Assignment 1: Issues in Health Care Reform (Interview) NURS 8100

A Sample Answer For the Assignment: Assignment 1: Issues in Health Care Reform (Interview) NURS 8100

Basis for Formation and Potential Positives

ACO’s were developed as a part of the Medicare Shared Saving Program (MSSP) around 2012.  Conceptually, the goals were referred to as the “triple aim” which included improved patient experience, improved health outcomes (based on Medicare population) and cost reduction.  Incentives for ACO’s would include reimbursement based on shared savings as goals of their development (benchmark based) and include efficient utilization of resources and improvement of quality and outcomes of care (Chukmaitov, et. al., 2019). 

Unintended Consequences

Unfortunately, in the first three years of the ACO development, less than half of the organizations were able to attain reimbursement for shared shavings as benchmarks were not met.  Additionally, contributing factors included a mix of primary care and specialist providers, ultimately causing misaligned goals especially in relation to preventative care. (Mikhailitchenko, et. al., 2020).  Many organizations decided not to continue in the program due to these outcomes.

Personal/Organizational Consideration 

My organization is currently one of 5 ACO’s in the state of Massachusetts.  Our Medicare brand “Steward Health Choice” services a large population of the state.  As with other commercial payer goals, preventative care, meeting quality metrics and managing chronic conditions are priorities.  In 2018, there were 17 ACO’s in the state (Goff, et. al., 2021).  It does seem that unless the system is well organized and prioritizes benchmark and outcomes, the profitability is significantly reduced.  So far, my organization has fared relatively well.

References

Chukmaitov, A. S., Harless, D. W., Bazzoli, G. J., & Yangyang Deng. (2019). Factors associated with hospital participation in Centers for Medicare and Medicaid Services’ Accountable Care Organization programs. Health Care Management Review, 44(2), 104–114.

Goff, S. L., Gurewich, D., Alcusky, M., Kachoria, A. G., Nicholson, J., & Himmelstein, J. (2021). Barriers and Facilitators to Implementation of Value-Based Care Models in New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol. Frontiers in Public Health, 9, 645665. https://doi.org/10.3389/fpubh.2021.645665

Mikhailitchenko, A., & Pforsich, H. (2020). An Empirical Insight: Accountable Care Organizations’ Profitability and Quality Drivers. International Journal of Medicine & Public Health, 10(4), 155–159. https://doi.org/10.5530/ijmedph.2020.4.34

This paper looks into an accountable care organization (ACO) in California and ways that it impacts population health. Accountable health care organizations play vital roles in promoting coordinated efforts between clinicians and medical practitioners while at the same time reducing costs and unnecessary treatments (McWilliams, 2016).

Accountable care organizations are a representation of changing health dynamics in the American care system. Accountable care organizations are formed when medical providers, for instance, doctors, nurses, health organizations and non-physician providers collectively agree to be responsible for financial and quality of care in a defined population.

Accountable Care Organization

In California, one of the common ACOs is the Shared Savings Programs (SSP) which is a voluntary program that is formed to encourage hospitals, doctors and other health providers in the country to come together as accountable care organizations. The organization gives coordinated and high-quality care to members who are beneficiaries of Medicare. The SSP was formed wit the intention of moving the payment system of Medicare from a volume perspective to outcome and value-based (Lipa, 2020). 

SSP has significantly impacted population health in California. By coming together, SSP has improved the quality of care to patients who could not have afforded such care. The SSP ensures that patients from different areas in the state get the correct care at the right time. Quality care also means that patients do not go for unnecessary tests.

Another way that SSP has impacted population health in California is by focusing on preventative care through coordination of services across the different levels of care (Milwee, 2020).

The concept of bundled care.

Bundled care is a concept that entails Medicare implementing voluntary episode of payment models.  Medicare used to make individual payments to individual services offered to patients. In Bundled care, all payments are combined in a single payment for physicians and hospital facilities. Bundled care increases the incentives for providers to work together to deliver patient care.

Bundled care exposes healthcare facilities to certain risks and challenges. Some of the risks of bundled care include the fact that patients may have comorbidities (Agrwal, 2020). This is where some patients might require expensive treatment procedures that are uncontrollable by the provider. Another risk of bundled care in handling cases of uncompliant patients. When patients fail to comply with their care plan such as the medication regimen, health care providers will have difficulties in managing the costs.

Benefits of showing pricing for care.

