Ethical and Policy Factors in Care Coordination

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Hello, I’m pleased to be here today to discuss the impact of ethical and policy factors on care coordination. I will explore the potential ethical dilemmas care coordination professionals face in light of existing policies and how government regulations affect care coordination in nursing homes. NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination. Finally, I will examine the nursing code of ethics and its influence on care coordination.

Slide 2:

Let me start by providing a brief explanation of care coordination. It involves planning and sharing Patient care actions and information to improve safety and efficacy. This involves prior knowledge of the patient’s needs and preferences and timely communication of this information to the relevant parties to provide safe, appropriate, and effective care. Effective communication is crucial in care coordination, particularly in nursing homes, where streamlined care can benefit complex patients. According to the American Nursing Association, Care coordination is essential for patient health, satisfaction, and cost reduction. As such, nurses have access to various resources and play a vital role in patient satisfaction and the quality of care provided (AGHRQ, 2018).

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Government Policies in the U.S. for Accessible Healthcare Services

The U.S. government has implemented various policies to ensure people have access to affordable and quality Healthcare services. These policies aim to promote community well-being and protect people from healthcare disparities.

Affordable Care Act (ACA)

 The ACA is one of the most recognized policies in the U.S., offering community healthcare coverage. NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination. It provides individuals and families with affordable insurance options and helps them to access necessary medical care services. The ACA ensures everyone can access safe, quality patient care services (U.S. Centers for Medicare & Medicaid Services, 2022).

Nursing Centers Transparency and Improvement Act

This important governmental policy aims to ensure community safety and health. This policy specifically targets nursing homes, ensuring they provide quality care services to their residents. It also helps families to make informed decisions about nursing home placement for their loved ones (Nursing Home Resource Center, 2022).

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The HIPAA is a policy that protects patient medical information. It ensures that patient’s medical information is kept confidential and secure. HIPAA gives patients control over their medical records and ensures they are not misused (Edemekong & Haydel, 2022).

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Impact of Specific Policies on Care Coordination

Several policies have been implemented in the U.S. healthcare system to improve care coordination. These policies have various goals, including affordable healthcare insurance, disease prevention, and patient data privacy protection. In this presentation, I will discuss the impact of four specific policies on care coordination.

Affordable Care Act 

This comprehensive healthcare policy has significantly impacted care coordination in the U.S. ACA ensures affordable health insurance, expands healthcare coverage to people with low socioeconomic opportunities, and supports patient care provision methods that reduce healthcare costs. ACA affects care coordination in multiple ways, such as:

NURS FPX 4050 Assessment 2- Ethical and Policy Factors in Care Coordination

• Offering affordable health insurance to people makes healthcare quality improvement.
• Encouraging disease prevention programs for the wellness of society (Ercia, 2021).
• Enabling people with pre-existing medical conditions to access high-quality healthcare services ultimately leads to a controlled disease rate (Ercia, 2021).

Hospital Readmission Reduction Program (HRRP)

Introducing the Hospital Readmission Reduction Program (HRRP) to incentivize healthcare organizations to improve care coordination and communication for better caregivers and patient engagement in their hospital discharge plans (CMMS, 2022).

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Nursing Home Transparency and Improvement Act

 A policy that aims to reform nursing homes by improving the transparency of patient medical information. This policy ensures the accountability of nursing home patient care providers for healthcare services, and patients can question the standard of healthcare offered. The policy also implements ethical programs to evaluate administrative and civil violations in nursing homes, along with performance and quality improvement programs (Nursing Home Resource Center, 2022).

HIPAA

 This federal policy safeguards the confidentiality of patients’ health information by forbidding the dissemination of such information without first obtaining the patient’s permission. HIPAA regulations are introduced to prevent medical data privacy breaches or other improper use of medical records (Edemekong & Haydel, 2022).

 HIPAA affects care coordination by:  NURS FPX 4050 Assessment 2- Ethical and Policy Factors in Care Coordination

• Keeping patient medical information safe and secure (Edemekong & Haydel, 2022).
• Ensuring the safe transfer of patient information between healthcare providers.
• Implementing strict penalties against patient data privacy breaches (Edemekong & Haydel, 2022).

