Individual Client Health History And Examination Benchmark ✓ Solved

Benchmark - Individual Client Health History and Examination 1 Unsatisfactory

Identify health care policies that use cost shifting. Argue the benefits of cost shifting. How might the Affordable Care Act decrease cost shifting within hospitals?

In what way does managed care actually manage cost? Does it do so without diminishing the quality of care? If so, how does it accomplish this?

The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the healthcare team. Although originally developed for patient-centered communication, it is also used to address critical issues collaboratively within healthcare settings.

It offers a structured method to convey vital information efficiently, ensuring clarity and prompt action. The SBAR process begins with clearly stating the Situation, providing pertinent Background, offering an Assessment of the issue, and finally, delivering a specific Recommendation for action.

Implementing SBAR enhances communication and patient safety, reduces errors, and promotes team collaboration. It encourages concise, relevant exchanges of information, essential for high-stakes decision-making in clinical environments.

Effective use of SBAR requires understanding each component's purpose. For example, the Situation succinctly states the problem, while the Background gives context. The Assessment evaluates the issue's severity, and the Recommendation specifies the desired actions.

Training healthcare providers in SBAR fosters consistent communication standards. When systematically used, it improves efficiency in patient handoffs, emergency responses, and interdisciplinary dialogues, ultimately contributing to better patient outcomes.

Sample Paper For Above instruction

Cost shifting in healthcare refers to the practice where hospitals, physicians, or other providers compensate for financial losses incurred from serving lower-income or uninsured populations by charging higher prices to insured or paying patients and insurers. This practice is a consequence of the complex and often fragmented healthcare financing system. Policies that utilize cost shifting include the hospital's practice of increasing charges for privately insured patients to offset uncompensated care expenses, and the way public programs like Medicaid reimbursement rates often do not cover the actual costs incurred by providers, leading to a financial gap that is shifted to other payers.

The benefits of cost shifting are debated; proponents argue that it enables healthcare providers to sustain their operations and continue serving all patients, including the uninsured and underinsured. By compensating for losses associated with treating economically disadvantaged populations, hospitals can maintain service availability and avoid closures that could disproportionately harm vulnerable populations. Additionally, cost shifting can incentivize hospitals to accept a broader patient base, promoting access to care.

However, critics suggest that cost shifting contributes to higher healthcare costs overall, which can burden private insurance premiums and out-of-pocket expenses for individuals. It may also distort pricing and reimbursement mechanisms, leading to inefficiencies and inequities within the healthcare system.

The Affordable Care Act (ACA) aimed to reduce cost shifting by expanding insurance coverage and improving the reimbursement rates for Medicaid and Medicare. By decreasing the number of uninsured individuals, the ACA reduced the financial burden hospitals face from uncompensated care, thereby lowering the necessity for hospitals to recover costs through higher charges to private payers. The ACA also introduced value-based payment models, such as the Hospital Value-Based Purchasing program, which incentivize hospitals to improve quality and efficiency rather than rely solely on fee-for-service revenue models, further mitigating cost shifting.

Managed care is a strategy that aims to control healthcare costs by coordinating care delivery, emphasizing preventive services, and negotiating payment rates with providers. Managed care organizations (MCOs) implement various mechanisms such as capitation, provider networks, and utilization review to contain expenditures. For example, through capitation, providers receive a fixed amount per patient, encouraging cost-effective care delivery without sacrificing quality.

Research indicates that managed care can manage costs effectively while maintaining quality of care when properly implemented. Managed care emphasizes preventive care, which helps reduce costly hospitalizations and emergency interventions. It also encourages case management and care coordination, which improve health outcomes and patient satisfaction. Furthermore, the adoption of electronic health records (EHRs) and data analytics supports efficient resource allocation and early identification of at-risk populations, facilitating timely preventive and chronic disease management.

While concerns about compromised quality have persisted, evidence shows that carefully designed managed care plans can deliver high-quality care through incentivizing evidence-based practices and patient-centered approaches. For example, programs like the Patient-Centered Medical Home model involve comprehensive, team-based care that emphasizes primary care, leading to improved health outcomes and patient engagement without increasing costs.

In conclusion, cost management in healthcare through policies like managed care and the ACA plays a vital role in balancing cost containment with quality care. Effective communication frameworks like SBAR further support these goals by ensuring clarity and efficiency in information exchange among healthcare teams, ultimately enhancing patient safety and care outcomes. The integration of policy, management strategies, and communication tools is essential to navigate the complexities of modern healthcare systems effectively.

References

• Blendon, R. J., Buur, C., & Solomon, L. (2017). Understanding the implications of the Affordable Care Act. New England Journal of Medicine, 376(17), 1688-1693.
• Cohen, S. B., & Reiter, K. (2018). Managed care and the future of healthcare delivery. Journal of Healthcare Management, 63(4), 232-245.
• Ginsburg, P. B. (2019). Cost shifting and hospital finance. Health Affairs, 38(11), 1844-1850.
• Kaiser Family Foundation. (2020). The impact of the ACA on Medicaid expansion and hospital finances. Retrieved from https://www.kff.org/health-reform
• Levit, K. R., & Frank, R. (2016). Managed care and health care quality: The debate continues. Medical Care Research and Review, 73(4), 377-396.
• Meyer, J. C., & Williams, A. (2020). Strategies for controlling healthcare costs: policy and practice. Journal of Health Economics, 69, 102317.
• Siegel, B. S. (2019). SBAR communication framework to improve patient safety. Journal of Nursing Care Quality, 34(2), 189-194.
• Tseng, P., et al. (2018). The effects of managed care on healthcare quality. Medical Care, 56(1), 20-25.
• Walker, D. M., & Du, Z. (2019). Health policy strategies for reducing cost shifting. Policy & Politics, 47(2), 263-280.
• Zhang, Y., et al. (2021). Implementing SBAR in clinical settings: benefits and barriers. Journal of Clinical Nursing, 30(3-4), 599-606.