Discussion: Technology and Cost Containment NURS 8100

A Sample Answer For the Assignment: Discussion: Technology and Cost Containment NURS 8100

A significant challenge to containing health care costs is the price of the equipment and medications needed to diagnose and treat patients and the lack of adequate reimbursement. Bodenheimer and Grumbach (2020), speculate that “the price of prescription drugs in the United States is 50% higher than that in other countries” (p. 94).

IN my world the charge for delivering a baby is around $7,500.00. Private insurance companies pay approximately 2/3 of the delivery fee compared to Medicaid covering on average about 20%. This is not sustainable if a hospital operates in a community with high Medicaid rates.

Additionally, the quality of health care is directly tied to reimbursement.  A hospital that operates with a low-profit margin makes cuts in staffing, replaces needed equipment, and struggles to attract physicians and care providers that provide high-quality care.

One way that Bodenheimer and Grumbach (2020), describe technology being utilized to decrease costs is a broader use of robotic surgeries. Gall bladder surgery, specifically described in the reading from this week can be performed in less time if robotics is used, is less invasive for the patient which decreases the length of stay, and requires less payout to providers who perform the surgery related to the decrease in time.

It is hard to say if I agree or disagree with the policymakers on reducing health care costs. I would say that it depends on how collaborative policymakers are with the individuals who provide healthcare. A few years ago Colorado tried to pass a bill  (www.coloradoindependent.com) that was well-intended in the effort to provide broader coverage for the public but wanted to introduce the idea that all hospitals would be reimbursed at Medicare and Medicaid rates to accomplish this.

The governor was convinced that hospitals were price gouging and so in his mind reimbursing hospitals at a lower rate made sense. Fortunately, the bill lost momentum with the Covid-19 pandemic and has not resurfaced.

The concept of patient-centered medical homes (PCMHs) according to Rosenthal et al. (2010), continues to be a popular idea. The notion of a PCMH is to provide care to patients in a more coordinated fashion to reduce inefficiencies.  One provider guides all of the care of the patients. Although specialists, subspecialties, and acute and long-term care may be needed, the overseeing provider organizes all of this.

References:

Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach. McGraw Hill.

The Colorado Independent. (March, 2020), Update: Colorado’s public/private healthcare option clears first hurdle. Retrieved at https://www.coloradoindependent.com/2020/03/12/colorado-public-option-healthcare/

Rosenthal, M., Beckman, H., Forrest, D., Huang, E., Landon, B., & Lewis, S. (2010). Will the patient-centered medical home improve efficiency and reduce costs for care? A measurement and research agenda. Medical Care Research & Review, 67(4), 476-484.

In the healthcare industry, nurses’ turnover is a significant challenge to contain health costs. It was ranked third of the top three industries with high turnover, with the nurses’ turnover becoming a rapidly growing human resource problem that affects the healthcare sector worldwide (Cohen, 2019). 

Its world rate is considered very high, ranging from 15 to 44%, resulting in a significant impact on a hospital’s profit margin, with the average cost of turnover for a nurse ranging from $37,700 to $58,400, and hospitals losing $5.2 million to $8.1 million annually (Lockhart, 2020).

According to the 2019 National Healthcare Retention & RN Staffing Report, it costs between $40,300 and $64,000 to replace one clinical nurse, with the average hospital losing $4.4 million to $6.9 million each year (Lockhart, 2020). The turnover rate for RNs continues to rise, 43 percent of new nurses working in hospitals leave their jobs within three years, and additionally, 33.5 percent resign after two years, and 17.5 percent work only one year (Lockhart, 2020).

Nursing turnover is extremely costly for healthcare organizations, which struggle to keep experienced and novice nurses alike, but 18% percent of new nurses change jobs or even professions, within the first year after graduation, and an additional one-third leave within 2 years (Lockhart, 2020). Nationally, the nursing turnover rate averages 19.1% and rising, leaving a nursing vacancy rate of 8%, and the average period it takes to fill a nursing position is 85 days, with more than three months, for a specialized nursing position (Lockhart, 2020).

