Ethics and the Affordable Healthcare Act
Intro
Healthcare reform has been an increasingly popular topic of conversation since the passing of the Patient Protection Affordable Care Act (PPACA) in 2010 by President Barack Obama. Though this nine-hundred and four page document contains several intricate and complicated issues related to healthcare, the majority of these are not well understood and have caused much distress to the American population. Nine components make up the sections of the PPACA in an attempt to divide the topics of reform and simplify the changes that are hand: Quality, affordable health care for all Americans, the role of public programs, Improving the quality and efficiency of health care, prevention of chronic disease and improving public health, health care workforce, transparency and program integrity, improving access to innovative medical therapies, community living assistance services and supports and revenue provisions (Democratic Policy & Communication Centers, 2012). Each topic discusses the changes that will be made once the reform has completely taken effect and is predicted to provide healthcare coverage for ninety four percent of Americans for under a $900 billion limit. Elders and the baby boomer generation feel that their care and quality of life will be compromised once this reform act becomes a reality. By reviewing the PPACA and its implications for older Americans, rationing of care and costs in a universal healthcare environment can be better understood.
Summary and Synthesis of case including ethical issues
The PPACA is an extensive document that contains information that the majority of Americans do not have the time, or the ability to understand. When it comes to being informed related to these issues, as a whole, the American population relies on the media. In relation to the PPACA, much of the media attention has been directed toward the implications of healthcare reform on elders and the baby boomer generation. When discussing the proposed rationing of care for those in this age group, several questions and concerns arise. For instance, the major concerns are that elders will not receive the care that they may need or deserve because of the allocation of funds and that for these individuals to receive care, they will have to rely on healthcare providers who may or may not receive reimbursement for the services that are provided (Gitterman & Scott 2011).
The ethical issues related to this scenario are numerous. As the baby boom generation is becoming increasingly more educated in regards to the PPACA and what it means for their health, many of them feel as though they are no longer important and will be left to die. As a nurse practitioner there are several implications related to this case that must be taken into account. Because of the rising cost of healthcare and predicted physician shortage, much of the primary care setting will be left in the hands of nurse practitioners (Cleary& Wilmoth 2011). With the proposed budget, and “bending” of the health care cost curve, where will this leave reimbursement rates? Another possible set back related to this reform and the elderly is that it is primarily based on the prevention of chronic disease processes (Democratic Policy & Communication Centers, 2012). As the focus of spending turns to education and methods of preventing these diseases, primarily diabetes and heart disease, funds will be drifted away from the actual treatment of those who did not have prevention and have already developed the disease process. As healthcare professionals, we find ourselves ethically and morally responsible for treating those who have developed these health conditions, whereas government reform focuses on symptom reduction and not necessarily finding a solution for the problem at hand (Democratic Policy & Communication Centers, 2012). With the board of financial advisors for President Obama and the PPACA being known as “The Death Panel,” it is easy to see why the baby boom generation is worried about the future of their healthcare. As nurse practitioners, we will be in a position to help with this adjustment and to ensure that they receive the best care possible.
Summary and Synthesis of the implications from a leadership perspective
The nurse leader will play a significant role in the changes that have recently occurred and will continue in the years to come related to health care reform. Nurse leaders on the micro and macro levels encounter issues closely related to both patient satisfaction and reimbursement, both of which are focuses of this reform. In an effort to increase the quality of care that is delivered to patients, the PPACA is implementing “pay for performance,” which means that the amount of reimbursement for the designated facility will be based upon the perceived quality of services received by the patient (Democratic Policy & Communication Centers, 2012). This is a concept that is not unheard of among other professions, but it the world of healthcare is almost foreign. Due to the new reality of pay for performance, a push has been made to increase the quality of treatment measures for specific diagnosis that are most commonly seen in the hospital, such as stroke, heart attack, and pneumonia (Kruse, Polsky, Stuart, & Werner 2012). The thought is that by focusing on these and creating a specific set of measures to guide healthcare providers, patients will receive a higher quality of care at a lower cost and will be less likely to be readmitted to the hospital for the same issue.
The role that nurse leaders must take in this change is insuring that staff is adequately educated related to the new information and expectations of them. The transformational leader, who is particularly aware of staff moral and involved in establishing a trusting relationship would more than likely be very successful in this situation (Kelloway, Turner, Barling & Loughlin, 2012). A leader who practices this theory would be a strong example to coworkers and colleges during what could be a very stressful time. Nurse managers around the country have been sharing results of hospital surveys with their employees in order to determine where the unit succeeds and where more help is required to reach the government set marks. There is a certain “mark” for which the hospital is required to meet and maintain patient satisfaction scores in order to receive a predetermined reimbursement percentage (Democratic Policy & Communication Centers, 2012). As a transformational leader it is important to anticipate changes and adapt to them quickly, making it even more appropriate for this scenario (Kelloway, Turner, Barling & Loughlin, 2012).
