Various reimbursement changes that have been implemented over the years focus on reducing healthcare costs. According to Ihejirika et al. (2015), some of the most common models of reimbursement are penalties, pay for performance, and capitation care. An increase in healthcare cost affects the ability of the public to access quality healthcare services. Additionally, increased healthcare costs affect the reimbursement of a healthcare facility hence the need for various facilities to implement cost-containment measures.
The article by Stadhouders et al. (2019) identifies various cost-containment measures, which primarily focus on most aspects of the healthcare system, including market processes, prices, volumes, supply, and demand. These cost-containment measures, especially those focusing on improved care of patients, can reduce the instances of penalties for a healthcare facility. By taking a societal approach to the issue, Stadhouders et al. (2019) focus on increased health costs for both the patients and payers. From the literature review consisting of a total of 61 articles, Stadhouders et al. (2019) established 72 policies that have been implemented to contain healthcare costs. The effectiveness of several policies is critically analyzed in the article, and for example, cost-sharing is a feasible strategy that can reduce necessary and unnecessary care.
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According to Stadhouders et al. (2019), various policies can be implemented to reduce healthcare costs, including payment reform, managed care, and cost-sharing. A combination of managed care competition, cost-sharing, reference pricing, generic substitution, and tort reform are the most effective healthcare policies that can bend the growing healthcare costs curve. The reduction of administrative costs is a crucial concern for healthcare professionals. The primary reason for the existence of various reimburse models is to ensure a reduction in the cost of care delivered to patients. The fragmented healthcare system and the lack of accessible healthcare services have contributed to the development of creative innovations such as telehealth services.
In addition to the cost containment services described by Stadhouders et al. (2019), telehealth services have been identified as the ultimate achievable cost-saving strategy (Abbasi-Feinberg, 2020). The reduction of administrative costs is a crucial concern for healthcare professionals. The primary reason for the existence of various reimburse models is to ensure a reduction in the cost of care delivered to patients. The fragmented healthcare system and the lack of accessible healthcare services have contributed to the development of creative innovations such as telehealth services. Telehealth improves the delivery of managed care services, a common occurrence in the current healthcare system (Abbasi-Feinberg, 2020).
A nurse practicing either in the collaborative or independent practice may be impacted differently by these healthcare containment policies. For instance, in independent practice, a nurse may consider tort reform and reference pricing over generic substitution. In collaborative practice, managed care would be the main focus. For a nurse in either practice, delivery of high-quality care to the patients should be essential. Further, Holtrop et al. (2015) assert that direct reimbursement for care management visits in primary care should be the focus and not only quality improvement incentives.
The article by Stadhouders et al. (2019) suggests the generic substitution of drugs as a cost-containment measure in healthcare delivery. Considering the economic significance of medications in healthcare, this practice might not seem legally and ethically complicated; however, as Danta & Ghinea (2017) explains, the substitution of a generic medication with a brand medication may pose ethical and legal challenges for the nurse practitioner. For instance, generic medications are associated with certain risks that the nurse practitioner should be aware of. While generic substitution may enhance medication access, some patients' associated health risks are detrimental enough to cost a nurse practitioner their practicing license.
References
Abbasi-Feinberg, F. (2020). Telemedicine coding and reimbursement - Current and future trends. Sleep Medicine Clinics . https://doi.org/10.1016/j.jsmc.2020.06.002
Danta, M., & Ghinea, N. (2017). The complex legal and ethical issues related to generic medications. Viral hepatitis: A case study. Journal of Virus Eradication , 3 (2), 77-81. https://doi.org/10.1016/s2055-6640(20)30286-7
Holtrop, J. S., Luo, Z., & Alexanders, L. (2015). Inadequate reimbursement for care management to primary care offices. The Journal of the American Board of Family Medicine , 28 (2), 271-279. https://doi.org/10.3122/jabfm.2015.02.140207
Ihejirika, R. C., Sathiyakumar, V., Thakore, R. V., Jahangir, A. A., Obremskey, W. T., Mir, H. R., & Sethi, M. K. (2015). Healthcare reimbursement models and orthopaedic trauma. Journal of Orthopaedic Trauma , 29 (2), e79-e84. https://doi.org/10.1097/bot.0000000000000162
Stadhouders, N., Kruse, F., Tanke, M., Koolman, X., & Jeurissen, P. (2019). Effective healthcare cost-containment policies: A systematic review. Health Policy , 123 (1), 71-79. https://doi.org/10.1016/j.healthpol.2018.10.015