One benefit of showing pricing of care is that it promotes price transparency. When there is access to price transparency, it helps them to choose accountable payment models that are implemented by different organizations to improve healthcare quality. Another benefit of showing care pricing is that it empowers patients to make informed decisions and get more involved in their care. Care pricing also ensures equitable prices for both insured and uninsured patients since in most cases the uninsured patients are often charged more (Mummadi & Mishra, 2020). Finally, showing care prices helps the patient to make decisions on which provider will be most effective at a low cost. Showing care prices increase competition in healthcare facilities thereby improving the quality of care provided.

In conclusion, the Shared Saving Program (SSP) is an accountable care organization (ACO) that is designed to improve population health as well as the quality of care to patients. Showing care pricing benefits healthcare in various ways. By showing care prices, patients can make an informed decision based on the pricing and quality of services offered.

References.

Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The Impact of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review: A systematic review of the impact on spending, utilization, and quality outcomes from three Centers for Medicare and Medicaid Services bundled payment programs. Health Affairs, 39(1), 50-57.

Lipa, S. A., Sturgeon, D. J., Blucher, J. A., Harris, M. B., & Schoenfeld, A. J. (2020). Do Medicare Accountable Care Organizations Reduce Disparities After Spinal Fracture?. Journal of Surgical Research, 246, 123-130.

McWilliams, J., Hatfield, L., Chernew, M., Landon, B., & Schwartz, A. (2016). Early Performance of Accountable Care Organizations in Medicare.

Millwee, B. (2020). Accountable Care Organizations in Medicaid. The Journal of ambulatory care management, 43(1), 11-14.

Mummadi, S. R., Mishra, R., & Mummadi, R. R. (2020). Price Transparency in the Electronic Health Record. Jama, 323(3), 281-281.

Health reform involves revamping a country’s or state’s health care system. It entails addressing the ever-rising costs of health care for individuals, families, and the government. Health reforms center on improving the benefits citizens receive from the country’s healthcare system and increasing access to health insurance. Healthcare reforms aim to lower the number of uninsured individuals, making healthcare more affordable and enhancing the quality of care. During this course, I met with a state legislator and discussed a healthcare reform issue that has caught my interest. The purpose of this paper is to give a summary and analysis of the interview and discuss the health care reform issues I presented.

Selected State Legislator

I planned to present my healthcare reform of interest to a legislator from my state Illinois. With the help of my colleagues, I was able to plan a meeting with Representative LaToya Greenwood through her personal assistant. Greenwood is a Democratic member of the Illinois House of Representatives. She has represented the 114th district since January 2017 and is the chairperson of the Health Care Availability and Access Committee (Illinois General Assembly, n.d.). She is also a member of several other committees such as Prescription Drug Affordability; Agriculture & Conservation; Approp-Elementary & Secondary Education (Vice-Chairperson); Data Analytics & IT; Appropriations-Human Services; Cybersecurity, Public Utilities; Museums, Arts, & Cultural Enhancement.

Rep. LaToya Greenwood was the legislator of choice due to her admirable track record. She has chiefly sponsored numerous bills as a Representative. She recently passed House Bill 4645 to strengthen minority representation in health care and stop the uneven quality of care across underserved communities (Illinois General Assembly, n.d.). The bill was founded on her belief that every citizen in Illinois deserves the highest quality of health care at an affordable cost. Furthermore, Rep. Greenwood is dedicated to fighting for affordable prescription drugs and increasing the workforce in public health.

Summary of the Interview

The PA scheduled a one-hour meeting on 15^th April 2022 at the Representative’s office from 10 am to 12 pm. The Rep welcomed me to her office, and after establishing rapport, I explained my purpose for the meeting and the desired outcomes from the meeting. The health care reform of interest was the introduction of a bill on mandatory Nurse-to-Patient ratios in all healthcare settings across Illinois. I explained to the Rep that hospitals in Illinois do not observe the WHO-recommended nurse-to-patient staffing ratios, which are purposed to promote safe patient care and prevent nurse burnout. I gave an example of the California nurse-to-patient staffing ratios act. The bill was passed to address the increasing concern that patients’ safety is often compromised by inadequate staffing attributed to the increasing severity of health conditions and complexity of care (Livanos, 2018).

I explained the benefits of enacting a bill on mandate nursing ratios, including the challenges the state currently faces due to the lack of that reform. There is a connection between nurse workload and patient morbidity and mortality rates. Hospitals with unsafe nurse-to-patient ratios overwork their nurses, resulting in burnout. Features of hospitals with high nursing workloads include increased incidences of medical errors and missed nursing care. Various studies found a high prevalence of hospital-acquired infections, like urinary tract infections and pneumonia, and failure to perform CPR in facilities with a high nurses’ workload.

