NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination

Ethical and Policy Factors in Care Coordination

I will be presenting on the ethical and policy issues in care coordination. In specific, I will be discussing the ethical and policy factors in care coordination as they apply to nursing homes. I have structured my presentation so that it covers four major areas. First, I will briefly define the term care coordination. Then, I will show how government policies affect care coordination. Thereafter, I will identify some of the national, state, and local policy provisions that raise ethical dilemmas and questions for care coordination. Lastly, I will conduct a review of the impact of the code of ethics for nurses on coordination and continuum care. 

NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination

What is care coordination? 

To start with, the Institute of Medicine take care coordination to mean the degree to which patient care services are coordinated across sites, people, activities, and functions progressively to maximize the value of healthcare services provided to patients (Okado et al., 2021).  It entails the deliberate organization of patient care activities and sharing medical information among the interested parties to attain more effective and safer care. What this means is that the needs and preferences of the patient are known in advance and communicated to the right people at the right time and that this information is critical in providing effective, safe, and appropriate patient care. Care coordination is beneficial to nursing homes as it can reduce hospital admissions, improve patient satisfaction, and improve the quality of chronic disease management. In their MU study, Popejoy et al (2021)  uncovered that a care coordination program meant to promote effective and safe hospital discharges is good at reducing readmissions to nursing homes leading to higher quality care and better patient outcomes. 

How Government Policies Affect Care Coordination

In the US, different federal policies have a far-reaching effect on the healthcare system and the overall coordination of patient care. Some of the policies and programs that influence care coordination include HIPPA, Medicaid, and Medicare. Through its numerous, the US’s federal and local government is directly responsible for ensuring that the funds that it set-asides annually to the healthcare system via different medical programs are used well (Bower, 2016). The government ensures that all healthcare programs and policies implemented are used wisely to reduce the burden of disabilities, ailments, and injuries. Medicare is a notable government policy that influences care coordination. In the US, this program provides health insurance services to about a million citizens with this number expected to rise (Andes et al., 2019). This program care coordination in the sense that it works to improve access to care for the covered population. It has been shown that beneficiaries of Medicare are mainly those burdened by chronic conditions which lower their functionality. This program has significantly reduced the associated cost of patient care by eliminating unnecessary tests and procedures. 

Elsewhere, Medicaid serves more than 42 million Americans. The majority of these people are from poor backgrounds and depend heavily on medical care services to meet their healthcare needs and remain healthy. Medicaid is financed and administered by both the federal and state government. This program primarily depends on community health centers, private providers of medical care, and different managed care plans to allow for effective care coordination. Through this policy, the US government ensures that the care delivered by different providers is not offered in silos. Because of this, challenges that adversely affect the care coordination, like the cost of medical care, is substantially reduced. Patients’ private data is protected under the Health Insurance and Accountability Act (HIPAA). The main aim of federal guidelines is to enable the promotion of electronic data exchange within the healthcare setting. The main concern for the government is to ensure confidentiality of patient data to safeguard the patient against data violations accessed within the area of professional data. Via HIPAA, a healthcare professional is allowed to share important information about the patient with anyone who can help lessen or prevent the threatened harm in the event a patient poses a serious and imminent threat to his own or someone else’s health or safety (Qin, 2019). As a result, HIPAA has resulted in improved patient safety since healthcare professionals can easily access patient data.  This enhances patient-provider response. This also applies to nursing homes where patients’ wellness and well-being majorly depends on the availability of data that eventually helps in decision implementation processes. 

NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination

National, State, and Local Policy Provisions that Raise Ethical Questions or Dilemmas for Care Coordination

Many healthcare providers and care coordinators in the US find the act of balancing access to quality care and cost an unethical dilemma that requires engagement. The reformation of American healthcare system has undoubtedly led to a myriad of ethical questions. For instance, the Patient Protection and Affordable Care Act (PPACA) has brought several ethical issues to the forefront in care coordination. The goal of PPACA was to secure medical care for all Americans irrespective of socioeconomic status, age, medical history, gender, or race (Kerkhoff & Hanson, 2019). The provisions of this Act were to take effect by 2020. The provisions fall into two groups: improving access to medical care by mandating insurance coverage, and enhancing the efficiency and quality of healthcare delivery. Despite these benefits, the Act raises several ethical questions and issues. The big question is who will be covered? A major concern was that PPACA will offer free care to undocumented immigrants which are contrary to the true purpose of the law. It was expected that by 2014, Obamacare will improve coverage for about 30 million of the 47 million people who were uninsured by then, none of whom were residents without legal documents. The law neither is eligible for insurance through state exchanges nor provides free care for non-US citizens (Kerkhoff & Hanson, 2019). 

