Overview: It Is Important For You As A Healthcare Pro 700968

Overviewit Is Important For You As A Healthcare Provider To Advocate

Overview: It is important for you as a healthcare provider to advocate for populations through policy. Assessing the needs of a vulnerable population and identifying the policies affecting them to ensure positive outcomes is part of the advocacy process. Understanding U.S. health policy is a crucial component of developing a global perspective. A global perspective also requires considering the Millennium Development Goals in relation to U.S. policy; this allows advocates and decision makers to clarify the direction necessary to ensure health globally.

Prompt: After reviewing the Final Project Two Guidelines and Rubric document, develop a paper summarizing the policy approved for your project, and analyze the effectiveness of the policy. In addition to your research, incorporate information gathered as to how Nurse Managers are affected by this policy. Policy is Medicare policy of 2019.

Paper For Above instruction

Medicare policy of 2019 was a significant legislative framework aimed at restructuring and enhancing the quality and efficiency of healthcare delivery for the elderly and disabled populations in the United States. This policy introduced several modifications to Medicare reimbursement models, aimed at promoting value-based care, reducing fraud, and expanding access to preventive services. Understanding its implications is essential for healthcare providers, especially nurse managers, who play a pivotal role in implementing policy changes at the clinical level.

The 2019 Medicare policy primarily focused on shifting from volume-based reimbursement to value-based models. This change incentivized providers to improve care quality while controlling costs, aligning with broader health policy goals of transparency and accountability. Initiatives such as the Bundled Payments for Care Improvement (BPCI) Advanced aimed to foster care coordination among providers, encouraging integrated care pathways that reduce redundancies and improve outcomes. The policy also expanded coverage for certain preventive services, including screening and vaccination programs, to promote early detection and health maintenance.

Assessing the effectiveness of the 2019 Medicare policy reveals mixed but largely positive outcomes. Studies indicate that value-based payment models under this policy have contributed to a reduction in hospital readmission rates and improved patient satisfaction. For instance, a report by the Centers for Medicare & Medicaid Services (CMS) highlighted a decline in readmissions for conditions like heart failure and pneumonia, suggesting that the incentives for better transitional care and follow-up are working effectively (CMS, 2020). However, some critics argue that the complexity of new billing procedures and administrative requirements can burden providers, particularly smaller practices with limited administrative support, potentially impacting care delivery (Melnick et al., 2021).

From the perspective of nurse managers, the 2019 Medicare policy has had profound effects. Nurse managers are on the frontline in translating policy mandates into daily clinical practice. The shift toward value-based care necessitates increased emphasis on care coordination, documentation, and quality metrics, which can challenge staffing workflows and resource allocation. Nurse managers must ensure their teams understand and adhere to new protocols to optimize patient outcomes while maintaining compliance with reimbursement criteria. Additionally, the policy’s focus on preventive care has expanded nurses’ roles in health education and community outreach, requiring enhanced skills in patient engagement.

Furthermore, nurse managers are instrumental in implementing the technological and administrative changes brought about by the policy. Electronic health records (EHR) systems have become central to documenting care quality and patient outcomes, integral to reimbursement calculations under value-based models. Effective training and leadership are essential to navigate these technological adaptations successfully. The policy’s emphasis on reducing hospital readmissions also underscores the importance of transitional care programs, where nurse managers coordinate interdisciplinary teams to ensure seamless patient discharge planning and follow-up.

In conclusion, the 2019 Medicare policy has significantly influenced healthcare delivery in the U.S., promoting a shift toward value-based care that aims to improve quality, safety, and efficiency. While challenges remain, particularly in administrative burdens and resource constraints, overall, the policy has demonstrated positive impacts on healthcare outcomes. Nurse managers play a crucial role in implementing these changes, ensuring that care delivery aligns with policy objectives, thus advocating for vulnerable populations and contributing to improved health outcomes on both individual and population levels.

References

• Centers for Medicare & Medicaid Services (CMS). (2020). Medicare Claims Data Shows Improvements in Readmissions. CMS.gov. https://www.cms.gov/newsroom/fact-sheets/medicare-claims-data-shows-improvements-readmissions
• Melnick, G., Lin, H., & Caswell, D. (2021). Administrative Burdens of Value-Based Purchasing. Health Affairs, 40(2), 236-243. https://doi.org/10.1377/hlthaff.2020.00312
• Office of Inspector General. (2019). Medicare Advantage Program Oversight. OIG.gov. https://oig.hhs.gov/oei/reports/oei-09-19-00301.asp
• Kaiser Family Foundation. (2020). Medicare Policy Trends and Changes. KFF.org. https://www.kff.org/medicare/report/medicare-policy-trends-and-changes/
• Centers for Medicare & Medicaid Services. (2019). CMS Innovation Center Initiatives. CMS.gov. https://www.cms.gov/medicare/innovation-center
• Schneider, E. C., Zaslavsky, A. M., & Epstein, A. M. (2019). The Impact of Value-Based Payment on Hospital Quality. Journal of Health Economics, 68, 102195.
• Scheffler, R. M., & Pan, Y. (2020). Impact of Medicare Value-Based Purchasing on Hospital Readmission Rates. Medical Care Research and Review, 77(2), 130-139.
• Williams, M. V., et al. (2020). The Role of Nurse Managers in Policy Implementation. Nursing Management, 27(4), 12-17.
• American Nurses Association. (2021). Advocacy and Policy Perspectives for Nurse Managers. ANA.org. https://www.nursingworld.org/practice-policy/advocacy/
• Joynt Maddox, K. E., et al. (2020). How Value-Based Payment Affects Health Care Delivery. New England Journal of Medicine, 382, 2637-2644.