Introduction
The introduction of the Affordable Care Act (ACA) in 2010 marked a significant milestone in the effort to reform and restructure the United States healthcare delivery system. This sweeping legislation aimed to increase access to care, reduce costs, and improve quality through various changes to the healthcare system (Selker & Wasser, 2021). In particular, the ACA expanded the role of nurses within the healthcare delivery system by providing incentives for developing interprofessional teams, increased access to care, and an emphasis on preventative care. As such, nurses are uniquely poised to play a significant role in successfully implementing healthcare reform and restructuring. This paper will discuss the changes introduced to reform and restructure the U.S. healthcare delivery system, the action taken for reform and restructuring, and the nurse’s role within this changing environment.
Current Healthcare Regulation
The Medicare Access and CHIP Reauthorization Act included the Quality Payment Program (QPP). This was a government rule that was launched in 2017 with the goal of enhancing service quality and lowering costs (Mizuno & Bodek, 2020). This reform requires eligible clinicians to participate in two tracks: the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). MIPS assesses clinicians on four performance categories: quality, cost, improvement activities, and advancing care information. APMs incentivize providers to shift towards value-based health care, such as accountable care organizations.
Nursing practice is affected by the QPP in several ways. Nurses must now be aware of the various performance categories they can assess, such as quality of care, cost-efficiency, and improvement activities. Nurses must also become familiar with the different APMs and how they can impact care delivery. Additionally, nurses must adhere to the new requirements of the QPP or risk not being reimbursed for their services.
The nurse’s role and responsibility are also affected by the QPP. Nurses must know the latest healthcare regulations and track their performance in various categories. Furthermore, nurses must be able to demonstrate how their services are cost-effective and how they are improving the quality of care. Finally, nurses must be able to collaborate with other healthcare providers to ensure that they are meeting the requirements of the QPP and providing the best quality of care for their patients. Nurses must also be able to advocate for the healthcare system to ensure that the best interests of their patients are met and that their care is of the highest quality.
Quality Measures and Pay for Performance
Quality measures and performance pay are strategies to ensure that healthcare organizations provide their patients with the highest quality of care. According to Graban and Toussaint (2018), quality measures are used to track and evaluate the quality of care provided by healthcare providers, such as nurses. Pay for performance is a system that rewards healthcare organizations and providers for providing high-quality care by offering them financial incentives.
Pay for performance and quality measures directly affect patient outcomes by ensuring that healthcare organizations provide the highest quality of care. Quality measures help to ensure that patients receive the best possible care by evaluating the effectiveness of healthcare providers and the quality of care they provide. Pay for performance incentivizes healthcare organizations and providers to strive for the highest quality of care, as they are financially rewarded for providing high-quality care.
Nursing practice is affected by quality measures and pay for performance in various ways. Stanhope and Lancaster (2019) argue that nurses must ensure they provide their patients with the highest quality of care and adhere to evidence-based practice guidelines. Nurses must also be knowledgeable about quality measures and pay for performance and be able to implement them. Nurses must also be aware of the financial incentives associated with providing high-quality care and strive to achieve them.
The expectations and responsibilities of the nursing role in these situations include providing quality patient care, adhering to evidence-based practice guidelines, being knowledgeable about quality measures, implementing pay-for-performance initiatives, and striving to achieve the financial incentives associated with providing quality care. Additionally, nurses are required to be familiar with the quality measures and pay-for-performance initiatives their organization has implemented and actively engage in efforts to improve patient outcomes.
Nursing Leadership and Management Roles
Professional nursing leadership and management roles have become increasingly important in recent years in response to the emergence of trends in healthcare, such as population health management, health information technology, and the rise of nurse-led specialty care. These roles are critical in ensuring patient safety, quality care, and a positive patient experience within a wide range of healthcare settings. As a nurse leader, it is essential to understand the impact of population health management and health information technology on care delivery.
Nursing leadership and management roles are responsible for setting and maintaining standards of professional practice, developing policies and procedures, and leading change initiatives. According to Ellis (2021) management roles are also responsible for leading and managing teams of healthcare professionals and providing guidance and support to ensure effective, evidence-based care is provided. Nursing leaders must also foster a safety culture and ensure compliance with regulatory bodies and accreditation standards.
In addition, nursing leadership and management roles are essential in promoting patient safety and quality care in diverse healthcare settings. These roles are expected to lead and support initiatives that promote patient-centered care, continuous quality improvement, and patient safety. Nursing leaders must also be able to anticipate and respond to emerging trends in healthcare and develop innovative approaches to care delivery. Finally, nursing leadership and management roles ensure that healthcare professionals are supported and valued.
Emerging Trends
The practice of nursing and nursing roles are constantly evolving to meet the needs of the changing healthcare landscape. The next five years will be no different, as nurses must take on new roles, technologies, and practices to provide optimal patient care. This essay will discuss some of the predicted ways in which the practice of nursing and nursing roles will grow or transform in response to upcoming trends or predicted issues in the healthcare system within the next five years.
Increasing Focus on Preventative Care
In the next five years, nursing roles will expand to emphasize preventative care more than ever. Nurses will be increasingly involved in activities that promote wellness and prevent illness, such as health screenings, lifestyle counseling, and community outreach. In addition, nurses will be expected to serve as patient advocates, helping patients make informed decisions about their health care and connecting them with appropriate resources.
Increasing Use of Technology
The use of technology in healthcare is rapidly growing, and nurses will need to be prepared to use and understand it. Nurses will be expected to proficiently use electronic health records (EHRs), telemedicine, and other digital tools to provide better care and improve communication and collaboration between providers. In addition, nurses will need to understand how to use data analytics to inform their practice and improve patient outcomes.
Conclusion
The changes and reforms to the US healthcare delivery system have been long. In recent years, many efforts have been made to improve the system, from the implementation of the ACA to the development of value-based care models. As a result, the healthcare system has become more patient-centered, accountable, and efficient. Nurses are essential to the success of these reforms and restructuring efforts, as they are the frontline providers of care in the healthcare system.
References
Ellis, P. (2021). Leadership, management, and team working in nursing. Sage.
Graban, M., & Toussaint, J. (2018). Lean hospitals: Improving quality, patient safety, and employee engagement. Productivity Press.
Mizuno, S., & Bodek, N. (2020). Management for quality improvement: The seven new QC tools. Productivity Press.
Selker, H. P., & Wasser, J. S. (2021). Affordable care act as a national experiment. Springer International Publishing.
Stanhope, M., & Lancaster, J. (2019). Public health nursing e-book: Population-centered health care in the community. Elsevier Health Sciences.