Secondly, a major focus of the PPACA is that hospital readmission rates be decreased. When patients are readmitted to the hospital within thirty days of discharge for a problem related to the original admission diagnosis the hospital will not receive full, if any reimbursement (Democratic Policy & Communication Centers, 2012). Leadership is this aspect is related to ensuring that staff receives adequate education of the importance of teaching patients the proper way to take medications and to preform tasks related to the diagnosis. Education has always been an important portion of nursing, but now it is going to be an even greater part of providing adequate care. Finally, the Centers for Medicare and Medicaid (CMS) have established a list of specific diagnoses that are related to increased length of hospital stay, which will influence hospital reimbursement. These diagnoses, which are closely related to nursing care, are nosocomial infections and pressure ulcers (Kavanagh, Cimiotti, Abusalem & Coty, 2012). These are two situations where nurses can have a major impact on patient outcomes. Nurse leaders are yet again responsible for providing adequate education to staff nurses on prevention measures and ensuring that nurses abide by these measures. Overall these changes are all related to ensuring that the patient receives the safest and best quality of care possible. Times of change are difficult on all parties involved; but with strong leadership the new implementation related to healthcare reform have a positive impact on nursing- from senior leadership to the staff nurse.
*** Written in conjunction with A. Ladner, Auburn University MSN student
References
Archer, P. M. (2012). Healthcare Reform Act's Impact on Older Americans. Chart, 110(4), 9-13.
Cleary, B., & Wilmoth, P. (2011). The Affordable Care Act -- what it means for the future of nursing. Tar Heel Nurse, 73(2), 8.
Democratic Policy & Communication Centers. (2012). Responsible Reform for the middle class. Retrieved from www.dpc.senate.gov/healthreformbill/healthbill04.pdf
Gitterman, D. P., & Scott, J. C. (2011). "Obama Lies, Grandma Dies": The Uncertain Politics of Medicare and the Patient Protection and Affordable Care Act. Journal Of Health Politics, Policy & Law, 36(3), 555-563. doi:10.1215/03616878-1271252
Kavanagh, K. T., Cimiotti, J. P., Abusalem, S., & Coty, M. (2012). Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing. Journal Of Nursing Scholarship, 44(4), 385-395. doi:10.1111/j.1547-5069.2012.01469.x
Kelloway, E., Turner, N., Barling, J., & Loughlin, C. (2012). Transformational leadership and employee psychological well-being: The mediating role of employee trust in leadership. Work & Stress, 26(1), 39-55. doi:10.1080/02678373.2012.660774
Kruse, G., Polsky, D., Stuart, E., & Werner, R. (2012). The Impact of Hospital Pay-for-Performance on Hospital and Medicare Costs. Health Services Research, 47(6), 2118-2136. doi:10.1111/1475-6773.12003
Intro
Healthcare reform has been an increasingly popular topic of conversation since the passing of the Patient Protection Affordable Care Act (PPACA) in 2010 by President Barack Obama. Though this nine-hundred and four page document contains several intricate and complicated issues related to healthcare, the majority of these are not well understood and have caused much distress to the American population. Nine components make up the sections of the PPACA in an attempt to divide the topics of reform and simplify the changes that are hand: Quality, affordable health care for all Americans, the role of public programs, Improving the quality and efficiency of health care, prevention of chronic disease and improving public health, health care workforce, transparency and program integrity, improving access to innovative medical therapies, community living assistance services and supports and revenue provisions (Democratic Policy & Communication Centers, 2012). Each topic discusses the changes that will be made once the reform has completely taken effect and is predicted to provide healthcare coverage for ninety four percent of Americans for under a $900 billion limit. Elders and the baby boomer generation feel that their care and quality of life will be compromised once this reform act becomes a reality. By reviewing the PPACA and its implications for older Americans, rationing of care and costs in a universal healthcare environment can be better understood.
Summary and Synthesis of case including ethical issues
The PPACA is an extensive document that contains information that the majority of Americans do not have the time, or the ability to understand. When it comes to being informed related to these issues, as a whole, the American population relies on the media. In relation to the PPACA, much of the media attention has been directed toward the implications of healthcare reform on elders and the baby boomer generation. When discussing the proposed rationing of care for those in this age group, several questions and concerns arise. For instance, the major concerns are that elders will not receive the care that they may need or deserve because of the allocation of funds and that for these individuals to receive care, they will have to rely on healthcare providers who may or may not receive reimbursement for the services that are provided (Gitterman & Scott 2011).
The ethical issues related to this scenario are numerous. As the baby boom generation is becoming increasingly more educated in regards to the PPACA and what it means for their health, many of them feel as though they are no longer important and will be left to die. As a nurse practitioner there are several implications related to this case that must be taken into account. Because of the rising cost of healthcare and predicted physician shortage, much of the primary care setting will be left in the hands of nurse practitioners (Cleary& Wilmoth 2011). With the proposed budget, and “bending” of the health care cost curve, where will this leave reimbursement rates? Another possible set back related to this reform and the elderly is that it is primarily based on the prevention of chronic disease processes (Democratic Policy & Communication Centers, 2012). As the focus of spending turns to education and methods of preventing these diseases, primarily diabetes and heart disease, funds will be drifted away from the actual treatment of those who did not have prevention and have already developed the disease process. As healthcare professionals, we find ourselves ethically and morally responsible for treating those who have developed these health conditions, whereas government reform focuses on symptom reduction and not necessarily finding a solution for the problem at hand (Democratic Policy & Communication Centers, 2012). With the board of financial advisors for President Obama and the PPACA being known as “The Death Panel,” it is easy to see why the baby boom generation is worried about the future of their healthcare. As nurse practitioners, we will be in a position to help with this adjustment and to ensure that they receive the best care possible.
