The current U.S. healthcare system is under extreme pressure. The intense pressure can be attributed to a number of factors, such as the rapid demographic change, aging population, and the growing prevalence of chronic disease (Philips, 2019). Other factors mounting pressure on the current U.S. healthcare system is the increasing incidence of new powerful drugs and innovative technologies. This has led to the fragmentation of today’s healthcare delivery, “with high levels of clinical waste and unexplained variance in treatment and outcomes” (Philips, 2019). Adding to the challenge is the widely varying prices and increasing healthcare costs and high rates of staff burnout. Another challenge is the lack of financial incentives for prevention, disease management, and population health. Given the challenges facing the current healthcare system, it is clear that healthcare delivery and financing in the United States need to change.
The U.S. healthcare community is desperately searching for strategies and solutions to challenge the current situation –transforming from healthcare systems that are characterized by silos and waste to a more progressive system that will help improve health care in the U.S., such as a value-based system. This paper will delve into discussing why a value-based system may improve health care in the U.S. More specifically, the paper will address the following: how current policy has transformed the current practice of nurses, physicians, and other healthcare professionals; what distinction can be made between physician/healthcare providers working in a fee-for-service system and a value-based care (VBC) system; and how I view shared power between physicians and nurses in the U.S. and how it impacts care.
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Why a VBC System May Improve Health Care in the U.S.
The U.S. healthcare community are desperately searching for health policies that could help transform the current health care system towards more efficient and sustainable care models and pricing schemes. In the midst of policy-talk, value-based systems have taken the spotlight. Policymakers in the United States have gradually introduced the concept of value in care models as well as in pricing schemes. VBC systems are seen as a possible solution to the challenges facing the current healthcare system. More specifically, it is seen as a possible solution to the structural problems of care models today. According to Philips (2019), VBC is the answer to improving access to care and health outcomes at a lower cost. Philip states that the system focuses on what patients value. More to this is that the system focuses on assigning resources as per the health outcomes provided. This means, in order to drive efficiency and raise quality standards, this health care model attaches incentives and payments to outcomes for patients and population, not system workload.
Arguably, a value-based system may improve health care in the U.S. This is because it encourages elements of quality, safety, patient experience, and patient empowerment (Philips, 2019). Most importantly, this health care delivery framework seeks to avoid unnecessary diagnostic and therapeutic interventions. With the right execution, VBC supports the delivery of cost-effective care. Compare this with the traditional fee-for-service (FFS) system where a patient, whenever he or she goes to see his or her primary care physician or goes to a hospital to undergo a medical test or procedure, is required (or his insurance provider is required) to pay for every step in the process. It is vital to note that with the traditional FFS model, the patient or the patient’s insurance provider is required to make this payment regardless of whether a diagnosis or procedure is successful. In addition, the patient or patient’s insurance provider is required to make the payment regardless of whether or not the steps taken are high-quality or even considered as best practice. This is to say that the traditional FFS model is not necessarily working in the best interests of the patient.
How Current Policy has transformed the Current Practice of Healthcare Professionals
The health care system in the United States is undergoing rapid changes. This is because the current system is not putting emphasis on population health, healthcare quality, and the value of the services delivered. The transformation in the way health is delivered presents both opportunities and challenges to nurses, physicians, and other healthcare professionals. Health care payers, such as Medicare and Medicaid, are shifting away from the traditional FFS payments toward paying for value. As policymakers shift payment models, health care providers are redesigning how they deliver care. More to this is that health care providers are redesigning how they redeploy the workforce in new roles and settings. In redesigned health care systems, nurses, physicians, and other healthcare professionals are assuming expanded roles. New job titles and roles are emerging in various health care settings, particularly “population health management, patient coaching, informatics design and analysis, geriatric are, and managing patient care transitions” (Fraher et al., 2015). Current health policy has transformed the current practice of nurses. According to Fraher et al. (2015), nurses are increasingly employed as “boundary spanners.” This means that nurses are increasingly employed to connect patients with services in health and community settings. More to this is that nurse is called upon to collaborate as members of interprofessional teams and actively engage in performance improvement.
