History of reimbursement issues | NURSING | Chamberlain College of Nursing

I think that most nurses do not consider the reimbursement process in relation to our patients because the reimbursement process infrequently is recognized by the nurse as impactful to them. When patients need to transfer from acute care to rehabilitation or long-term care facilities there can be delays due to obtaining authorization and placement at appropriately contracted facilities. As I have become better informed about the financial importance of leadership, I seek opportunities to reduce waste and improve processes to streamline care. Nurses should begin to recognize the importance of getting paid appropriately for the services that are provided. Reimbursement is needed to fund the expenses of maintaining equipment and facilities, training staff, and investing in new technologies that will improve patient care (Rundio, 2014).

My current role as an educator affords me access to a lot of information regarding the background tracking and educational requirements that need to be tracked to maintain regulatory compliance. The training of the nurses, however, costs money but does not directly generate revenue. My personal experience with healthcare insurance influences my personal perceptions about healthcare and how it may also affect my patients. I have a Health Savings Account type of insurance and my family’s deductible is $5,600. As a full-time nurse in a first-world country, I find myself not utilizing health care because I am concerned about incurring costs. The Affordable Care Act (2010) was designed to improve access to healthcare for the many people who did not have health insurance. More people do have coverage now, but people who were previously happy with their insurance may still struggle to meet deductibles and co-insurance. I do consider how this aspect of healthcare reimbursement impacts my family and consider that my patients may be in a similar situation.

The value-based insurance design (VBID) was developed to reduce costs by bundling interventions and covering them with a single all-inclusive payment. This payment model reduces the use of interventions deemed to be of low value to the patient, but many patients are skeptical and have concerns that their healthcare options are limited (Perez et al., 2019). Many healthcare expenses are incurred for procedures that may not always relate to improved patient outcomes resulting in increased expenses for the healthcare organization and the patient, with minimal value. Tying reimbursement to outcomes is designed to make providers carefully consider the need before ordering expensive procedures when comparable information could be obtained with less invasive procedures (Doherty & Purtilo, 2020). VBID sets a predetermined price for comprehensive bundled care which will incentivize providers to improve care at the least possible expense (Perez et al., 2019).

References

Affordable Care Act. (2010). https://www.hhs.gov/sites/default/files/ppacacon.pdf (Links to an external site.)

Doherty, R., & Purtilo, R. (2020). Ethical dimensions in the health professions (7th ed.). Elsevier Health Sciences (US). https://doi.org/https://ambassadored.vitalsource.com/reader/books/978-1-4377-0896-7/epubcfi/6/30[idloc_014.xhtml-itemref]!/4[eid5753] (Links to an external site.)

Perez, S. L., Gosdin, M., Pintor, J., & Romano, P. S. (2019). Consumers’ perceptions and choices related to three value-based insurance design approaches. Health Affairs, 38(3), 456–463. https://doi.org/10.1377/hlthaff.2018.05048 (Links to an external site.)

Rundio, A. (2014). The doctor of nursing practice and the nurse executive role (Illustrated ed.). Wolters Kluwer Health. https://doi.org/https://ambassadored.vitalsource.com/reader/books/9781496353825/epubcfi/6/30[%3Bvnd.vst.idref%3DRundio-ch006.xhtml]!/4

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