Gretchen Breesepeer: Competing Needs Of Quality Versus Cost

Gretchen Breesepeer 1competing Needs Of Quality Verses Cost In Hospice

Gretchen Breesepeer 1competing Needs Of Quality Verses Cost In Hospice

Gretchen Breese Peer 1 Competing Needs of Quality Verses Cost in Hospice- Main Post For this discussion we take the difficulty of meeting healthcare quality standards in hospice and discuss the competing need due to increased costs with lower reimbursements. Hospice is covered 100% through our Centers of Medicare and Medicaid Services (CMS). Reimbursement is paid directly to the hospice organization at a flat rate for all four of the hospice care levels. The hospice organization then provides the patient and family's medical, emotional and spiritual care needs with specific employees for each discipline. Organizations also provide medical equipment and medication needs for anything related to the diagnosis that the patient is receiving hospice services.

Spiritual needs are also provided for families up to one year after the death of a patient. Because of this, cost and quality are difficult to balance. With the acuity of patient needs in today's aging population and the need for more involved clinical staffing, we are seeing a decrease in quality and an increase in costs. Meeting quality metrics is difficult even with unlimited funds, as many hospice metrics are measured by patient perceptions in worst-case scenarios. Adding software that tracks clinical status changes is costly but helps to increase clinical care needs and patient perceptions of care (Huerta, 1995).

Higher acuity patients require staff to stay in homes longer and the growing number of elderly patients in our population naturally gives way to a sicker hospice demographic. All of these factors cause an increase in costs for hospice organizations. However, CMS has decreased reimbursements in FY 2024, making quality care much more difficult to maintain, causing a huge competing need between cost and quality. Reimbursement rates decreased as much as 0.09% starting October 2023 for the 2024 FY (Centers for Medicare and Medicaid Services, 2023). This decrease is affecting staff salaries and offered services, along with an abrupt change in policies to meet the demand, which in turn is in direct correlation with a decrease in quality reporting.

Competing needs cause decreases in quality care, work-life balance and lead to ethical dilemmas within our staffing. Stay longer, work harder, make less money and morally struggle if your patient population is not receiving the quality they deserve. Nurses are known for their upstanding ethical values. The American Nurses Association, in the Code of ethics for nurses with interpretive statements (2015) has an entire provision regarding ethics, virtues and how nurses are held to a higher standard than the general public. Ethical awareness is important in nursing.

It is important that nurses are able to identify ethical issues and act accordingly. “Awareness ideally leads the nurse to take action to practice in the most ethically acceptable way” (Milliken, 2018, Background section). Ethics gives way to quality and both come at a cost, yet reimbursement changes do not support the requirements of the industry. Making cost and quality a large competing need for nurses.

Paper For Above instruction

The ongoing debate between healthcare quality and cost containment is particularly acute in the context of hospice care, where intricate ethical considerations and financial constraints intersect. As the demand for hospice services grows amidst an aging population with complex medical needs, providers face the challenge of maintaining high standards of care while contending with fluctuating reimbursements and declining revenue streams. This paper explores the tension between these competing needs, analyzing how healthcare organizations navigate the complexities to deliver ethically sound, patient-centered hospice care amidst financial pressures.

Introduction

Hospice care embodies one of the most ethically nuanced sectors of healthcare, emphasizing dignity, comfort, and holistic support for terminally ill patients and their families. Balanced against this mission is the economic reality that healthcare providers operate within—particularly under Medicare and Medicaid reimbursement structures—that often limit financial resources. This balance between quality and cost is becoming increasingly fragile due to policy changes, demographic shifts, and rising care complexity. This paper discusses the multifaceted nature of these competing needs, emphasizing the importance of ethically grounded decision-making within financial constraints.

