NURS 8100 Week 2 Discussion Unintended Consequences of Health Care Reform

A Sample Answer For the Assignment: NURS 8100 Week 2 Discussion: Unintended Consequences of Health Care Reform

The purpose of this discussion post is to identify the topic of accountable care organizations and what the reform approach presents for our overall health care organizations.  A positive result from an accountable care organization is an example that was brought to light by Dr. Kathleen White.  “I think there are three important reasons to become an accountable care organization.

Bundled payments for an organization. They’re [going to want to] stay in the game, essentially, of providing health care. And so they’re going to have to figure out a way to contract with insurance companies in order to be able to receive that bundled payment and work to control costs, because they’ll be given that set amount of money and how will they use their resources in the best way in order to provide the care that will be needed for the patient, and yet be able to, you know, maintain their bottom line.

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Hopefully, you see the idea of access and providing a continuum of care, which is certainly very desirable” (Walden University, LLC, 2011).  An unintended consequence that organizations may experience is that it was intended to minimize the reliance on emergency departments.  It was said that if more people were insured then more people will use a primary care provider instead of using the emergency department for primary care. 

This however wasn’t always the case and it actually encouraged more people to use the emergency department that wouldn’t do so otherwise as they have insurance now.  “ED visits typically become less expensive to the consumer after they gain insurance, and when a service becomes less expensive, people tend to use more of it” (McMorrow et al., 2020).

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References:

McMorrow, S., Blumberg, L. J., & Holahan, J. (2020). Ten Years Later: Reflections on Critics’ Worst-Case Scenarios for the Affordable Care Act. Journal of Health Politics, Policy & Law, 45(4), 465–483.

Walden University, LLC. (2011). Healthcare policy and advocacy: Reforming health care delivery: Accountable care organizations.

The Accountable Care Organization (ACO)s are defined as are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients and reductions in the rate of spending growth for a defined patient population (Wilson et al., 2020).

The goal of this harmonized kind of care is to ensure that patients get the right care at the right time, in addition to minimizing or totally avoiding unnecessary duplication of services as well as the prevention of medical errors. The ACOs are dedicated to quality and efficient care, e.g, Medicare has a shared services program, where healthcare organizations meet quality benchmarks while reducing spending by a certain percentage to qualify for cost savings.

They also have the authority to impose practice, reporting, and compensation standards including penalties and rewards across a group of physicians on behalf of the patient population (Wilson et al., 2020). The providers are responsible for ensuring the objectives of the coordination are met completely and embody alternative payment models capitation (Blackstone, & Fuhr, 2016). 

They are also primarily accountable to patients and third-party payers for high quality, efficient, and competency-based care, equating provider reimbursements to quality metrics and reducing the cost of care while at it (Burke, 2011).

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The ACOS organizations have various advantages, they improve the population health of the community that they serve by increasing emphasis on preventive care, providing basic but essential primary care services, and lowering the cost to the patients (Blackstone, & Fuhr, 2016). This is through preventive care, and increasing operational efficiencies which reduce the chances of readmissions, thereby saving on the operational cost which translates to low patient charges. 

The other advantages include fostering quality through the greater clinical integration of care, across healthcare settings, greater financial efficiency, and increased transparency and information about the process, costs, and outcomes of health care (Colla & Fisher, 2017). Other positive results achieved include having the providers meet patient-centeredness criteria, as developed by the Secretary of HHS, with a focus on strategies to engage patients better and actively in their health, measure patient satisfaction, and increase patient accountability (Burke, 2011). 

It also mandates that both the providers and patients are expected to be mutually accountable for following a predetermined treatment plan. It equips the patients with the knowledge to discuss and request the care they feel they need, instead of completely depending on the physician’s advice and orders (Burke, 2011).

One of the unintended consequences of OCAs is that physician integration with hospitals was associated with higher outpatient spending that did not appear to be warranted by the observed differences in disease burden. This has implications for potential harms from increased hospital market power spurred by consolidation with physicians under ACO formation (Lin et al., 2021). 

My current organization does not participate in ACOs because it has yet to meet the required quality benchmarks for participation and to focus on prevention and managing patients with chronic diseases (Colla & Fisher, 2017).

References

Blackstone, E. A., & Fuhr, J. P., Jr (2016). The Economics of Medicare Accountable Care Organizations. American health & drug benefits, 9(1), 11–19.

Burke T. (2011). Accountable care organizations. Public health reports (Washington, D.C.: 1974), 126(6), 875–878. https://doi.org/10.1177/003335491112600614

Colla, C. H., & Fisher, E. S. (2017). Moving Forward with Accountable Care Organizations: Some Answers, More Questions. JAMA Intern Med. 177(4):527–528. doi:10.1001/jamainternmed.2016.9122

Lin, M.-Y., Hanchate, A. D., Frakt, A. B., Burgess, J. F., Jr, & Carey, K. (2021). Do accountable care organizations differ according to physician-hospital integration? A retrospective observational study. Medicine, 100(12), e25231. https://doi.org/10.1097/MD.0000000000025231

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

NURS 8100 Week 2: The Health Care System, Part 2

Discussion: Unintended Consequences of Health Care Reform

The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.

Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges.

This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered.

To prepare

• Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result.
• Consider the information presented about the individual mandate and accountable care organizations. What are some questions or concerns you might have regarding the individual mandate? What are the pros and cons associated with becoming an accountable care organization?
• With posting instructions in mind, select either the individual mandate or accountable care organizations as the focus of your Discussion this week.

By Day 3

Post a cohesive response that addresses the following:

• In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience.
• Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession.

Read a selection of your colleagues’ postings.

By Day 6

Respond to at least two of your colleagues in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.

Return to this Discussion: Unintended Consequences of Health Care Reform Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.