Leadership for Advanced Nursing Practice|Essay helper

Posted: February 12th, 2023

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DNP-840A Leadership for Advanced Nursing Practice

QUESTION: With attention to Figure 7-1, “Basic Components of a Healthcare Delivery Service,” in Advanced Practice Nursing: Essential Knowledge for the Profession, consider the following discussion question. There are four basic functional components of a health care delivery system. Discuss two components which will impact the implementation of your project site.

Misty Walton

The figure 7.1, “Basic Components of a Healthcare Delivery Service,” outlines the four base functional components of the healthcare delivery system within the United States, including, financing, insurance, delivery, and payment (DeNisco, 2021). This system is often referred to as the quad and is misleading in the terminology of being called a system versus a service (DeNisco, 2021). My project site is within an acute care facility on a forty eight bed medical surgical unit in an urban area.

The two components that will impact the implementation of listening to music to reduce post operative pain at this site will be financing and delivery. Under the financing component falls employers, government including Medicare and Medicaid along with individual self-funding (DeNisco, 2021). It is important to have buy-in from the stakeholders and the ability to supply the tools needed to complete the DPI project. The other component of delivery includes the providers and the hospital (DeNisco, 2021). It will be necessary to have full support and buy in from the orthopedic physicians and the healthcare team on the unit site. The hospital bills based on services provided. The acute care setting will have to supply the headphones, education time and music listening tools if the patient is unable to provide their own. These items may be re-used between patients if infection prevention approved cleaning is appropriate between the patients, which will in return minimize the costs. The Magnet designated facility supports and encourages evidence-based practice and the environment to help drive buy-in from the stakeholders implementing a non-pharmacological method to reduce post operative pain. Magnet designated facilities outperform patient experience and quality measures which are directly tied to financial reimbursement (McCaughey et al., 2020). Since the Affordable Care Act passed, nursing care is more directly linked to healthcare delivery outcomes of quality and safety (Stimpel et al., 2019). The ability to apply evidence-based practices such as listening to music will improve patient pain scores and their experience and outcomes with a reduction in adverse outcomes from opiates. As I continue to develop my DPI project at the chosen site is critical to consider all four components of healthcare delivery systems in the United States.

References

DeNisco, S. (2021).  Advanced practice nursing: Essential knowledge for the profession. (4th ed.). Jones & Bartlett. ISBN-13: 9781284176124

McCaughey, D., McGhan, G. E., Rathert, C., Williams, J. H., & Hearld, K. R. (2020). Magnetic work environments: Patient experience outcomes in magnet versus non-magnet hospitals.  Health Care Management Review, 45(1), 21-31.

Stimpfel, A. W., Djukic, M., Brewer, C. S., & Kovner, C. T. (2019). Common predictors of nurse-reported quality of care and patient safety.  Health Care Management Review, 44(1), 57–66. Https//doi.org/10.1097/HMR.0000000000000155

Shabnampreet Kaur

The four basic components of the healthcare delivery system as illustrated in the model “Basic Components of a Healthcare Delivery System” are financing, insurance, delivery, and payment (DeNisco,2022). Financing includes government sources like Medicaid and Medicare, employer-based and individual self-funding. Insurance is a means to protect and safeguard people against various happenings. The insurance determines what type of services and how much service an individual gets based on the plan. Delivery of healthcare services means how the services are rendered by different providers including physicians, hospitals, nursing homes, diagnostic centers, therapists, community health centers, and suppliers of medical equipment.   Payment refers to how the providers are reimbursed for the services they provided.  The two components which will impact the implementation of the learner’s site are delivery and payment. The DNP project is fall prevention among older adults seen at primary care clinics by using tai chi as the intervention. In this project, healthcare delivery and payments play a vital role and are visible to all stakeholders. There are four major global healthcare models namely the Beveridge model, the Bismarck model, national health insurance, and the out-of-pocket model(Vera Whole Health, 2022). The Beveridge model is funded mostly by taxes and the government is the single-payer. The department of Veteran affairs is one such example using the Beveridge Model. In the Bismarck model, employees and employers together are responsible for funding their health insurance. This model does not provide universal health coverage. The employer-based plans in the country are using this model. The national health insurance model combines both the Bismarck and the Beveridge model elements. The private providers drive the model and the government provides sources. Medicare and Medicaid are examples of this model. In the out-of-pocket model, the people have to pay for their treatments. This is mooe prvealemt in dveeloping and udnerdeveleoped coutnries. The uninsured and underinsured people are included in this model. At the practice site, the client population is driven by all these four models except the Beveridge model since there are no VA department patient beings seen at the facility.  The facility has an influx of mostly populations similar to the national health insurance model and the out-of-pocket model. So, going into details of healthcare delivery is one of the most important aspects of the DPI project. While for some patients who are underinsured or uninsured, it will be difficult to include them in this program since doctor visits and the fall assessments, referrals, and tai chi enrollment will not be covered by the insurance in the long term and hence not suitable for sustainability. The majority of the people seen at the facility have Medicaid/Medicare, and the cost of fall assessment will be covered. As per CDC, the providers can safely add an ICD-10 diagnosis for fall risk assessment in order to obtain compensation (Centers for Disease Control and Prevention,2022).

