discusses multiple barriers to EBP that persist in healthcare settings. Duncan, Thorne, Van Neste-Kenny, and Tate (2012) noted that involvement of nurses in policy advocacy is changing as a result of the IOM report study. The CCTP was successful in decreasing readmission rates for nearly 8,000 patients over a two year period to 13.9% and developing best practices for transitions of care (Warren et al., 2019). All rights reserved. (2012). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. nurses provide leadership in roles as care managers, care coordinators, and informatics experts by directing process changes and evidence-based interventions necessary to quantify and accurately report these quality measures. Published: November 2, 2018. doi: 10.1001/jamanetworkopen.2018.4295. The time is ripe for nurses to harness the power of a unique disciplinary perspective and enduring patient trust to advocate for the advancement of policy and continuation of quality research, evidence-based initiatives, and patient centered innovation. Federal Trade Commission (2014). When these strategies complement daily patient centered care, continued quality improvement and cost reductions will follow. Nurse practitioners can help patients with many of the same concerns that primary care physicians. In the VBP model, healthcare payments are based on quality care that is cost efficient, and patient and family centered. An example was the launch of a school for nurses and physician assistants in partnership with Hofstra University that includes a track for nurse practitioners. Retrieved from: https://www.naic.org/documents/index_health_reform_general_ppaca_section_by_section_chart.pdf, National Council of State Boards of Nursing. 29439099 DOI: 10.18043/ncm.79.1.26 Abstract The United States is the only high-income country that does not have publicly-financed universal health care, yet it has one of the world's highest public health care expenditures. The DRG system had some effect on slowing the healthcare expenditures share within the GDP, but lacks evidence of improved efficiency and quality of care (Bachnick et al., 2017). A CAUTI is associated with anywhere from $7,670.00 to $10, 197.00 in inpatient and outpatient costs to Medicare (Hollenbeak & Schilling, 2018). (2018). What does the Affordable Care Act mean for nursing? Whether through direct care (e.g., APRN) or as a care coordinator, nurses are essential to maximize the financial return to and through these organizations. 1). Cost analysis of implementing evidence-based practices (EBP) has become important within implementation science and is critical for bridging the research to practice gap to improve access to quality healthcare services. Population management represents a paradigm shift in healthcare from care within individual organizations (sometimes called siloed care) to coordinated care across the patients health trajectory (Ariosto et al., 2018). Nurses have an important role in reducing waste and influencing other professionals in the healthcare environment to increase their efficiency and productivity. The emphasis to extend nursing practice, led by the IOM and ACA, has fueled efforts to increase the number of states that grant full practice authority to APRNs. A., & Bittner, N. B. Through development of population health-based initiatives in health information technology (HIT), research, education, and policy, nurses can leverage initiatives to support the transformation of healthcare from an expensive, disease-based model to a cost effective, quality focused health management system (Ariosto et al., 2018). We organize our recommendations around five policy priorities: expanding insurance coverage, accelerating the transition to value-based care, advancing home-based care, improving the affordability. There has never been a time quite as compelling as the present to inspire nurses to earn DNP and PhD degrees. Journal of Nursing Care Quality, 24(1), 5-9. doi: 10.1097/NCQ.0b013e31818f55b4, Robert Woods Johnson Foundation. Care coordinators set goals and prioritize care with patients and families, coaching and educating patients and coordinating and evaluating care provided by others (Lamb, 2013). This linkage provides support that directs the agenda to advance nursing education by decreasing costs and supporting opportunities to encourage advanced degrees. The Affordable Care Act: Where are we now? 2, Manuscript 2. Nurses engaged physicians, pharmacists, and social work colleagues to identify post-acute care environments that offered lower cost discharge opportunities beyond high cost, short term, acute care hospitals when possible. U.S. Health Reform--Monitoring and Impact. Health Services Research, 51(4). In this environment, APRNs, case managers, physicians, administrators, pharmacists, physical therapists, psychologists, nutritionists, and social workers form an interactive multidisciplinary team that manages the life of an individual, as