NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

Walden University NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

Whether one passes or fails an academic assignment such as the Walden University NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

The introduction for the Walden University NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

After the introduction, move into the main part of the NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

The selected topic for this discussion is Accountable Care Organizations (ACOs). ACOs refer to networks of healthcare professionals who collaborate to deliver enhanced and more cost-effective treatment interventions to patients (Lewis et al., 2018). ACOs were instituted under the Medicare Shared Savings Program, a segment of the Patient Protection and Affordable Care Act (PPACA) of 2010. 

Positive results that could be achieved with ACOs include having cost-effective treatment services. The ACA incentive matrix was created to offset the trend of costs rising unreasonably under the traditional Medicare fee-for-service model. ACOs could reduce healthcare costs since ACO providers are ranked against a sequence of quantitative benchmarks that are modified to account for regional cost variations (Wilson et al., 2020). Besides, ACOs can realize substantial savings and maximize their Medicare incentives if they meet their agreements with the CMS. Nonetheless, individuals may face unintended consequences such as perceiving that they are stuck in an unfavorable network (Lewis et al., 2018). ACOs are created to lower this risk by getting rid of the structural barriers of the HMO system. However, some healthcare economists express concerns that consolidation may restrict options available to consumers. 

My current organization should consider unintended issues such as facing losses with regard to ACOs. Financial losses may occur because ACOs have savings to share if they fail to reduce the cost of care. Consequently, the organization’s operating budget may be affected because of the costs of investments used to improve care (Wilson et al., 2020). Besides, the organization may pay penalties if it fails to meet quality and cost savings benchmarks. Furthermore, the nursing profession should consider the quality of patient care with respect to ACOs. Healthcare providers who participate in an ACO must meet particular quality benchmarks, focusing on prevention and adequately managing patients with chronic diseases (Colla & Fisher, 2017). Thus, nurses who participate in an ACO must consider providing high-quality preventive care and management of chronic illnesses.   

References 

Colla, C. H., & Fisher, E. S. (2017). Moving forward with accountable care organizations: some answers, more questions. JAMA internal medicine, 177(4), 527-528. https://doi.org/10.1001/jamainternmed.2016.9122 

Lewis, V. A., D’Aunno, T., Murray, G. F., Shortell, S. M., & Colla, C. H. (2018). The Hidden Roles That Management Partners Play In Accountable Care Organizations. Health affairs (Project Hope), 37(2), 292–298. https://doi.org/10.1377/hlthaff.2017.1025 

Wilson, M., Guta, A., Waddell, K., Lavis, J., Reid, R., & Evans, C. (2020). The impacts of accountable care organizations on patient experience, health outcomes and costs: a rapid review. Journal of Health Services Research & Policy, 25(2), 130–138. https://doi.org/10.1177/1355819620913141 

Sample Answer 2 for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

Since the Patient Protection and Affordable Care Act (PPACA) was signed into law, health care delivery has evolved from traditional fee-for-service-based care to value-based care in an effort to deliver high-quality, coordinated care to patients (Patient Protection and Affordable Care Act, 2010). One approach to achieve this goal has been the creation of accountable care organizations (ACOs), defined as a group of providers who are jointly held accountable for achieving measured quality improvements and reductions in the rate of spending growth (McClellan, McKethan, Lewis, Roski, & Fisher, 2010). Accountable care organizations emphasize team-based care and shared responsibility for patient outcomes. The Centers for Medicare and Medicaid Services (CMS) is promoting the formation of accountable care organizations (ACOs). In these population-based models, CMS aligns a Medicare beneficiary population to an ACO with associated expenditure and quality targets, transitioning away from purely volume-based revenue of fee-for-service Medicare. Patients with mental illness are among high-cost Medicare beneficiaries, but this population has received little attention in ACO implementation. Although the ACO goals of providing chronic and preventive care in a coordinated, patient-centered manner are consistent with what some mental health providers have long advocated, the population-based orientation may be unfamiliar. 

Accountable care organizations (ACOs), by focusing on coordinating care for Medicare patients across providers and multiple care settings, are a key element of the “better health care, better health, and improved quality” CMS triple aim. However, as has been the case for other quality improvement initiatives across the lifespan (Zima & Mangione-Smith, 2011), attention to patients with mental illness has been virtually absent in ACO implementation. Mental health conditions are among the most expensive as primary disorders and, when comorbid with general medical disorders, are associated with increased costs for the primary general medical disorder (Maust, Oslin & Marcus, 2013). The cohort of older adults with mental illness is expected to increase from under eight million in 2010 to 15 million in 2030 for several reasons, including the aging of baby boomers, their higher rates of depression and anxiety, and the onset of late-life psychiatric disorders in the expanding aged population (Maust, Oslin & Marcus, 2013). Despite this growing burden of mental illness and its cost implications, current ACO disease-specific quality and cost efforts are focused almost entirely on chronic general medical conditions. The one exception—depression screening with a documented follow-up plan—may have minimal impact on actual care (Maust, Oslin & Marcus, 2013). 