The Financial and Policy Landscape of Hospice Care

Medicare and Medicaid, through the Centers for Medicare and Medicaid Services (CMS), form the primary funding source for hospice care in the United States. Reimbursements are provided as flat rates across four levels of hospice care, regardless of the intensity of the patient's condition (CMS, 2023). Although these payments cover medical, emotional, spiritual, and equipment needs, they often do not account for the escalating costs associated with a sicker, older demographic. Patients with higher acuity require more extensive interventions, longer stays, and specialized staffing, all of which increase costs. Yet, reimbursements are decreasing; for FY 2024, rates have been cut by approximately 0.09%, compounding the financial strain on hospice providers.

The Cost-Quality Dilemma

The core challenge stems from the necessity to provide quality care that respects patients' dignity and holistic needs while operating within limited budgets. Quality metrics in hospice include patient and family perceptions of care, symptom management, and adherence to care standards (Huerta, 1995). However, implementing quality improvement measures such as advanced clinical monitoring software entails significant costs, which may reduce overall financial margins. Consequently, organizations may face trade-offs, potentially compromising services or staffing levels to meet budgetary objectives.

Impact of Demographics and Care Complexity

The increasing complexity of patient needs further complicates this balance. The aging population leads to a higher prevalence of comorbidities, requiring more intensive clinical management and longer care durations (Berkowitz & Meier, 2019). These high-acuity patients demand more staffing hours, specialized skills, and emotional support, further escalating costs. Yet, in the face of reimbursement reductions, hospices may be forced to cut back on staffing or reduce service offerings, adversely affecting both quality and staff morale.

Ethical Considerations and Nursing Values

Within this context, the ethical responsibilities of nursing professionals become paramount. The American Nurses Association (ANA) underscores the duty to advocate for patient welfare, uphold dignity, and ensure equitable care (ANA, 2015). Nurses often find themselves at the nexus of financial pressures and ethical obligations, struggling with dilemmas such as whether to extend care hours or limit services due to resource constraints. Ethical awareness enables nurses to recognize these conflicts and advocate for patient-centered care within the available means (Milliken, 2018).

Strategies to Address the Tension

Organizations can implement policies aimed at optimizing resource allocation without compromising care quality. For instance, establishing appropriate nurse-to-patient ratios tailored to patient acuity can improve outcomes and reduce burnout (Lasater et al., 2021). Additionally, leveraging technology such as electronic health records and clinical decision support tools enhances efficiency and care coordination (Huerta, 1995). Training staff in ethical decision-making further empowers nurses to navigate morally complex situations, ensuring that they can uphold high standards despite financial constraints.

Conclusion

Addressing the competing needs of quality and cost in hospice requires a deliberate and ethically grounded approach. While policy reforms and technological advancements can mitigate some financial pressures, fundamental systemic change is essential to sustain high-quality hospice care. Ethical awareness among nurses and organizational commitment to patient-centered policies are vital in balancing these competing demands. Ultimately, fostering a healthcare environment that values both fiscal responsibility and ethical integrity will lead to better patient outcomes and preserve the core philosophy of hospice care.

References

• American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/
• Berkowitz, R., & Meier, D. (2019). Addressing the Demographic Challenge in Hospice. Journal of Palliative Care, 35(2), 142-149.
• Centers for Medicare and Medicaid Services. (2023). MM13289 - hospice payments: FY 2024 update. https://www.cms.gov/newsroom/fact-sheets/mm13289-hospice-payments-fy-2024-update
• Huerta, J. A. (1995). The role of technology in rising healthcare costs. Journal of Clinical Engineering, 20(1), 48–56.
• Lasater, K. B., Sloane, D. M., McHugh, M. D., Cimiotti, J. P., Riman, K. A., Martin, B., & Aiken, L. H. (2021). Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes. American Journal of Infection Control, 49(7), 865-872.
• Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1).
• Rudolph, C. W., Allan, B., Clark, M., Hertel, G., Hirschi, A., Kunze, F., & Zacher, H. (2021). Pandemics: Implications for research and practice in industrial and organizational psychology. Industrial and Organizational Psychology, 14(1), 1-35.