opposed to reacting to the disease state needs of a patient (Salmond & Echevarria, 2018). The ACA requires insurers to provide a specified minimum coverage that includes preventive care at no additional cost to the individual and allows more expensive comprehensive plans that exceed minimum coverage requirements (NAIC, 2011). These organizations focus on preventive care, communication, and resource stewardship that avoids waste. Policy perspectives: Competition and the regulation of advanced practice nurses. National Bureau of Economic Research, 122(3), 1-37. doi: 10.3386/w11619, Griffith, K., Evans, L., & Bor, J. Yvonne Smith is an Associate Professor and Concentration Coordinator for Nursing and Health Care Management (NHCM) at Kent State University College of Nursing, in Kent, OH, with extensive experience in nursing education, accreditation and regulation. nurses contribute to and develop solutions in an enhanced regulatory environment through the formation of health policy. How Do Medical Homes Reduce Costs? - medhomeinfo.org This systematic review aims to . The Inquiry, 55(1-2), 1-14. doi: 10.1177/0046958018790164, National Advisory Council on Nurse Education and Practice. The Role of Nurses in Improving Health Care Access and Quality - The Hawaii Medical Service Association (HMSA). Older people projected to outnumber children for the first time in U.S. history. (2010, March 23). School nurses have been instrumental in offering access to care for children through several ACA provisions: reimbursement for school health services and activities related to community-based prevention; and health education and counseling programs (e.g., immunizations, integrated behavioral health screening, suicide prevention activities, and substance use programs) (Maughan & Mazyck, 2014). States that have expanded Medicaid have reduced disparities in access to care among the unemployed by 11%, and those with low annual incomes by 15% (Griffith et al., 2017). Retrieved from: http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx, Kaiser Family Foundation (2018). Orthopaedic Nursing, 36(1), 12-25. doi:10.1097/NOR.0000000000000308, Schiff, M. (2012). Nurse Leader, 12(4), 48-52. doi: https://doi.org/10.1016/j.mnl.2014.05.011, Prybil, L. (2009). Retrieved from: https://www.urban.org/sites/default/files/publication/95196/2001631_medicares_evolving_approach_to_paying_for_primary_care_0.pdf, Campaign for Action (2019). Policy makers moved to control upward spending trends in an attempt to leverage resources across the population. In these situations, nurses utilize their knowledge to re-position communities to care for populations they manage through formation and utilization of legislative action and policy teams; this reduces healthcare costs by keeping communities healthy (Smith & Cleveland, 2018). Bundled Payments for Care Improvement (PBCI) reimburse lump sum payments for an individual episode of care. Triage nurses have the power to appropriately minimize the wait time for more urgent matters, reducing the risk of complications that can lead to poorer outcomes and more expensive care. This provides opportunity for clinical nurses and nurse practitioners to utilize transformational leadership skills to empower patients and the interdisciplinary team to create health management plans that are unique, quality driven, and patient focused. Opportunities for Nurses to Impact Access to CareIn addition to expanding scope of practice for APRNs, the ACA placed increased emphasis on primary and geriatric care to provide support to underserved populations and decrease disparities. (2011). In the VBP model, healthcare payments are based on quality care that is cost efficient, and patient and family centered. Key facts about the uninsured population. As services expanded, costs escalated. The relative success of the Johns Hopkins Community Health Partnership suggests that comprehensive inpatient and outpatient care coordination can be effectiveeven, and perhaps especially, in socioeconomically disadvantaged areas like East Baltimore, Maryland. Examples of this work include new evidence-based care bundles, clinical pathways, and models of care. Cost and quality concerns along with changing social and disease-type demographics created the greatest urgency for the need for change. Academic Medicine, 92(9), 1225-1227. doi: 10.1097/ACM.0000000000001854, Kavanagh, K. T., Cimiotti, J. P., Abusalem, S., & Coty, M.B. Nurses are now empowered to extend their ability to improve quality beyond the bedside. Broadened language to include other practitioners as authorized caregivers to perform all functions within their scope of practice (CMS, 2012). Retrieved from https://www.cms.gov/About-CMS/Agency-Information/History/index.html, Centers for Medicare & Medicaid Services, Medicare Learning Network. (2012). The introduction of DRG funding and hospital nurses changing perception of their practice environment, quality of care and