As new roles diffuse through the health care system as a result of current health policies, nurses, physicians, and other healthcare professionals need to focus on building their knowledge and skills in order to meet patient needs in a rapidly changing and increasing value-focused care environment. In order to achieve this, nurses, physicians, and other healthcare professionals will need to identify and advocate for the education and regulatory changes to support the health care workforce, such as a nurse, physicians, and other healthcare professionals, as they shift employment settings and take on new roles. This reimbursement model is believed to be key to achieving the “Institute for Healthcare Improvement (IHI) Triple Aim Initiative” “improving the patient experience of care (including quality and satisfaction), improving the health of the population, and reducing the per capital cost of health care” (IHI, 2020).
Distinctions that can be made between Healthcare Providers working in an FFS System vs. a VBC System
There are a number of distinctions that can be made between healthcare providers working in an FFS system and VBC system. Historically, healthcare providers have been compensated for care provided based on FFS reimbursement models. Based on this model, a healthcare provider is compensated for each procedure, test, treatment, etc. they perform regardless of whether the diagnosis or procedure is successful, or whether or not the steps taken are high-quality or even considered as best practice (Brown & Crapo, 2014). Essentially, with the FFS model, healthcare providers are financially rewarded for quantity over quality. With this model, healthcare providers do not take patient outcomes into account when determining reimbursement amounts. Since the providers do not take into account patient outcomes, this can lead to unnecessary tests and treatment when less invasive as well as less expensive options may be available and more desirable.
Increasingly, insurance providers are shifting toward a VBC reimbursement model. In contrast to FFS, VBC reimbursement models compensate healthcare providers for the quality of care they provide, rather than the quantity (Brown & Crapo, 2014). The quality of care provided by healthcare providers using this model is measured by patient health outcomes. With VBC reimbursement models, healthcare providers are required to take a more team-oriented approach to patient care (Brown & Crapo, 2014). More to this is that they are required to collaborate with a patient’s other care providers. This helps ensure the healthcare providers deliver the best health outcomes possible.
View on Shared Power between Physicians and Nurses and how it impacts Care
Throughout history, physicians and nurses have shared a complicated relationship. The relationship between physicians and nurses was influenced by a number of factors, which, according to McKay & Narasimhan (2012), include social status, gender, power, and perspectives. In my healthcare system, I view shared power between physicians and nurses as very essential for improving patient outcomes as well as the quality of health services. In climate constantly demanding efficiency, cost-effectiveness, and quality improvement, it is vital to have a good interprofessional collaboration between physicians and nurses. Poor nurse/physician relationships have far-reaching implications when it comes to the delivery of healthcare services in health care settings. According to a study done by Rosenstein & O’Daniel (2005), disruptive behavior by physicians can lead to nursing burnout. In addition, such behavior significantly contributes to decreased job satisfaction and the decision to leave the profession (Rosenstein, O’Daniel, 2005). Therefore, it vital to have a positive interprofessional collaboration between physicians and nurses as it holds promise for improving patient care. In addition, it holds promise for creating satisfying work roles.
Conclusion
To sum up, VBC systems are key to improving patient experience and improving healthcare outcomes. This healthcare delivery model is constantly replacing the FFS system, which focuses more on quantity rather than quality. With regard to the current practice of healthcare professionals, current health policy has transformed the roles and responsibilities of nurses, physicians, and other healthcare professionals. As policymakers shift payment models, such as from FFS systems to VBC systems, health care providers are redesigning the way they deliver care as well as the way they redeploy the workforce in new roles and settings.
References
Brown, B., & Crapo, J. (2014). The key to transitioning from fee-for-service to value-based reimbursement. Health Catalyst .
Fraher, E., Spetz, J., & Naylor, M. (2015). Nursing in a transformed health care system: New roles, new rules. Interdisciplinary Nursing Quality Research Initiative (Research Brief).
IHI. (2020). The IHI Triple Aim. [Online]. Retrieved April 6, 2020, from http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx
Mckay, K., & Narasimhan, S. (2012). Bridging the gap between doctors and nurses. Journal of Nursing Education and Practice , 2 (4), 52.
Philips, K. (2019). Value-based care: Turning healthcare theory into a dynamic and patient-focused reality. [Online]. Retrieved April 6, 2020, from https://www.philips.com/c-dam/b2bhc/de/innovation/vitalhealth/Value-based_care_position_paper.pdf
Rosenstein, A. H., & O’Daniel, M. (2005). Disruptive Behavior & Clinical Outcomes: Perceptions of Nurses & Physicians: Nurses, physicians, and administrators say that clinicians’ disruptive behavior has negative effects on clinical outcomes. Nursing Management , 36 (1), 18-28.