The hospital managers state that nurse turnover disrupts hospital service operations, staffing processes, managerial processes, hospital revenue, loss of experienced and trained nurses, nurse shortages, and an imbalanced composition of new and remaining nurses, which increases the costs for recruitment and training cost for new hires (Dewanto & Wardhani, 2018).

The turnover negatively affects hospital services, revenue is disrupted, due to the decreased work productivity of the new nurses, increased expenses related to new hires’ recruitment, mentoring training to placement, and, because the new nurses require an orientation process, as their skills do not meet the expected standards (Dewanto & Wardhani, 2018).

These staffing problems cause issues in setting schedules, necessitating increased overtime, low morale of existing nurses, the less-than-optimal service provided, because of communication, and, barriers between the senior and the new nurses (Dewanto & Wardhani, 2018).

The services are heavily impacted, leaving the patients frustrated with frequent replacements, mediocre treatment by a less competent new nurse leading to the patient’s decreased trust, satisfaction, and increased complaints about nursing service (Dewanto & Wardhani, 2018).

The advancements in technology and their implementation can alleviate some of the turnovers by improving workflows and making patient care easier. Technology use can reduce medical care costs. reduce the burden on nurses, motivate more clinicians into the workforce to mitigate the shortage, and improve the transparency of medical records between healthcare organizations (Cohen, 2019).

The development of innovative nursing practice models with increased computer technology, to be used for all documentation of patient care, and generation of the electronic medical records (EMRs) is an example (Moore, 2000). There are several other technologies which include including telehealth, artificial intelligence, texting, blockchain credentialing, mobile staffing apps staff augmentation, and artificial Intelligence being some of the tools, which make daily workflows easier for nurses and nurse practitioners amid a shortage of clinicians (Agbo et al., 2019).

These tools can help to alleviate the shortage’s effects on nurses and NPs, by improving efficiencies in their daily workflows and how they provide care for patients. Many providers and patients were initially uncomfortable with telehealth, however, the pandemic not only increased adoption but also led to a rise in comfort levels, for those using the technology, allowing nurses and NPs to see more patients in a day (Rojahn, et al., 2016).

Blockchain credentialing is an app that allows for a nurse’s credential data to be stored on multiple servers, rather than just a single server, allowing organizations to see entries in real-time, which creates a public electronic ledger, making it easier for healthcare organizations to look up a nurse’s credentials and speed up approvals (Agbo et al., 2019).

The mobile staffing apps and staff augmentation, modulate the staffing based on patient volume and acuity, allowing nurses and NPs to see the hospital’s schedule, sign in, swap a shift, or pick up holidays (Mayer et al., 2019). It also allows healthcare organizations to supplement their support staff, through third-party staffing to ensure operations run smoothly, with the clinicians being to able to focus better on patient care and complete their day-to-day tasks efficiently (Mayer et al., 2019).

Artificial Intelligence is often applied within healthcare to make sense of clinical data by identifying trends, that can lead to better patient outcomes, and can be used to assess fall risk, or detect tuberculosis in x-rays (Mayer et al., 2019).

I agree with policymakers that technology needs to be more introduced as mainstream in health care because healthcare policies and insights, need to be revolved around a multifaceted approach to address nurses’ shortage and turnover. One insight is the introduction of the electronic medical record (EMR) and other technological advances, which can also affect nurses staying in or leaving the organization (Haddad et al., 2022).

Another insight is the electronic scheduling tool, which allows nurses to sign up for individual shifts they are qualified to cover, as well as trade shifts with other nurses with the same skill set when needed, this has the ability not only helps with work-life balance, flexibility but also makes scheduling easier for both nurses and management (Haddad et al., 2022). 

Social media on job recruitment platforms have become major sources of information for nurses looking for jobs as they provide an opportunity for the organization to communicate, introduce and explain the kind of environment they have, through the reviews provided by both workers and patients (Haddad et al., 2022).