There is also an issue with the role of the government. The Act requires that the majority of legal residents and citizens have health insurance but this insurance can come from state-based insurance exchanges, Medicare, private companies, and employers. Through the insurance exchanges, people who pay more than 8% of their household incomes for health insurance would get subsidized premiums (Kerkhoff & Hanson, 2019). PPACA does not invite the government to intervene in the healthcare system but rather tries to improve both efficiency and access via mandates to be performed by private medical providers, states, and insurers. Lastly, will this law hurt small businesses?  With the efficiency of group insurance policies offered by American employers, an ethical issue for managers is whether such policies provide the best care for many employees and so should be management’s responsibility to provide it whenever possible. The present law requires all firms with 50+ employees to avail insurance to qualified employees.  The question is, is it right to leave the employees of small businesses to their own devices in securing medical care?  Even when the law does not provide for this, we know that small enterprises are morally obliged to do everything within their powers to cover for their workforce. 

The Impact of the Code of Ethics for Nurses on the Coordination and Continuum of Care 

A code of ethics is important in nursing homes because it sets out rules for behavior and forms the basis for preemptive warning. The American Nurses Association (ANA) list nine provisions of the nursing code of ethics to show which behavior is unacceptable in the healthcare setting and support the need for adequate care coordination. This is made possible through provisions 2, 4, and 8. Provision 2 requires nurses to be committed to the patient (ANA, 2021). Nurses should be there for their clients and help them by directing or providing them with the support and resources they need. They should consider patients’ need to incorporate their individual thought into care practices. The fourth provision states that the nurse has the responsibility, authority, and accountability for nursing practice and makes a decision to offer optimal patient care (ANA, 2021). Nursing care decisions should be planned, well-thought, and implemented responsibly. Provision eight stresses the need for the nurse to collaborate with other healthcare professionals and the general public to reduce health disparities and protect human rights (ANA, 2021). Via teamwork, the nurse will uphold the idea that health is a right for all people and this opens the channel of best practice. The code, therefore, shows that enhancing care coordination is an important section of ethical nursing practice. 

NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination

Conclusion

Many government policies influence care coordination not only for individuals but also the community programs like nursing homes. Local, state, and national policy programs like HIPAA, Medicaid and Medicaid substantially affect care coordination in healthcare settings. ANA’s codes of ethics which govern nurse-patient interaction also affect coordination and continuum of care. All these factors if not well addressed may deteriorate care coordination in nursing homes. 

References

American Nurses Association. (2021). Code of ethics with interpretative statements. Silver Spring, MD: American Nurses Association; 2015.

Andes, L. J., Li, Y., Srinivasan, M., Benoit, S. R., Gregg, E., & Rolka, D. B. (2019). Diabetes prevalence and incidence among Medicare beneficiaries—the United States, 2001–2015. Morbidity and Mortality Weekly Report, 68(43), 961.

Bower, K. A. (2016). Nursing leadership and care coordination: creating excellence in coordinating care across the continuum. Nursing administration quarterly, 40(2), 98-102.

Kerkhoff, T. R., & Hanson, S. L. (2019). Applied ethics.

Okado, I., Pagano, I., Su’esu’e, A., Cassel, K., Rhee, J., Berenberg, J. L., & Holcombe, R. F. (2021). Mixed-methods research to assess care coordination experiences among NCORP clinical trial participants.

Popejoy, L. L., Vogelsmeier, A. A., Wang, Y., Wakefield, B. J., Galambos, C. M., & Mehr, D. R. (2021). Testing Re-Engineered Discharge Program Implementation Strategies in SNFs. Clinical Nursing Research, 30(5), 644-653.