The United States’ health care delivery system has experienced several changes. The changes have led to restructuring and reforming the health care delivery system, resulting in better healthcare services to the public. For several years the United States under the various administrations has undergone health care restructuring or reforms. For example, between 1945-1953, Truman administration advocated for the universal health coverage, administering and paying for the National Health Insurance Board (NHIB) (Haas, 2011). The other reform was under the Eisenhower Administration between 1953 and 1961 supported the Military Medicare program that paid for health care services for military beneficiaries. Therefore, under every administration, there are significant healthcare reforms. This paper, therefore, outlines the current health care law or federal regulation to restructure some aspects of the health care delivery system and highlight how quality measures and pay for performance affect patient outcomes, among others.
Current or emerging health care law or federal regulation introduced to restructure or reform some aspect of health care delivery system
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The current health care law that has restructured or reformed the health care delivery system is the 2010 Affordable Care Act (ACA). The goals of ACA law are such as reducing the number of uninsured, making health coverage more affordable, and expanding access to care to the public (Haas, 2011). The law further expanded Medicaid eligibility and created new marketplaces whereby those without coverage by employers would purchase policies from private insurers. With the use of so-called carrot and stick strategy to promote enrollment, most of the adults are expected to have health coverage or pay the fines, and the moderate-income persons receive premium subsidies to purchase policies. From the time the ACA was implemented, the uninsured rates have significantly reduced by about 43%, which is from 16% in 2010 to 9.1% in 2016 (Salmond & Echevarria, 2017).
The enactment of the Affordable Care Act law has also affected the nursing practices, the roles, and responsibilities of the nurses. For example, it has led to the demand for registered nurses surge (Salmond & Echevarria, 2017). The shortage of nurses has been around for several years, but ACA has led to even higher requirements. According to the United States Bureau of Labor Statistics (BLS), the nursing profession is expected to grow by 16% in the future, and the average pay projections for registered nurses (RNs) have steadily increased (Haas, 2011). Thus, it has the meaning that ACA is likely to boost the nurses’ financial standing and opportunities as well.
The other effect of ACA on nursing practice is the nurse-to-patient ratios changing, as the number of people with health coverage increases. Moreover, ACA has increased higher learning opportunities for the nurses, which has since become more affordable. The Affordable Care Act has poured money into the United States’ overall health care system, which includes educational institutions (Haas, 2011). Therefore, the ACA has more significant effects on the nursing practices, which have changed the nurses’ roles and responsibilities in their respective workplaces.
How quality measures and pay for performance affect patient outcomes. explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
The Pay for Performance (P4P) refers to a term used for the initiatives or strategies aimed towards the improvement of efficiency, quality, and overall health care services. The strategies offer physicians with financial incentives, health care facilities, and other health care providers to undertake such improvement and achieve optimal patient outcomes. Pay-for-performance has gained popularity among the public and private players, as well as the policymakers ( Bodrock & Mion, 2008) . The ACA extends the use of P4P strategies in Medicare and encourages experimentation for the identification of programs and designs effective in-patient outcomes.
Pay-for-performance quality measures are categorized into four; process measures, outcome measures, structure measures, and patient measures. Process measures access to the activities performed that contributes to positive patient outcomes. For example, the process measure determines whether or not a given medicine was administered to heart attack victims or patients or counseled to quit alcohol or smoking. The other quality measure is Structure measures related to the personnel, facilities, and equipment used in patient treatment ( Bodrock & Mion, 2008) . For example, several P4P initiatives provide incentives to health providers to undertaken health IT.
Patient experience measures as a quality measure help in assessing the quality of care perception by the patient and care experience. For example, in the inpatient environment, patient experience measures would involve how patients perceive the communication quality with the care providers and whether the rooms and premises are clean ( Bodrock & Mion, 2008) . Lastly is the outcome quality measure, which refers to the impacts such care had on patients, for instance, whether or not patients’ condition such as diabetes is under control as provided in the laboratory tests.
