In 2012, the government initiated a plan for ACO “because no sole entity - providers, payers, or employers - takes full responsibility for managing patient care” and the cost of health care has been on the rise (Hart, 2012, p.23). First, the author wants to ensure that the nurses role of the nurse in the ACO model; especially the role of the nurse practitioner. The ANA wants to acknowledge the “role of nurses as primary care providers and care coordinators” the ACO model (Hart, 2012, p.24). In 2010, the ANA “urged the CMS” to add nurses to the ACO model because nurses are a “central role” in coordinating patient center quality care (Hart, 2012, p.24). In addition, the ACO model is supposed to include “interprofessional collaboration”; hence,
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That the “qualified health professionals…may act as leaders in quality assurance and process improvements initiatives” (Hart, 2012, p.24). Thirdly, the author points to the change from “fee-for-service model” to the ACO model (Hart, 2012, p.25). The provider has “incentives” to provide quality care and outcomes; hence, the “ACO can be rewarded for providing better care” and receive better reimbursement for the health network and/or facility (Hart, 2012, p.25). This helps to decrease the cost of health care by decreasing unnecessary test and treatments. According to the “ANA president” the “ACOs must be more than just a business structure for compensating members of the health care team”; rather, it should “achieve the larger goal of providing true patient-centered care” (Hart, 2012, p.25). The ACO model will help decrease the high cost of healthcare; because with the increasing cost nurses need to “consider how nursing practice adds value for patient” (Yoder-Wise, 2015, …show more content…
However, Medicare and Medicaid have some of the strictest regulations; so if the nurse knows the government insurance rules, then the other insurance companies are probably covered. Therefore, the unit receives reimbursement for care through “diagnosis-related groups (DRGs)”, which is what the government and some private insurance companies use (Yoder-Wise, 2015, p.215). DRGs are “groups” of clients who have similar “medical diagnoses” with attention to “age, complications, and other illnesses” to determine the “expected cost” (Yoder-Wise, 2015, p.215). The downfall of DRGs is that it does not reflect the “amount of resources used to care for the patients”; therefore, not all cost are reimbursed to the hospital (Yoder-Wise, 2015, p. 215). For example, anything with a yellow sticker is an additional cost that the nurse must chart in order for the unit to get reimbursed. Which relates back to reimbursement for medication from the insurance company, concerning timing. Documentation is critical for any type of
That the “qualified health professionals…may act as leaders in quality assurance and process improvements initiatives” (Hart, 2012, p.24). Thirdly, the author points to the change from “fee-for-service model” to the ACO model (Hart, 2012, p.25). The provider has “incentives” to provide quality care and outcomes; hence, the “ACO can be rewarded for providing better care” and receive better reimbursement for the health network and/or facility (Hart, 2012, p.25). This helps to decrease the cost of health care by decreasing unnecessary test and treatments. According to the “ANA president” the “ACOs must be more than just a business structure for compensating members of the health care team”; rather, it should “achieve the larger goal of providing true patient-centered care” (Hart, 2012, p.25). The ACO model will help decrease the high cost of healthcare; because with the increasing cost nurses need to “consider how nursing practice adds value for patient” (Yoder-Wise, 2015, …show more content…
However, Medicare and Medicaid have some of the strictest regulations; so if the nurse knows the government insurance rules, then the other insurance companies are probably covered. Therefore, the unit receives reimbursement for care through “diagnosis-related groups (DRGs)”, which is what the government and some private insurance companies use (Yoder-Wise, 2015, p.215). DRGs are “groups” of clients who have similar “medical diagnoses” with attention to “age, complications, and other illnesses” to determine the “expected cost” (Yoder-Wise, 2015, p.215). The downfall of DRGs is that it does not reflect the “amount of resources used to care for the patients”; therefore, not all cost are reimbursed to the hospital (Yoder-Wise, 2015, p. 215). For example, anything with a yellow sticker is an additional cost that the nurse must chart in order for the unit to get reimbursed. Which relates back to reimbursement for medication from the insurance company, concerning timing. Documentation is critical for any type of