References:

Agbo, C. C., Mahmoud, Q. H., & Eklund, J. M. (2019). Blockchain Technology in Healthcare: A Systematic Review. Healthcare (Basel, Switzerland), 7(2), 56. https://doi.org/10.3390/healthcare7020056

Cohen, J. K. (2019). Tech helping to alleviate nurse shortage, experience gaps. Modern Healthcare, 49(32), 14.

Dewanto, A., Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC Nurs 17, 5. https://doi.org/10.1186/s12912-018-0317-8

Haddad, L. M., Annamaraju, P., &Toney-Butler, T. J. (2022). Nursing Shortage. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/

Lockhart, Lisa. (2020). Strategies to reduce nursing turnover, Nursing Made Incredibly Easy: March/April Volume 18 – Issue 2 – p 56 Doi: 10.1097/01.NME.0000653196.16629.2e

Mayer, M. A., Rodríguez Blanco, O., & Torrejon, A. (2019). Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study. JMIR MHealth and UHealth, 7(11), e15195. https://doi.org/10.2196/15195

Moore P. (2000). Perspectives. How can we help to alleviate the nursing shortage? ONS News, 15(5), 14

Containment

In response to continually rising health care costs, the Health Information Technology
for Economic and Clinical Health (HITECH) provision was created to promote the
meaningful use of health care information technology through numerous incentive
programs for health care providers.

By enhancing data collection, streamlining
electronic medical records, and increasing transparency, it is believed that significant
cost savings can be realized as well as other positive outcomes. What are some of the
tradeoffs involved in this type of policy?

Policies form a critical part of any professional body as they have a substantial influence on how the activities are run and the directions which the operations take. One such area is nursing. Policy making is an area of interest in nursing as it influences the nature of care offered to patients and how the nurse professionals operate within the care settings (Rasheed et al., 2020).

The implication is that nurses should be up to date with current policies that directly impact or affect patient care, the nursing profession, and nursing activities. Nurses can ensure this by participating in various policy issues and advocacy processes.

Therefore, the purpose of this assignment is to analyze a policy issue. Various aspects will be discussed, including the policy definition, application of a policy analysis framework in exploring the issue, policy options or solutions, and building a consensus.

Part One: The Policy Issue

Currently, there are various policy issues in the area of nursing which directly impact patient outcomes and the nurses’ working environment. One of them is the nursing shortage. The issue of nursing shortage has existed for years and, surprisingly, is still a policy issue to date.

A nursing shortage is a case where the available nursing professionals like registered nurses can not adequately fill the available professional slots implying that the demand has exceeded the supply (Haddad et al., 2022). The nursing shortage has been shown to lead to various undesirable impacts such as increased rates of mortality and morbidity as well as higher cases of medical errors.

This issue has affected the policy arena for decades, with legislators participating in the law-making processes geared toward reducing nursing shortages (Haddad et al., 2022). In addition, various lobby groups and nursing professional organizations have been advocating for an increased number of nursing staff for better nurse-to-patient ratios.

Currently, there are politics surrounding the issue. For example, one of the major discussions has been expanding the expansion of nursing roles to reduce nursing shortage (Marć et al.,2019). While some argue that expansion of the nursing roles would be key to reducing nursing shortage, others argue that such expansion may put the patients at risk since nurses are not well equipped or trained to handle some patient care services.

As earlier discussed, the nursing shortage has been a policy issue for some time now and has attracted various stakeholders such as healthcare professionals and legislators. The latest attempt to solve the problem through policy-making and process came recently when the legislation titled the build back better act which was an initiative by President Biden.

As part of this legislation, there was a provision for the nursing workforce (Peter, 2022). The proposal was to invest about $5 billion in nursing care and the nursing workforce in the next decade. Specifically, $500 was proposed to be used in the expansion of the nurse corps program, which offers scholarships and also helps in repaying student loads for APRNs and RNs to encourage more to go for the nursing course. Another $170 million would be used to grow and diversify the perinatal nursing workforce.

