The Economic Context of Nursing in the United States
The United States is now utilizing a health economics approach that lays much emphasis on value and equity. According to Garrison et al. (2018), the application of the cost-effectiveness threshold in conducting cost-effectiveness analysis can help the United States to maximize value by ensuring that patients have an increased health gain and positive health outcomes with just a small budget. Most of the recommendations aimed at maximizing value focus on improving payment and reimbursement decisions (Garrison et al., 2018). The purpose of this assignment is to discuss how changes in Medicare rules in relation to offering full payment to nurse practitioners for providing preventive services in an outpatient setting might affect the quality of care, access, and cost. The discussion will also include a description of ways in which the Doctor of Nursing Practice (DNP) provides leadership in helping a health care entity optimize reimbursement from insurers.
Full Payment to Nurse Practitioners
Offering full payment to nurse practitioners under the Affordable Care Act (ACA) for providing preventing services in an outpatient setting will improve healthcare quality, increase access to care, lower healthcare costs for ACA beneficiaries, and increase the financial burden for the United States government. Poor health care quality, limited access to care, and high healthcare costs are some of the major forces that are driving reforms in the healthcare industry, particularly in the nursing profession (Salmond & Echevarria, 2017). Access to preventive services will increase when nurses receive full payment under the ACA as opposed to 85% of physician payments under the Medicare rules. In this respect, demand for preventive healthcare services is expected to increase as many people strive to seek these services (Waxman, 2018). Besides, the changes will have a positive effect on the quality of healthcare received by patients and populations. As Lathrop and Hodnicki (2017) explain, nurse practitioners have the capacity to utilize evidence-based practice and demonstrate clinical practice expertise to improve clinical outcomes. Their motivation to perform in these areas is greatly enhanced by better payments. Notably, while offering full payment to nurse practitioners will reduce the cost of care for ACA beneficiaries, it will increase costs for the United States government because the changes require adequate funding to successfully be implemented (Lathrop & Hodnicki, 2017; Waxman, 2018).
How DNPs Optimize Reimbursement for Insurers
Doctorally-prepared nurses can assume leadership positions to help healthcare organizations to optimize reimbursement from insurers. Salmond and Echevarria (2017) describe how nurses’ roles have changed from caring to leading reforms that are aimed at addressing healthcare fragmentation, quality, access, cost, and disparity issues. For instance, in their leadership roles, DNP nurses possess the knowledge and skills to design training for leaders of a healthcare entity to offer advice on how to optimize reimbursement. Additionally, they can advocate for the implementation of new policies, using an interdisciplinary collaboration approach, aimed at optimizing reimbursements (Waxman, 2018). When doctorally-prepared nurses are influencing reimbursement-related decisions in their leadership roles, they should always remember how their actions affect healthcare costs, quality, and access.
Conclusion
Doctorally-prepared nurses should possess economics knowledge and leadership competencies which they can apply to influence meaningful reforms in the healthcare industry. Part of this knowledge includes an adequate understanding of the positive impacts that offering full payment to nurse practitioners will have on healthcare quality, access, and cost. DNP nurses should be able to utilize their leadership competencies to help their healthcare organizations to optimize reimbursement from insurers.
References
Garrison, L. P. Jr, Neumann, P. J., Willke, R. J., Basu, A., Danzon, P. M., Doshi, J. A., Drummond, M. F., Lakdawalla, D. N., Pauly, M. V., Phelps, C. E., Ramsey, S. D., Towse, A., & Weinstein, M. C. (2018). A health economics approach to US value assessment frameworks-summary and recommendations of the ISPOR Special Task Force Report. Value Health, 21(2):161-165. doi: 10.1016/j.jval.2017.12.009. PMID: 29477394.
Lathrop, B., & Hodnicki, D. (2017). The Affordable Care Act: Primary care and the Doctor of Nursing Practice nurse. OJIN: The Online Journal of Issues in Nursing, 19(2). doi:10.3912/OJIN.Vol198No02PPT02. https://doi.org/10.3912/OJIN.Vol198No02PPT02.
Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12–25. https://doi.org/10.1097/NOR.0000000000000308
Waxman, K. T. (2018). Financial and business management for the Doctor of Nursing practice. 2nd ed. Springer Publishing Company.