In addressing the needs of high-cost, high-risk patients to meet quality and expenditure targets, an ACO should examine the quality of mental health care it provides as well as medical quality for patients with mental illness. In addition, federal agencies should invest to ensure understanding of the impact of population-based initiatives on patients with mental illness. Mental health conditions need to be examined for their impact not only as primary disorders but also for their impact on quality of care for comorbid general medical conditions. High-quality diabetes care, for example, is an explicit goal that has quality measures included for ACO beneficiaries; if the overall quality of diabetes care improves in an ACO, the improvements should include those with comorbid mental illness. Although improving mental health care is not an explicit ACO goal, part of the overall evaluation of medical care should focus on vulnerable populations, such as persons with mental illness (Maust, Oslin & Marcus, 2013). 

References 

Maust DT, Oslin DW & Marcus SC. (2013). Mental Health Care in the Accountable Care Organization. https://doi.org/10.1176/appi.ps.201200330 

McClellan M, McKethan AN, Lewis JL, Roski J, & Fisher ES. (2010). A national strategy to put accountable care into practice. Health Affair, 29 (5), pp. 982-990 

The Patient Protection and Affordable Care Act. (2010). US Centers for Medicare & Medicaid Services https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/. 

Zima BT & Mangione-Smith R. (2011). Gaps in quality measures for child mental health care: an opportunity for a collaborative agenda. Journal of the American Academy of Child and Adolescent Psychiatry 50:735–737 

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Sample Answer 3 for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

 I concur with you that introducing the Patient Protection and Affordable Care Act (PPACA) as law in the American healthcare sector was a game-changer. Since the law was effected healthcare delivery has transformed from traditional fee-for-service-based care to value-based care. The evolution has benefitted Americans due to high and coordinated healthcare services offered in most healthcare organizations (Alvarez et al., 2017). Creating accountable care organizations (ACOs) has enabled the policy to achieve its goals. ACOs consider a group of healthcare providers who measure quality improvement and reduction of high expenditures in healthcare organizations. The Centers for Medicare and Medicaid Services (CMS) has played an important role in developing ACOs by promoting the idea (Chu et al., 2021). CMS understands that it is through these groups that PPACA can achieve its goals and objectives. The financial incentives and programs introduced in the American healthcare sector aim at increasing both the quality and accessibility to affordable healthcare services.  

References 

Alvarez, E. M., Keegan, T. H., Johnston, E. E., Haile, R., Sanders, L., Wise, P. H., … & Chamberlain, L. J. (2018). The Patient Protection and Affordable Care Act dependent coverage expansion: disparities in impact among young adult oncology patients. Cancer, 124(1), 110-117. https://doi.org/10.1002/cncr.30978 

Chu, Q. D., Li, T., Hsieh, M. C., Yi, Y., Gibbs, J. F., Lyons III, J. M., & Wu, X. C. (2021). Positive impact of the Patient Protection and Affordable Care Act Medicaid expansion on Louisiana women with breast cancer. Cancer, 127(5), 688-699. https://doi.org/10.1002/cncr.33265 

Sample Answer 4 for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.  The healthcare payment process is undergoing a dramatic transformation as payers and providers shift from volume to value. While stakeholders are currently piloting many different value-based care models, accountable care organizations are among the most popular and successful strategies to date. Accountable care organizations, or ACOs, are groups of hospitals, physicians, and other providers who agree to coordinate care for patients and deliver the right care at the right time, while avoiding unnecessary utilization of services and medical errors. ACO participants also agree to take on responsibility for the total costs of care for their patients. ACOs that reduce the total costs of care for their patient populations can share in the savings with the payer.  In certain models, they may also be liable to pay back losses if their costs exceed their spending benchmarks (Moore et al., 2017). Policymakers and healthcare leaders believe tying financial incentives to care quality, patient outcomes, and care coordination through ACOs is a key solution for fixing the inefficient fee-for-service system. The programs encourage providers to partner with others across the care continuum. Some providers are formally acquiring to gain control over a wide range of services, achieve economies of scale, and access the technology, data, and clinical capabilities of their peers. In fact, ACOs are and are likely to continue to be a major player in the value-based care and payment transformation. When all the parts work together, providers in an ACO can bring down costs and improve care quality while earning incentive payments. HMOs, on the other hand, seek to cut costs by setting fixed prices for services, which may encourage providers to reduce utilization or skimp on care in an effort to stay under the cap(Colla et al., 2018).