I informed Rep. Greenwood that the biggest benefits from a health reform on safe nurse-to-patient ratios would be improved patient outcomes, reduced morbidity and mortality rates, reduced nursing turnover, and increased patient and staff satisfaction (Griffiths et al., 2018). Safe staffing ratios are equivalent to greater job satisfaction and reduced nurse turnover, saving organizations from the costs spent in frequently hiring new nurses. nurse-to-patient ratios influence most patient outcomes, most noticeably in mortality rates. Nurse staffing ratios are linked to a higher likelihood of patient survival. Lee et al. (2018) found that patients were 95% more likely to stay alive when health facilities observed a hospital-mandated nurse-to-patient ratio. Besides, managing critically ill patients in settings with high nursing workloads and unsafe staffing ratios was associated with a significant decrease in the odds of survival.

Potential Challenges with the Health Reform

We discussed the potential challenges of enacting mandatory nurse staffing ratios and approaches to address them with Rep. Greenwood. I explained that the main shortcoming of the health reform is that health organizations will be mandated to increase the number of nurses without getting increased reimbursement for patient care. Besides, the costs of hiring additional nurses needed for the increased mandated ratios will not be compensated by additional payments to health organizations (de Cordova et al., 2019). This will lead to unfunded mandates. Fortunately, the challenge can be addressed by providing a market-based incentive to healthcare organizations to improve nurse staffing levels (de Cordova et al., 2019). This will separate nursing care from the current room and board charges and adjust healthcare payments for optimum nursing care.

Feedback from the Legislator

Rep. Greenwood was pleased with the presentation since she is devoted to increasing the workforce in Illinois public health. She agreed that the proposed reform would significantly improve nurses’ working environment and quality of patient care resulting in improved health outcomes. She requested that I leave her with the printed proposal so that she can through it and make amendments where necessary. She also stated that she would organize another meeting to discuss the amendments and the way forward.

Conclusion

Enacting mandatory staffing ratios is the healthcare reform of interest. I presented the reform to Rep. LaToya Greenwood of the Illinois House of Representatives representing the 114th district. I presented the reform to Rep. Greenwood and discussed the benefits of enacting the bill on patients’ health outcomes and nurses’ job satisfaction. We also discussed potential challenges and solutions.

References

de Cordova, P. B., Rogowski, J., Riman, K. A., & McHugh, M. D. (2019). Effects of Public Reporting Legislation of Nurse Staffing: A Trend Analysis. Policy, politics & nursing practice, 20(2), 92–104. https://doi.org/10.1177/1527154419832112

Griffiths, P., Maruotti, A., Recio Saucedo, A., & Redfern, O. C. (2018). Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ Qual Saf.. https://doi.org/10.1136/bmjqs-2018-008043

Illinois General Assembly. (n.d.). Representative Biography. https://www.ilga.gov/house/Rep.asp?MemberID=2902

Lee, A., Cheung, Y. S. L., Joynt, G. M., Leung, C. C. H., Wong, W. T., & Gomersall, C. D. (2018). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals of intensive care, 7(1), 1-9. https://doi.org/10.1186/s13613-018-0269-2

Livanos, N. (2018). A broadening coalition: Patient safety enters the Nurse-to-Patient ratio debate. Journal of Nursing Regulation, 9(1), 68-70. https://doi.org/10.1016/S2155-8256(18)30056-5

By Day 7 of Week 9

 List View
Excellent Good Fair Poor
RESPONSIVENESS TO
DISCUSSION QUESTION
Discussion post minimum
requirements:

8 (26.67%) – 8 (26.67%)
Discussion postings and responses
exceed the requirements of the
Discussion instructions. They:
Respond to the question being
asked or the prompt provided; – Go

7 (23.33%) – 7 (23.33%)
Discussion postings and responses
meet the requirements of the
Discussion instructions. They: –
Respond to the question being
asked or the prompt provided; -Are

6 (20%) – 6 (20%)
Discussion postings and responses
are minimally responsive to the
requirements of the Discussion
instructions. They: – do not clearly
address the objectives of the

0 (0%) – 5 (16.67%)
Discussion postings and responses
are unresponsive to the
requirements of the Discussion
instructions. They: – do not clearly
address the objectives of the

*The original posting must be
completed by Wednesday, Day 3,
at 11:59pm MST. Two response
postings to two different peer
original posts, on two different
days, are required by Saturday,
Day 6, at 11:59pm MST. Faculty
member inquiries require
responses, which are not
included in the minimum number
of posts. Your Discussion Board
postings should be written in
standard edited English and
follow APA style for format and
grammar as closely as possible
given the constraints of the online
platform. Be sure to support the
postings with specific citations
from this week's Learning
Resources as well as resources
available through the Walden
University online databases. Refer
to the Essential Guide to APA
Style for Walden Students to
ensure your in-text citations and
reference list are correct.