satisfaction: Comparison of cross-sectional surveys over a 10-year period. (2019). On the business side, PwC projects that 2019 healthcare costs will continue rising based on increased access to care, provider megamergers, and physician consolidation and employment. Parenting is one of the most complex and challenging jobs you'll face in your lifetime -- but also the most rewarding. The first attempt to control healthcare costs was introduced in 1989, when the Diagnosis Related Group (DRG) system replaced cost-based reimbursement. . (2018). They work closely with primary care physicians to increase patient adherence to the medication and treatment plan. Interestingly, the initiative to link reimbursement reductions for these adverse outcomes has not resulted in reduced incidence (Lee et al., 2012). Performance-based care places value on nursing care and demonstrates the important role of nurses as part of the healthcare team.Removing barriers to practice for APRNs has enabled these nurses to become full partners with physicians and other health professionals in most states. Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Opportunity for Nurses to Impact QualityThere has never been a time quite as compelling as the present to inspire nurses to earn DNP and PhD degrees. In the VBP model, healthcare payments are based on quality care that is cost efficient, and patient and family centered. (PwC, 2018). The affordable care act attenuates financial strain according to poverty level. Nurses have historically led team based careQuality of care has also been impacted by the move to population management. The Role of Nurses in Cost Savings & Efficiency - VIE Healthcare Consulting Nurses holding PhD degrees formulate clinical and theoretical questions, followed by scientific examinations. The rationale for nurses on boards in the voice of nurses who serve. (2015). From choosing baby's name to helping a teenager choose a college, you'll make . Retrieved from https://www.ftc.gov/system/files/documents/reports/policy-perspectives-competition-regulation-advanced-practice-nurses/140307aprnpolicypaper.pdf, Finkelstein, A. Retrieved from http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf. (2005). Strategies to reduce nursing turnover : Nursing made Incredibly Easy - LWW Journal of Advanced Nursing, 73(7), 1735-1746. doi: 10.1111/jan.13287. Historically, most states have limited the practice of APRNs to a role that involved physician collaboration or supervision. Retrieved fromhttps://nurse.org/articles/BSN-initiative-80-2020/, Maughan, E., & Mazyck, D. (February 27, 2014). Nurses historically respond to changes in regulation and financing of healthcare with innovation and professional responsibility. Nurse Advocacy: Adopting a Health in All Policies Approach Table 2. Step 1: Determine the cost avoided. How can nurses reduce healthcare costs? The affordable care act and school nurses enhancing student health. (Baker et al., 2018). Population management requires an integrated team approach. International Journal of Nursing Studies, 50(2), 219-229. doi:10.1016/j.ijnurstu.2012.07.008, https://doi.org/10.3912/OJIN.Vol24No02Man02. As stakeholders in the health of the communities where they live and work, nurses make their voices heard about issues of concern. Additionally, the HRRP has added post coronary bypass graft surgery to the list (CMS, 2017), The NP role includes daily rounding during the patients hospital stay, and participation in discharge planning. Nurses bring to the table their intellectual capital and position as trusted patient advocates to build partnerships with policymakers to innovate economical solutions for identified needs of families. Hospitals. Health Care USA: Understanding its organization and delivery (8th ed.). Recommended states change their nurse practice acts to expand APRN scope of practice to increase access to care and to increase APRN involvement in primary care (Schiff, 2012). nurses contribute to and develop solutions in an enhanced regulatory environment through the formation of health policy.This new paradigm accelerated the development of advanced practice roles and the expansion of nursing education while enhancing administrative and policy skills development in nursing curricula and administrative practice. The Hospital Acquired Condition Reduction Program (HACRP) is a CMS program that financially penalizes hospitals that continue to have poor patient outcomes based on hospital-acquired conditions (HACs) such as central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) (Collins & Saylor, 2018b).VBP measures impacted by nursing care include CAUTI; CLABSI; clostridium difficile infection; site infections for colon surgeries and abdominal hysterectomies; 30-day readmission rates; and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey (CMS, 2017).
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how can nurses reduce healthcare costs scholarly articles