References

Colla, H., & Fisher, E. S. (2018). Moving forward with accountable care organizations: some answers, more questions. JAMA internal medicine, 177(4), 527-528. https://doi.org/10.1001/jamainternmed.2016.9122

Moore, K. D., & Coddington, D. C. (2017). Accountable care the journey begins. Healthcare Financial Management, 64(8), 57-63. Retrieved from https://www.proquest.com/trade-journals/accountable-care-journey-begins/docview/746684537/se-2?accountid=14872

Sample Answer 5 for NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

This is insightful . Value-based care has developed from conventional fee-for-service-based care to high-quality, coordinated care since the PPACA was enacted into law (Kaufman et al., 2019). The creation of accountable care organizations (ACOs) significantly led to the improvement of quality of healthcare service delivered to different patients. There is a lot of excitement around accountable care organizations (ACOs) as a way to improve the quality and value of healthcare (Lewis et al., 2019). But while there are many potential benefits to ACOs, addressing the needs of high-cost, high-risk patients is critical to their success. One challenge for ACOs is that they are often rewarded for keeping patients healthy and out of the hospital (Resnick et al., 2018). But many high-cost, high-risk patients require expensive interventions and care coordination in order to stay healthy. Without focused attention on this population, ACOs may not be able to achieve the cost savings and quality improvements they are hoping for.

Question: what are some of the contribution of accountable care organizations (ACOs) in the management of ethical issues in the healthcare system?

References

Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of accountable care organizations on utilization, care, and outcomes: a systematic review. Medical Care Research and Review, 76(3), 255-290. https://doi.org/10.1177/1077558717745916

Lewis, V. A., Tierney, K. I., Fraze, T., & Murray, G. F. (2019). Care transformation strategies and approaches of accountable care organizations. Medical Care Research and Review, 76(3), 291-314. https://doi.org/10.1177/1077558717737841

Resnick, M. J., Graves, A. J., Buntin, M. B., Richards, M. R., & Penson, D. F. (2018). Surgeon participation in early accountable care organizations. Annals of Surgery, 267(3), 401-407. https://journals.lww.com/annalsofsurgery/Abstract/2018/03000/Surgeon_Participation_in_Early_Accountable_Care.1.aspx

NURS 8100 Week 3 Discussion Agenda Setting Sample

Clinical Practice Issue: Nurse-Patient Ratios 

As the chair of the Nurse Peer Review Council at my institution, we review many problems that arise from clinical practice issues that are unresolved. In the first two months of 2022, we have reviewed clinical practice issues with the nurse-to-nurse handoff, staffing shortages, and failures to escalate the chain of command.  

I have been a perinatal services director for over 10 years and in my time as a leader, I have often felt that the patient ratios in the perinatal services arena are not in alignment with the Association of Women’s Health and Neonatal Nursing (AWHONN) staffing acuity guidelines. Although these guidelines were created in 2010 to promote caring for patients in the perinatal period in a safe manner based on the acuity of the patient (Simpson et al., 2019) hospital financial colleagues do not understand the importance, and frequently these guidelines have to be overlooked to maintain compliance financially. The guidelines break down different types of diagnosis and acuity of specific clinical care scenarios and rank them into categories. This information is further broken down into the number of FTEs that would be appropriate to care for this type of patient. An example would be that any patient that is pushing while in labor would require a 1:1 patient ratio whereas three patients in triage could be cared for by one nurse. The problem with this is that patients can move in and out of different levels of acuity based on their course of labor up to and after delivery. From a financial and productivity perspective this does not make sense. Staffing for a patient that begins at the lowest level of acuity then turns into the highest level of acuity, and then back to a moderate level of acuity after delivery is hard to measure from a productivity standpoint. This is even harder to maintain if departments are held to a productivity standard that is not in alignment with the patient ratios that mirror actual care a patient needs to receive during their hospital stay. The result is less safe care for patients, poor outcomes for mothers and infants, and staff dissatisfaction and burnout (Simpson, 2016). 

I am currently working with an internal PI specialist piloting a program for the health care system that involves assessing the AWHONN staffing acuity guidelines and how often my labor and delivery unit is overstaffed or understaffed based on the AWHONN staffing acuity guidelines. We have collected eight months of data and have now created a presentation for the senior leadership team to help inform them of the need to deploy additional resources at a certain time of the day and on certain days of the week. This additional resource would increase the safety of care being provided to mothers and infants.  

Some of the strategies I have used up to this point are in an agency for healthcare and research quality toolkit (AHRQ). The strategies include having a well-outlined plan that involves getting the right people on the team for the project, identifying a champion, communicating regularly with the stakeholders, and moving systematically through the stages of a project (www.ahrq.gov). By doing this the end-user has a well-developed objective presentation to support the need for a change. The importance of presenting a proposal that not only includes the need for change based on safety, but needs to include the financial, and operational impacts also. 

References 

Agency for Healthcare Research and Quality. (October, 2014). Designing and Implementing Medicaid Disease and Care Management Programs. Retrieved from https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm2.html 

Simpson, K. R., Lyndon, A., Spetz, J., Gay, C. L., & Landstrom, G. L. (2019). Incorporation of the AWHONN Nurse Staffing Guidelines into Clinical Practice. Nurse Women’s Health, 23(3), 217–233. https://doi.org/10.1016/j.nwh.2019.03.003  

Simpson, K. R., Lyndon, A., & Ruhl, C. (2016). Consequences of inadequate staffing include missed care, potential failure to rescue, and job stress and dissatisfaction. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(4), 481–490. https://doi.org/10.1016/j.jogn.2016.02.011