beyond what is required in some
meaningful way (e.g., the post
contributes a new dimension,
unearths something unanticipated);
-Are substantive, reflective, with
critical analysis and synthesis
representative of knowledge gained
from the course readings and
current credible evidence. –
Demonstrate significant ability to
generalize and extend thinking and
evaluate theories or concepts within
the topic or context of the
discussion. -Demonstrate that the
student has read, viewed, and
considered the Learning –
Resources as well as additional
resources and has read, viewed, or
considered a sampling of
colleagues' postings; -Exceed the
minimum requirements for
discussion posts*.

substantive, reflective, with critical
analysis and synthesis
representative of knowledge gained
from the course readings and
current credible evidence.re –
Demonstrate ability to generalize
and extend thinking and evaluate
theories or concepts within the topic
or context of the discussion. –
Demonstrate that the student has
read, viewed, and considered the
Learning Resources and has read,
viewed, or considered a sampling of
colleagues' postings -Meet the
minimum requirements for
discussion posts*.

discussion or the question or
prompt; and/or -May (lack) lack in
depth, reflection, analysis, or
synthesis but rely more on
anecdotal than scholarly evidence;
and/or -Do not adequately
demonstrate that the student has
read, viewed, and considered the
Learning -Resources and/or a
sampling of colleagues' postings;
and/or has posted by the due date
at least in part. – Lack ability to
generalize and extend thinking and
evaluate theories or concepts within
the topic or context of the
discussion. -Do not meet the
minimum requirements for
discussion posts*.

discussion or the question or
prompt; and/or – Lack in substance,
reflection, analysis, or synthesis but
rely more on anecdotal than
scholarly evidence. – Lack ability to
generalize and extend thinking and
evaluate theories or concepts within
the topic or context of the
discussion. -Do not demonstrate
that the student has read, viewed,
and considered the Learning
Resources and/or a sampling of
colleagues’ postings; and/or does
not meet the minimum requirements
for discussion posts*.

CONTENT KNOWLEDGE 8 (26.67%) – 8 (26.67%)

Discussion postings and responses:
-demonstrate in-depth
understanding and application of
concepts and issues presented in
the course (e.g., insightful
interpretations including analysis,
synthesis and/or evaluation of topic;
– are well supported by pertinent
research/evidence from a variety of
and multiple peer- reviewed books
and journals, where appropriate; –
Demonstrate significant mastery
and thoughtful/accurate application
of content, applicable skills or
strategies presented in the course.

7 (23.33%) – 7 (23.33%)
Discussion postings and responses:
-demonstrate understanding and
application of the concepts and
issues presented in the course,
presented with some understanding
and application of concepts and
issues presented in the course
(e.g., insightful interpretations
including analysis, synthesis and/or
evaluation of topic; -are supported
by research/evidence from peer-
reviewed books and journals, where
appropriate; and · demonstrate
some mastery and application of
content, applicable skills, or
strategies presented in the course.

6 (20%) – 6 (20%)
Discussion postings and responses:
– demonstrate minimal
understanding of concepts and
issues presented in the course, and,
although generally accurate, display
some omissions and/or errors; –lack
support by research/evidence
and/or the research/evidence is
inappropriate or marginal in quality;
and/or lack of analysis, synthesis or
evaluation of topic – demonstrate
minimal content, skills or strategies
presented in the course. ——-
Contain numerous errors when
using the skills or strategies
presented in the course

0 (0%) – 5 (16.67%)
Discussion postings and responses
demonstrate: -A lack of
understanding of the concepts and
issues presented in the course;
and/or are inaccurate, contain many
omissions and/or errors; and/or are
not supported by
research/evidence; and/or lack of
analysis, synthesis or evaluation of
topic -Many critical errors when
discussing content, applicable skills
or strategies presented in the
course.

CONTRIBUTION TO THE
DISCUSSION

8 (26.67%) – 8 (26.67%)
Discussion postings and responses
significantly contribute to the quality
of the discussion/interaction and
thinking and learning by: -providing
Rich and relevant examples;
discerning and thought-provoking
ideas; and stimulating thoughts and
probes; – -demonstrating original
thinking, new perspectives, and
extensive synthesis of ideas
supported by the literature.

7 (23.33%) – 7 (23.33%)
Discussion postings and responses
contribute to the quality of the
discussion/interaction and thinking
and learning by -providing relevant
examples; thought-provoking ideas
– Demonstrating synthesis of ideas
supported by the literature

6 (20%) – 6 (20%)
Discussion postings and responses
minimally contribute to the quality of
discussion/interaction and thinking
and learning by: – providing fe