Costs of Health Care and Quality

¶ … Health Care Cost and Quality

The objective of this study is to examine the relationship between health care cost and quality. This study will select one public agency and one private agency and differentiate their roles and major activities in addressing cost and quality in health care and analyze current and projected initiatives to improve quality while simultaneously controlling costs. This study will additionally conduct a synthesis of indications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality.

There are many initiatives presently underway to meet the growing need of health care for a population that is greatly under-insured and many that are uninsured.

U.S. Department of Health and Human Services Report

According to the U.S. Department of Health and Human Services (2014) "Medicare is improving the way it pays for physician services. The Center for Medicare and Medicaid Innovation (Innovation Center) is exploring new payment models and service delivery models, including some models that are testing movement away from payment based solely on the number of procedures or services delivered to patients and towards models that reward high quality, patient-centered care." (p. 6) Reported as key components of the initiative are the following: (1) modernization of graduate medical education; (2) National Health Service Corps (NHSC): Expand the Corps to increase the availability of providers in those areas across the country most in need; and (3) Extend Enhanced Medicaid Primary Care Payments: Extend the Affordable Care Act's (ACA's) enhanced Medicaid primary care payments through Calendar Year (CY) 2015 to better target primary care and expand eligibility to mid-level providers practicing independently, at an estimated cost of $5.44 billion. (U.S. Department of Health and Human Services, 2014, p. 7)

II. Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality reports that reducing the risk of stroke for elderly patients with irregular heartbeat, employer lowering costs through offering multiple insurance plans to their employees, and a change in Medicaid coverage for anti-ulcer drugs are all part of the program to reduce hospitalizations and ultimately to reduce health care costs.

III. American Nurses Association

The American Nurses Association reports that legislators are working in bringing about change in U.S. Health care and that their focus is on "increasing access for the nation's more than 50 under- and uninsured." (p. 1) Among the providers that legislatures have focused on in health care is the advanced practice registered nurse (APRN) which is reported as "an umbrella term for RNs who have met advanced educational and clinical practice requirements -- including nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists." (American Nurses Association, nd, p. 1)

These Advanced Practice Registered Nurses will be able to fill a need for the large population of individuals requiring health care and will be able to do so under the supervision of a physician including the ability to perform check-ups, write prescriptions and develop plan of care for patients in need of these services. This will ultimately reduce the costs of health care and improve health care quality while additionally reducing the numbers of patients admitted to the hospital. It is reported that the Institute of Medicine's Future of Nursing report recommends that APRNs be able to "practice to the full extent of their education and training and recommends that states reform their scope of practice regulations to conform "to the National Council of State Boards of Nursing Model Nursing Practice Act and Model Nursing Administrative Rules." (American Nurses Association, nd, p. 2) It is reported that other policy groups have additionally "called for the removal of legislative and regulatory barriers that impeded APRN practice." (American Nurses Association, nd, p. 2) It is reported additionally that the "new federal health care reform law- the Patient Protection and Affordable Care Act= provides funding for an array of APRN services including nurse-managed health centers, as well as grants for graduate education in nurse-midwifery and geriatric nursing." (American Nurses Association, nd, p. 6) Additionally within the area of Medicare it is reported that the law would additionally "establish a demonstration program to reimburse eligible hospitals for their graduate education costs in training APRNs to provide primary and preventive care, transitional care, chronic care and other services for Medicare Patients." (American Nurses Association, nd, p. 6)