Other funds would go to schools of nursing to help them in developing, disseminating, reviewing, and evaluating health professional training and increasing the staffing levels for the nursing homes (Peter, 2022). This policy proposal recently received a major obstacle when Senator Joe Manchin stopped supporting the bill alleging failure to match the preferred cost, hence retracting his support.

Such opposition halted the bill, but President Biden indicated that the government would continue deliberating on how the bill could be brought back to ensure its implementation.

Part 2: Analysis Using a Policy Analysis Framework

Policy frameworks are key in analyzing policies in several contexts. One of the most common policies is the centers for disease control’s policy analytical framework. According to this theory, analysis of an issue can be done using four major steps. The steps include problem or issue identification, identification of a suitable policy solution, identification and description of policy options, and formulating a strategy that can be applied to fully adopt the policy solution (“CDC,” 2020).

Therefore, this framework can be used in the analysis of the policy in various contexts such as social, ethical, legal, historical, and economic/or financial. The first and the second steps in the framework are key in analyzing the policy issue. The social context of the issue is that the nursing shortage is closely connected to various social issues.

For example, an inadequate number of nurses potentially lead to poor rehabilitation of individuals such as those who have been impacted by drug and substance abuse, nursing services to individuals who have faced violence, and even survivors of natural calamities.

Nursing shortage as a policy issue also has an ethical context. For example, it is ethical that patients access equitable patient care and get appropriate nursing services. However, an inadequate number of nurses negatively impact access and the nursing services, an indication that appropriate strategies should be used towards solving the problem (Marć et al.,2019).

One of the adverse impacts of nursing shortage is medical errors; the medical errors can be deadly to patients and also increase healthcare costs. When medical errors occur, a possibility is that patients may sue the healthcare institution hence damaging the institution’s image.

The historical context of the policy issue. As earlier indicated, the nursing shortage has been an issue for years and has been caused by factors such as perceived poor working conditions, the desire by nurses to move on and seek greener pastures, nurse burnout, and an increase in the number of the aging population which needs more care.

Therefore, there have been attempts to formulate legislation with the major aim of fighting it. It is worth noting that, from a historical point of view, it is not possible to narrow down on a single causative factor since the problem of nursing shortage is complex.

The problem of nursing shortage also has a financial or economic context. As earlier discussed, nursing shortage results in various undesirable impacts (Marć et al.,2019). For instance, medical errors have been associated with a nursing shortage as nurses have to attend to more patients within a time schedule.

Such a requirement leads to fatigue and burnout, which offers a ground for medical errors. These errors are costly. For instance, the errors cost up to $20 billion every year in the USA, showing how expensive it is. Correcting the problem attracts a lot of money, as revealed in the recent bill, the build back better bill. It is evident that more funds are needed for training nurses, offering nursing scholarships, and developing nursing programs that align with the current market demands to help ease the problem.

The policy also has theoretical underpinnings. While the policy had several aspects included, a huge part of it was focused on nursing care and the nursing workforce. This aspect majorly aimed to improve the patient-nurse ratio by using various initiatives and increasing funding that can then be used to implement these programs.

One of the theoretical underpinnings of the policy is that an increase in the number of the nursing workforce would improve the nature of patient care services, especially after the Covid-19 pandemic, which saw the need for nursing services substantially rise. Another underpinning has been drawn from Jean Watson’s theory, especially offering patient care through a holistic approach (Watson & Woodward, 2020).

It is important that nurse offer affection and cares to patients, and these are only possible if the management ensures that there is appropriate staffing. Adequate staffing ensures that the nurses are able to offer holistic care to patients without burnout, hence appropriate patient outcomes.

There are various stakeholders of interest in this policy. Among them are nurses who are directly affected as an increase in funding for scholarship and training would improve the nursing workforce hence better outcomes. The other stakeholders include patients who would have improved access to care (Jarrar et al., 2018).

The next stakeholders include legislators, both democrats and republicans, nursing training institution leaders, and other healthcare professionals. The importance of the issue means that there are nursing position statements regarding the issue.

