NRS 440VN Evolving Practice of Nursing and Patient Care Delivery Models

Presentation about Continuity of care and ACO’s- Presented to my peers at ICON hosptial.

Coordinated Healthcare- many illnesses, as well as their treatments, affect mutiple parts of the body. One specialist may be an expert on heart or lungs. Specialist involved in a population’s health. Working together and speaking about the patient’s needs. Integration with the PCP’s for outpatient health. Focuses on decreasing readmissions to the hospital setting. Provides a productive relationship between patient and physicians.
Hospitals- Are focusing on lower readmissions and appropirate use of ED’s. Hospitals are working their Case Management teams to discharge plan appropriately to the most appropriate level of care quicker. Within 24 hours of admission the case manager should have a plan in place regarding discharge.
Payers are focused on lowering healthcare costs overall. Improved member satisfaciton. Employers are focused on lower costs and providing a more productive workforce with employee satisfaction. Overall healthier employees.
Post acute providers- Are reporting quality data on every patient to show their quality. Healthcare shifting towards Quality of care and reimbursement will depend on that.
Pharmaceutical- Having to work closesly with hospitals, payers and patients to provide the correct meds at the most cost effective manner.
Patient accountability- Employers are now doing testing to see if employees use tobacco. If it comes up positive their premiums are higher. Its just a matter of time if your BMI is high it will increase your premiums.
Preventative care- Preventative care is magnified. It takes primary role and insurances are paying for it at 100%. It is a great service to provide but one of the only services insurances pay for at 100%.
Post Acute Care- The post acute providers are being forced to provide care at a lower cost. Especially going into bundled payments. The acute care facilities are trying to increase their service lines by putting rehab facilities inside the acute care setting to where patient’s can transition. CMS will provide one lump sum for every level of care that a patient may need.
If a patient needs to go to a lower level of care, the lump sum would need to pay for all services in the episode of care.
Key is all coming together to provide an excellent patient experience with great outcomes at the most cost effective manner. When you stratify and identify gaps, hold people accountable for quality metrics. Communicate with patients engages them in their care. Coordination of care provides great outomes. Tracking optimizes everyone’s efforts to provide great quality care in the most cost effective manner possible. Physicians coming together to provide coordinated great patient care in the most cost effective manner is a great plus. If it is based off of quality metrics if someone or place gets paid, they are more likely to make sure all is successful. CEO’s will hire the right people for the right jobs in all areas of healthcare to maximize reimbursement at every level of care. Patient’s benefit trementously from these key things being done. All working together for the greater good of patients.

I presented my presentation to my team of collegues at ICON hospital. There were a lot of mixed opinions of ACO’s and change in nursing roles to help. There was a lot of the same questions related to my presentation. I showed a chart that is easyto understand and shows all aspects of care involved in successful outcomes. Nurse’s role changes some as they are not responsible to these quality metrics. Some of their assessments reflect different questions to address these quality metrics. Nurses have to be key members to moving patient’s along. Asking the appropriate questions of the doctors to ensure all is being done to allow maxximum progression by patients. One of the nurses I work with had a lot of questions related to what the hospitals were doing to maximize ther services offered. I discussed adding post acute providers right in the hosptials. Another one is providing DME and Home health services from the hospital. They have their own departments able to provide services in the home. They are trying to keep all of the bundled payments within their hospitals. Nurses role is always first and foremost to be the patient advocate. It is a patient’s choice which provider they go home with. If they don’t want to go to the rehab floor in a hospital. They get to choose where they go. If they don’t want the home healthcare services that the hosptial has, they can go with any home healthcare provider of their choice. That was the main point I was trying to make to the nurses is we are the patient advocate. Nurses also have to remember the patient satisfaction scores are all part of those quality metrics. Patient’s get survey’s all during their stay. Those satisfaction scores are part of the metrics that go to CMS and have to be reported.

One of the nurse had a question about how do the help prevent readmissions. So I discussed making sure the patient has everything they may need at home. Asking the appropriate questions and making sure they understand everything about their medications. If a patient does not understand, call the pharmacist to discuss medication management. Nurses can delegate and utilize resources to help with patient’s and their care. It is super important to make sure patient’s understand what they are suppose to be taking at home and when. 11% of readmissions are due to medication management. If all is done to make sure patient and family understand medication regime and interacitons that could happen. The less likely you are to have a readmsision to the hospital setting.

The third nurse’s input was regarding the government. They understand that the government wants to coordinate care and provide quality care in the most cost effective way. But they feel this is another strategy by the government to know everything about the people. All of their information is EHR on an electronic medical record. The nurse stated its another way for the government to spy on us. They will know all diagnosis and infections the patient had while in the hospital. I explained that it is part of a bigger plan to coordinate healthcare overall. Provide great quality care and hold the hosptials accountable.

Hospitals would get paid regardless of the service they provided. This is holding all accountable to their products. It forces them to abide by the higest of quality standards because if not they will not be paid all of their reimbursement. It hits the pocketbook if they don’t abide by specific quality measures. It is a great way to hold hospitals and physicians accountable. Physican accountability is a new concept. They have to provide the service to make maximum reimbursement. Our system is going towards a quality based reimbursement model. It is causing all of the hospitals and providers to provide the best care possible to be able to make their money. Nurses are the front line to all the changes that have to take

place to provide great quality care and outcomes. The nurses are the first and last person that a patient sees prior to leaivng the hospital setting.

References:

Piloting ACO’s readiness, Advisory board. Retrieved 7/10/17. Retrieved from:

https://www.advisory.com/research/market-innovation-center/resources/2011/piloting-aco-readiness

ACO financial, clinical, and implementation considerations. Smithback and spector. Retrieved 7/10/17. Retrieved from: http://healthsciences.utah.edu/hcr/2012/resources/43014083_MillimanWhitePaper_ACOs.pdf