Summary and Synthesis of the implications from a leadership perspective
The nurse leader will play a significant role in the changes that have recently occurred and will continue in the years to come related to health care reform. Nurse leaders on the micro and macro levels encounter issues closely related to both patient satisfaction and reimbursement, both of which are focuses of this reform. In an effort to increase the quality of care that is delivered to patients, the PPACA is implementing “pay for performance,” which means that the amount of reimbursement for the designated facility will be based upon the perceived quality of services received by the patient (Democratic Policy & Communication Centers, 2012). This is a concept that is not unheard of among other professions, but it the world of healthcare is almost foreign. Due to the new reality of pay for performance, a push has been made to increase the quality of treatment measures for specific diagnosis that are most commonly seen in the hospital, such as stroke, heart attack, and pneumonia (Kruse, Polsky, Stuart, & Werner 2012). The thought is that by focusing on these and creating a specific set of measures to guide healthcare providers, patients will receive a higher quality of care at a lower cost and will be less likely to be readmitted to the hospital for the same issue.
The role that nurse leaders must take in this change is insuring that staff is adequately educated related to the new information and expectations of them. The transformational leader, who is particularly aware of staff moral and involved in establishing a trusting relationship would more than likely be very successful in this situation (Kelloway, Turner, Barling & Loughlin, 2012). A leader who practices this theory would be a strong example to coworkers and colleges during what could be a very stressful time. Nurse managers around the country have been sharing results of hospital surveys with their employees in order to determine where the unit succeeds and where more help is required to reach the government set marks. There is a certain “mark” for which the hospital is required to meet and maintain patient satisfaction scores in order to receive a predetermined reimbursement percentage (Democratic Policy & Communication Centers, 2012). As a transformational leader it is important to anticipate changes and adapt to them quickly, making it even more appropriate for this scenario (Kelloway, Turner, Barling & Loughlin, 2012).
Secondly, a major focus of the PPACA is that hospital readmission rates be decreased. When patients are readmitted to the hospital within thirty days of discharge for a problem related to the original admission diagnosis the hospital will not receive full, if any reimbursement (Democratic Policy & Communication Centers, 2012). Leadership is this aspect is related to ensuring that staff receives adequate education of the importance of teaching patients the proper way to take medications and to preform tasks related to the diagnosis. Education has always been an important portion of nursing, but now it is going to be an even greater part of providing adequate care. Finally, the Centers for Medicare and Medicaid (CMS) have established a list of specific diagnoses that are related to increased length of hospital stay, which will influence hospital reimbursement. These diagnoses, which are closely related to nursing care, are nosocomial infections and pressure ulcers (Kavanagh, Cimiotti, Abusalem & Coty, 2012). These are two situations where nurses can have a major impact on patient outcomes. Nurse leaders are yet again responsible for providing adequate education to staff nurses on prevention measures and ensuring that nurses abide by these measures. Overall these changes are all related to ensuring that the patient receives the safest and best quality of care possible. Times of change are difficult on all parties involved; but with strong leadership the new implementation related to healthcare reform have a positive impact on nursing- from senior leadership to the staff nurse.
*** Written in conjunction with A. Ladner, Auburn University MSN student
References
Archer, P. M. (2012). Healthcare Reform Act's Impact on Older Americans. Chart, 110(4), 9-13.
Cleary, B., & Wilmoth, P. (2011). The Affordable Care Act -- what it means for the future of nursing. Tar Heel Nurse, 73(2), 8.
Democratic Policy & Communication Centers. (2012). Responsible Reform for the middle class. Retrieved from www.dpc.senate.gov/healthreformbill/healthbill04.pdf
Gitterman, D. P., & Scott, J. C. (2011). "Obama Lies, Grandma Dies": The Uncertain Politics of Medicare and the Patient Protection and Affordable Care Act. Journal Of Health Politics, Policy & Law, 36(3), 555-563. doi:10.1215/03616878-1271252
Kavanagh, K. T., Cimiotti, J. P., Abusalem, S., & Coty, M. (2012). Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing. Journal Of Nursing Scholarship, 44(4), 385-395. doi:10.1111/j.1547-5069.2012.01469.x
Kelloway, E., Turner, N., Barling, J., & Loughlin, C. (2012). Transformational leadership and employee psychological well-being: The mediating role of employee trust in leadership. Work & Stress, 26(1), 39-55. doi:10.1080/02678373.2012.660774
Kruse, G., Polsky, D., Stuart, E., & Werner, R. (2012). The Impact of Hospital Pay-for-Performance on Hospital and Medicare Costs. Health Services Research, 47(6), 2118-2136. doi:10.1111/1475-6773.12003