NURS FPX 4050 Assessment 2 Ethical and policy factors in care NR

NURS FPX 4050 Assessment 2 Ethical and policy factors in care NR

ETHICAL AND POLICY FACTORS IN CARE COORDINATION

What is “Care Coordination”?
“Continuum-based care involving all care team members aimed at achieving safer, relevant, and more effective care”

Today, my goal is to introduce you to a concept known as care coordination. Some of you may already be familiar with care coordination, while the idea may be new to others. The Agency for Healthcare Research and Quality (AHRQ, 2022) defines care coordination as “deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care.” In other words, care coordination ensures that every stakeholder involved in your wellbeing is appropriately updated with the correct information within the right time frame to provide you with safe, relevant, and effective care. By reducing the fragmentation in health care systems, proper care coordination can lead to improved health outcomes, superior patient experiences, and lower costs (Khullar, 2018).
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Today’s Topics:
Governmental policies related to community health and safety
Code of Ethics impact on care coordination
Ethical and Policy factors

While care coordination aims to improve the quality of care, it does not come without its challenges. Today, I would like to speak to you regarding some of the governmental policies regarding care coordination and the issues that stem from them. We will also review the role of the nurses’ code of ethics in care coordination and explore some ethical dilemmas that can be hindrances.
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Influence of Governmental Policies on Care Coordination
HIPAA
ACA
NHRA
Over the following few slides, we will dive into the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and the Nursing Home Reform Act (NHRA). These three governmental policies affect care coordination, and it is essential to understand how that affects you.
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HIPAA
Health Insurance Portability and Accountability Act
Enacted in 1996 under President Bill Clinton
Limits protected health information to those that “need to know”
Limits transmission of data within and and outside of health facilities
Allows for breach of confidentiality in specific situations
HIPAA was established to protect patient confidentiality within and beyond healthcare facilities (Edemekong, 2022). While this is a good thing in general, it creates specific implications and issues when implementing a solid care coordination plan. Each of you present today has protected health information (PHI) which HIPAA limits to a “need to know” (Edemekong, 2022) audience. This “need to know” rule limits information sharing between physicians, hospitals, insurance companies, pharmacies, and other medical agencies seeking your PHI access. Since 2013, your electronic medical records are also covered under HIPAA regulations, making them safer than ever before.

Considering the information and HIPAA goals listed above, HIPAA appears to go against the very concept of care coordination, which seeks to allow PHI sharing among your care team members. In limiting access to your PHI, HIPAA inadvertently creates a dilemma for the care team that needs access to your health information to provide you with safe, relevant, and effective care. HIPAA violations are a violation of federal laws that carry hefty fines. An unintended lapse in judgment can cost as low as $100, while repeated mistakes can have a maximum penalty of up to $1,500,000 annually (Edemekong, 2022). Considering this information and the potential minefield of violations that almost any medical professional can commit under HIPAA, care coordination can become a little tricky to navigate.
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ACA
Affordable Care Act
Signed into law by President Barack Obama in 2010
Seeks to achieve Universal Healthcare
Seeks to make healthcare more affordable
Seeks to increase healthcare quality and cut spending
The Affordable Care Act (ACA) was a new bill signed into law in 2010 by President Barack Obama. The bill’s primary goals were to achieve universal healthcare coverage and make healthcare more affordable while simultaneously increasing healthcare quality and reducing unnecessary spending (Isola, 2021). The issue that immediately sticks out in this bill is that it assumes what patient satisfaction means on a broad basis when it is a very individualized experience. What one person finds to be satisfactory, another may see as problematic. On the other hand, the idea of cost savings does not consider a person’s willingness to pay. For instance, a wealthier individual may prefer to pay more for care that they perceive as higher in quality.

NURS FPX 4050 Assessment 2 Ethical and policy factors in care NRTo tackle these complex issues, the ACA added specific programs which directly impact care coordination. Two of the most prominent ones are Community Based Care Transitions Program (CCTP) and Accountable Care Organizations (ACO). CCTP’s primary goal is to reduce admissions and readmissions by monitoring patient transitions from hospitals to other care facilities. On the other hand, ACO consists of providers and healthcare facilities that have banded together to provide affordable healthcare with good care coordination. The care coordination efforts of these groups have considerably reduced the number of hospital admissions and readmissions from nursing homes since their formation (Isola, 2021).
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NHRA
Nursing Home Reform Act
Introduced as part of Omnibus Budget Reconciliation Act of 1987
Included minimum set of care standards
Set quality of life expectations
First major overhaul to nursing home standards
This presentation would not be complete if I did not mention the Nursing Home Reform Act (NHRA) introduced in 1987 as part of the Omnibus Budget Reconciliation Act. This act was the first of its kind and sought to completely overhaul the nursing home system in the United States by setting minimum expectations and laws that protect senior citizens. The NHRA set a standard that all nursing homes must meet to receive Medicare/Medicaid benefits. As a result, staffing issues improved, nursing homes reduced the use of physical restraints, and mental health detection improved (Fashaw, 2020). The passing of this bill demonstrated what the positive implications of care coordination could achieve for the first time.
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Governmental Policies Raising Ethical Questions for Care Coordination
PHI ACCESS
STAFFING
LAWS AND RULES
As discussed earlier, one of the critical goals of care coordination is to improve information sharing among care team members. In its goal to protect PHI, HIPAA can be a stumbling block to care coordination due to the “need to know” (Edemekong, 2022) clause. The nursing home patient typically has more than one chronic disease that they are dealing with and a few providers or care team members. When considering this, all team members must have access to the PHI, which contains pertinent information such as new health developments, medication records, and patient history. Inadequate sharing of this information can lead to wrong interventions in emergencies which can be detrimental to the patient’s well-being. Physicians, caregivers, and facilities also fear the fines and penalties of the accidental HIPAA violations, further exacerbating the issue.

