Jasmine Matos
Florida National University
Nursing Leadership and Management
Professor: Carmen Lazo
09/25/2024
Case Scenario
It is interesting to note the limited awareness that bedside nurses may have of details related to patients’ payment sources such as Medicare, Medicaid, ACO (Accountable Care Organizations) in the cases of either RT or FS. Of course, it remains beneficial for dully trained a minimum of knowledge regarding the impact of such models in relation to patient care, resource allocation, and subsequent treatment. While most of the focus lies with nurses moving about in the clinical setting and ensuring actualization of positive patient outcomes, they may sometimes liaise with case managers or social workers who ensure that RT and FS receive equal care regardless of the differences in payment approaches.
Understanding the differences between payment methods such as FFS (Fee-For-Service) and ACO may help the nurses to control the patient’s expectations and provide the proper education. For instance, FS may get better organized and coordinated care if it is put under an ACO explaining why the diagram shows less organized help under FFS for RT (Pittman et al., 2021). This consciousness makes the nurses to personalized care but it also brings out the aspect of managing illnesses such as COPD and smoking cessation for the patients.
Whether nurses are paid for it or not, their priorities should include disease prevention, patient education, and chronic illness. RT and FS reported that both staff and patient need to be educated about Addressing Social Determinants of Health (COPD), the dangers of smoking and the correct use for medication such as inhaled steroids. Whereas FS may in a position to gain more from the ACO in terms of resource leverage there is also an element of opportunity for RT to manage more effective self-management nursing initiated self-management and optimal utilization of the resources available.
Variations between payor models RT and FS could put home support at variance if RT and FS were on the same unit of nursing. Nurses should also make sure that both the patients they have undergone surgery get enough follow up and home care services just as the other (Fan, 2020). Patient centered care is therefore done with the noble aim of halting disease progression and improving the quality of life of the concerned patient regardless of cost implication.
The concept of SDOH remains crucial because they play a decisive role in patients’ health state with reference to such conditions as social and economic status, healthcare access, literacy, and housing. Community health nursing also plays a special role in addressing these determinants through advocacy, policy making and promotion of activities in the community. Health equity should be a goal for health facilities and for nurses as professionals who can fight for resources and programs that can promote better health of the population. Realizing these possibilities, the nurses can develop significant macro level change in the organizations and settings of health care delivery.
References
Fan, L. R. (2020). Care Coordination in Interhospital Transfer: Different Transfer Types, Coordination Mechanisms, and Destination Choice Strategies.
Pittman, P., Rambur, B., Birch, S., Chan, G. K., Cooke, C., Cummins, M., … & Trautman, D. (2021). Value-based payment: What does it mean for nurses?. Nursing administration quarterly, 45(3), 179-186.