The pay-for-performance effect on nursing practice includes providing financial penalties or rewards to individual health care providers based on their performance on quality measures. The health care providers by observing the quality measures of pay-for-performance, there are several expectations. Some expectations include better and quality health care services in healthcare facilities ( Bodrock & Mion, 2008) . Quality health care, in this case, would ensure that the nurses and other health care providers work according to the nursing standards and policies, which would, in turn, lead to better quality health care.
The professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
The nursing profession incorporates four critical aspects, which are nurses should be providing services to the fullest based on their training and education. The second aspect is nurses should be in the position of achieving higher levels of training and education through an integrated education system that promotes professionalism. The third aspect is nurses should collaborate with partners, physicians as well as other healthcare providers, in healthcare redesigning. The fourth aspect is that effective policymaking and workforce strategy requires better sufficient data collection and infrastructure as well ( Hall & Doran, 2004) . The four elements are essential, especially to professional nursing leadership and management roles, as they help in the promotion of health care quality and patient safety.
As such, the nursing professional leadership and management roles can be categorized under the physician leader and nurse leader. The physician leader has the role of bringing the physician's perspective or view, implementing the initiatives, and communicating the significance of any healthcare project to colleagues who practice within the healthcare facilities ( Hall & Doran, 2004) . On the other hand, the nurse leader has the role of binging the nursing perspective, and communicating strategies or initiative specifications to frontline nursing staff within the health care facilities.
Nurse leader and physician leader bringing their heads together towards the improvement of health care via their roles, the patients who benefit from the projects and initiatives. The initiatives also provide a productive working environment, which also facilitates so-called interprofessional collaboration, which leads to patient safety and quality patient outcomes ( Hall & Doran, 2004) . Therefore, the nurses' and physicians' collaboration within the health care organization brings to the attention of the management the key aspects that need much concern that would, in turn, lead quality health care under the nursing code of ethics and professionalism.
Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.
The key emerging trends in the health care delivery system include the active involvement of consumers, improving coverage and access, encouraging healthy behavior among citizens, and strengthening the healthcare workforce ( Salmond & Echevarria, 2017) . The active participation of consumers in the health care services provision brings in the idea of consumer consent about the treatment likely to be administered to him or her. Patients are required to know the type of treatment and procedures suitable to be undertaken by the health practitioner. The Affordable Care Act law implementation enables low-income persons to gain access to health care cover and access under the EMTALA law (Haas, 2011) . EMTALA requires that any person who comes to an emergency department to be stabilized or treated without being turned back despite the income status of the patient.
The nursing practice and roles in the next five years would grow or transform in various ways among them are improving health care quality and improving the public health care across multiple health care facilities or organizations. The improvement of health care would address the issue of active patient involvement in healthcare practice. The patients becoming aware of the treatment procedures or process, this leads to quality and safety improvement ( Salmond & Echevarria, 2017) . On the other hand, public health care improvement would be due to the creation of an enabling environment for low-income earners to access health care and coverage.
Conclusion
From the above discussion, much is highlighted on the health care delivery systems or models and nursing practices in the United States. The critical aspects examined include the changes introduced to restructure or reform the health care delivery system in the U.S, and how quality measures and pay-for-performance impacts patient outcomes. Much is also discussed on the professional nursing leadership alongside management roles and how they respond to the emerging trends and nursing roles. Lastly, the emerging trends in healthcare delivery such as active consumer involvement, strengthening the healthcare workforce, and improving healthcare coverage and access.
References
Bodrock, J. A., & Mion, L. C. (2008). Pay for performance in hospitals: Implications for nurses and nursing care. Quality Management in Healthcare, 17 (2), 102-111.
Haas, S. A. (2011). Health reform act: new models of care and delivery systems. AAACN Viewpoint, 33(2), 11–12. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=104846661&site=eds-live&scope=site
Hall, L. M., & Doran, D. (2004). Nurse staffing, care delivery model, and patient care quality. Journal of Nursing Care Quality, 19 (1), 27-33.
Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing, 36 (1), 12.