For example, during the covid-19 pandemic, the American Nurses Association indicated that they are the severe nursing shortage is of deep concern and is likely to have considerable impacts on the nursing profession and the healthcare delivery system. These will eventually impact negatively on the nation’s health. They, therefore, called for it to be called a national crisis.

Part 3: Policy Options/Solutions

The issue of nursing shortage can be solved through various levels, including no change, partial change, and maximum change. It is evident that the first level is not a good option for this issue as adjustments are needed to ensure that the problem of nursing shortage is solved. As such, partial changes can be made to the existing strategies.

One of the possible solutions is to establish more nurse training institutions to ensure that more individuals enroll in the course. This will go all the way toward reducing the shortage. Another solution is increasing funding and scholarship opportunities for nursing, which would encourage more to register for the course (Harris, 2019).

This problem can also be solved using radical change. This radical change may come in the form of developing a new curriculum for the nursing course (Chan et al.,2019). This may involve integrating course content that focuses on offering care to a particular group of patients, such as the older population and the children.

This will call for specialization when the nurses train. Specialization can be a major step to ensuring that nurse training registration goes up. Specializing from the first year of training can be key in encouraging more nurses to register for training hence helping to solve the problem of nursing shortage. The theoretical underpinnings of the policy options or solutions are those of the system theory.

Open systems theory suggests that organizations are ordered in nature, and every part of the system is correlated to the other, and they work to achieve common goals. Therefore, the suggested solutions mean that nurses, as part of the healthcare organizations, are a critical part, and so increasing their number will help improve patient outcomes by improving patient to nurse ratio.

The proposed solutions have leadership and health advocacy requirements. Establishing more nurse training institutions means that more nurse leaders have to be trained to take leadership at the new training institutions. Again more nurse educators have to be trained to ensure there is enough personnel to train the nurses.

Health advocacy for this solution would involve influencing nurse legislators to formulate and support legislation that would support the establishment of new institutions to improve the nurse staff numbers (Turale & Kunaviktikul, 2019). Increasing funding and scholarship opportunities also require advocacy in terms of suggesting policies that would help ensure that every state has a structure that offers more funding and scholarship for nurses.

Formulating and establishing a new curriculum for nurse training is a radical change that requires more leadership requirements. For example, leaders have to put in place a framework for identifying individuals that can lead in the curriculum change; such individuals need to have appropriate leadership qualities, nursing knowledge, and knowledge regarding current trends in nursing.

In terms of health advocacy, nurse organizations will have to take an active part in ensuring that the new curriculum has appropriate content (Chan et al.,2019). Therefore, they will have to propose the content they feel should be part of the new curriculum and forward that to the new committee. They can then try to present their case in a bid to influence the outcomes and implementation process.

The options also offer opportunities for patient inter-professional collaboration. For example, establishing new nursing institutions would call for collaboration between the nursing profession and educators who would help in offering educational leadership. Again, financial experts will be brought on board to help advise on the financial viability of establishing each institution.

Offering more funding and scholarship to nurses would mean more would be registered for nurse training. Therefore, other healthcare professionals can be brought in to help train the nurses in specific areas. Establishing a new curriculum will also offer an opportunity for inter-professional collaboration with curriculum development experts (Chan et al.,2019). Doctors may also be brought along to suggest possible courses which can help improve the nursing profession in a bid to reduce the nursing shortage.

Each of the suggested options has pros and cons. Establishing new nursing institutions can have the advantage of improving nurse trainees’ registration. However, the cost could be high due to the need to build new structures and acquire new equipment. However, it will be effective and efficient in increasing the number of nurses hence lowering the shortage.

The option is feasible since the funding can be sourced. Increasing funding and scholarship for nurses may also be costly, but it will be effective and efficient in improving nurse enrolment hence lowering nurse shortage (Marć et al., 2019). This option is less feasible due to the fact that the healthcare system cost is already high, and it would only stretch it more.

Curriculum change may have the advantage of aligning the nurse skills with the current and emerging patient requirements