Centers for Disease Control and Prevention. (2022, August) | STEADI – Older adult fall prevention | CDC injury center. https://www.cdc.gov/steadi/patient.html

DeNisco, S. M. (2023). Advanced Practice Nursing: Essential Knowledge for the Profession. (4th ed.). Jones & Bartlett. ISBN-13:9781284176124

Vera Whole Health. (2022, August). Global healthcare: 4 major national models and how they work.   verawholehealth. https://www.verawholehealth.com/blog/global-healthcare-4-major-national-models-and-how-they-work

Veronica Montemayor

The two functional components of a healthcare delivery system that may impact the implementation of my project site are delivery and payment. Hanson et al. (2022) noted that primary health care (PHC) is a critical component of all high-performing health systems, an essential foundation for universal health coverage (UHC). The delivery component is composed of providers that provide care to the patient in various settings, mine being a hospital. In a government-run system, the functions are more closely integrated and may be indistinguishable (DeNisco, 2021, p. 182). My project will focus on reducing 30-day readmissions using the AHRQ discharge phone call toolkit. A registered nurse (RN) will do the discharge call after the patient has been discharged home from the medical-surgical unit. They will also be able to ensure to answer any questions the patients may have regarding their discharge instructions and medication administration. The hospital will pay the RN as they will be on the clock; I do not believe the hospital will be able to bill for such services.

The payment function deals with reimbursement to providers for services delivered (DeNisco, 2021, p. 183). This is the same concept as the delivery component, as the RN who will be performing the discharge calls may not bill for this service. The reasons listed above would impact my project if we were not able to do this service if we had to bill for it. Tseng et al. (2018) noted that billing costs are disproportionately high in the United States; for instance, in primary care practice, performing these activities in the United States costs nearly four times more than performing the corresponding activities in Canada. Our current healthcare system may affect patients differently depending on their comorbidities along with medication costs. This may have an impact on the delivery of care provided to the patients. However, I am interested in further researching the possibility of organizations being able to bill for the service provided by my proposed project. As a future DNP-prepared nurse, I look forward to proposing new implementations to current practice at the bedside and on the financial side that may benefit the patient and the organization.

References

DeNisco, S. (2021).  Advanced practice nursing: Essential knowledge for the profession. (4th ed.). Jones & Bartlett. ISBN-13: 9781284176124

Hanson, K., Brikci, N., Erlangga, D., Alebachew, A., De Allegri, M., Balabanova, D., … & Wurie, H. (2022). The Lancet Global Health Commission on financing primary health care: Putting people at the centre.  The Lancet Global Health,  10(5), e715-e772. https://doi-org.lopes.idm.oclc.org/10.1016/S2214-109X(22)00005-5

Tseng, P., Kaplan, R. S., Richman, B. D., Shah, M. A., & Schulman, K. A. (2018). Administrative costs associated with physician billing and insurance-related activities at an academic health care system.  Jama,  319(7), 691-697. doi:10.1001/jama.2017.19148

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