We have also recently seen a significant staffing shortage with the COVID 19 pandemic across the healthcare industry. This shortage adds to the issues nursing homes face as they struggle to comply with safe patient ratios and patient populations. An example of an ethical dilemma that arises from this scenario can be regarding how to deal with an elderly patient with dementia that is prone to falls. In an understaffed situation, this patient that requires a lot of attention may be best restrained for their safety. However, governmental laws regarding restraints (Fashaw, 2020) dictate when and how facilities can use them without considering a problem such as this one. In this scenario, the governmental laws and policies set in place to protect the patient can end up being the reason they get severely hurt.
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Nurses’ Code of Ethics Impact on Care Coordination
Justice: Nurses must be fair when they distribute care.
Beneficence: Doing good and the right thing for the patient.
Nonmaleficence: Doing no harm.
Autonomy: Allowing for patient self-determination.
Nurses are trained in what is known as the nurse’s code of ethics. These are a set of ethical principles that must govern nurses’ actions and thought processes at all times. These four main ethical principles are defined as follows by Varkey (2020):

Justice: Nurses must be fair when they distribute care.
Beneficence: Doing good and the right thing for the patient.
Nonmaleficence: Doing no harm.
Autonomy: Allowing for patient self-determination.

Regarding care coordination, nurses use these principles to ensure that the care continuum stays intact. By providing autonomy, nurses allow patients to have self-determination regarding their health and wellness based on their own beliefs. Justice ensures that the nurse treats all patients with equity and equality, while beneficence ensures good intent in care. All these culminate in nonmaleficence which provides no intentional harm is done.

NURS FPX 4050 Assessment 2 Ethical and policy factors in care NRWhen reviewing these ethical principles, it is easy to see a nurse’s dilemmas. For instance, sharing PHI with a provider could mean upholding the principle of beneficence. However, the nurse could be penalized for HIPAA violations in doing so. Another example would be maintaining the principle of justice during a nursing shortage. When the patient load is too high, it becomes almost impossible for a nurse to justly care for all their patients causing an ethical dilemma they must deal with internally.

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Summary
Pros/Cons
Nursing Implications
Take control of your care
In conclusion, I hope that this presentation has shown you the pros and cons of how governmental policies affect care coordination. I also hope that the ethical dilemmas faced by providers and nurses have been effectively presented. Nurses’ internal battles and struggles in keeping the nurses’ code of ethics and complying with governmental policies cannot be understated. My goal for you was to gain something from our time together and apply it to your healthcare outcomes. Thank you all so much for listening.

NURS FPX 4050 Assessment 2 Ethical and policy factors in care NR10

References:
Khullar, D. (2018, November 2). Can Better Care Coordination Lower Health Care Costs? JAMA Network Open. Retrieved March 10, 2022, from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2712173
AHRQ. (n.d.). Care coordination. Agency for Healthcare Research and Quality . Retrieved March 10, 2022, from https://www.ahrq.gov/ncepcr/care/coordination.html
Edemekong PF, Annamaraju P, Haydel MJ. Health Insurance Portability and Accountability Act. [Updated 2022 Feb 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500019/

Isola S, Reddivari AKR. Affordable Care Act. [Updated 2021 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549767/
Fashaw, S. A., Thomas, K. S., McCreedy, E., & Mor, V. (2020). Thirty-Year Trends in Nursing Home Composition and Quality Since the Passage of the Omnibus Reconciliation Act. Journal of the American Medical Directors Association, 21(2), 233–239. https://doi.org/10.1016/j.jamda.2019.07.004
Varkey, B. (2020, June 4). Principles of clinical ethics and their application to practice. Medical Principles and Practice. Retrieved March 10, 2022, from https://www.karger.com/Article/FullText/509119#:~:text=The%204%20main% 20ethical%20principles,each%20of%20them%20is%20discussed.

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