NUR 514 Topic 1 Discussion Question 1

Discuss the shift to value-based health care and its impact on the roles and

responsibilities of advanced registered nurses. What major evolving trends in the health

care policy and delivery systems will affect your practice in the next 3-5 years, and how

do you think advanced registered nurses leaders will continue to influence the direction

of health care?

Today’s healthcare is in a state of complex constant change. With the passing of the Affordable Care Act

in 2010, changes in healthcare have occurred that directly impact a patient’s ability to receive

healthcare and preventative care. New healthcare delivery models have emerged in the hopes of

providing quality care at the greatest value to the patient (McNiff, 2018).

Economic changes are necessary for health care in the United States to be sustainable while providing

quality patient care. With health care costs skyrocketing, methods were developed by the Centers for

Medicare and Medicaid Services (CMS) to help reign in these costs. Pay for performance was developed

to reward healthcare organizations and providers that are able to provide quality care and improve

patient outcomes. Through data collection of quality measures established in collaboration with the

Agency for Healthcare Research and Quality (AHRQ), providers and organizations are rewarded for

improving patient care and lowering costs, and holding organizations and providers who do not

accountable for these shortcomings (McNiff, 2018). This value based system is based on patient

satisfaction and proven best practices. Quality metrics are reported to the public through the Hospital

Consumer Assessment of Health Plan Survey (HCAHPS), care quality and delivery, and quality measures

related to falls, infections, morbidity, and mortality, in the inpatient setting, and the Healthcare

Effectiveness Data and Information Set (HEDIS), for outpatient settings. All nurses, including Advanced

Practice Registered Nurses (APRN’s) and administrators have a direct impact on quality initiatives and

patient outcomes (McNiff, 2018). With this, advanced registered nurses must be aware of current

concepts on quality including selection of quality measures, data collection, data measurement and data

reporting, and evaluation. Nurses will need to understand and promote their role and the impact they

have on high quality patient care through advocating for the necessary resources, fostering a culture of

safety, participation in decision-making regarding best practices, and leading and implementing quality

initiatives.

The nursing profession is in a key position to transition health care reform and patient care models. The

advent of these new care models that focus on preventive measures and health promotion across the

continuum has brought about the emergence of new roles for nurses (Salmond & Echevarria, 2017).

These new positions include: care coordinator, patient navigator, health coaches, virtual care nurses,

bundled care coordinators, and nurse-managed care centers. All of these roles are necessary as patient

care becomes more complex and extends beyond the acute care hospital. Nurse managed health

centers are run by nurse practitioners, nurse midwives, and public health nurses. Within these centers,

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