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Ethical Considerations and Consequences of the ACA: A Critical Analysis

The ACA is a widely popular healthcare policy in the United States that has provided healthcare coverage to millions of people. While healthcare insurance has benefited lower socioeconomic communities and disabled and unprivileged individuals, the ACA has raised ethical concerns surrounding healthcare costs. I will critically analyze the ethical implications and consequences of the ACA. Let’sbegin by examining how the ACA aimed to control healthcare costs while improving healthcare quality and coverage (Thomas Hebdon et al., 2022).

NURS FPX 4050 Assessment 2- Ethical and Policy Factors in Care Coordination

While this policy has fulfilled the healthcare needs of insured individuals, the healthcare cost remained unaffordable for uninsured patients. This has led to ethical dilemmas surrounding the provision of partial treatments and limited access to healthcare services for uninsured individuals (Thomas Hebdon et al., 2022).

Next, I will explore the ethical considerations surrounding government intervention in healthcare. The ACA has raised concerns about balancing individual autonomy and government control in healthcare decision-making. The Affordable Care Act (ACA) has raised concerns about balancing individual autonomy and government control in healthcare decision-making. Some opponents of the ACA argue that it gives the government too much power to determine what healthcare services individuals are entitled to. This can be seen as a violation of individual autonomy, as patients may not be able to make their own choices about the care they receive. 

One example is the ACA’s mandate that all individuals have health insurance coverage. While this mandate has been upheld as constitutional by the U.S. Supreme Court, it has been criticized as an infringement on individual autonomy, requiring individuals to purchase a product they may not want or need. However, supporters of the ACA argue that the mandate is necessary to guarantee that everyone can get the medical treatment they need and to control healthcare costs by expanding the insurance pool (Bishop, 2021).

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Ethical Implications of HRRP

The Hospital Readmission Reduction Program (HRRP) introduced by the government was a well-intentioned policy initiative to reduce patient readmissions, lower healthcare costs, and improve healthcare quality and patient satisfaction. While the program had good intentions and led to positive outcomes, it has also raised ethical concerns (Gai & Pachamanova, 2019).

One of the primary ethical concerns associated with the HRRP is the potential for miscommunication between patients and healthcare providers. The focus on reducing readmissions may have led to a decrease in the attention and focus of healthcare providers on accurate health diagnoses, which could result in incorrect diagnoses and hospital administration denying patients readmission. This could cause harm to patients (Flaks-Manov et al., 2020).

The ethical implications of the HRRP must be critically analyzed to understand the broader consequences of the program. While it has reduced readmissions and improved healthcare quality, the potential ethical concerns associated with the program must be addressed. These ethical considerations include patient autonomy, beneficence, and nonmaleficence (Flaks-Manov et al., 2020).

The implications of the HRRP may impact healthcare providers and patients in ways that require further examination. Understanding the broader implications for healthcare policy and practice is crucial, ensuring that ethical values, including patient autonomy, beneficence, and nonmaleficence, are upheld (Flaks-Manov et al., 2020).

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Impact of Nursing Code of Ethics and Coordination of Care

The nursing profession requires adherence to a code of ethics that guides nurses to perform their duties honestly and properly. The ANA defines the nursing code of ethics, which is essential in shaping nurse behavior and improving their performance in patient care services. The code includes principles such as justice for healthcare equality, nonmaleficence to prevent patient harm, autonomy for patient inclusion in medical decision-making, and beneficence to prevent any event that could hurt a patient (Faubion, 2022).

Patients who are conscious and able to make decisions about their care are considered autonomous. NURS FPX 4050 Assessment 2 Ethical and Policy Factors in Care Coordination. Nurses should provide patients with all possible options and allow them to decide according to their preferences. This ensures the autonomy of the patient, and it is an essential aspect of ethical nursing practice. Justice ensures that all patients receive equal treatment, regardless of color, race, or culture (Faubion, 2022).

Care Coordination in Nursing Homes

In nursing homes, care coordination can benefit from adhering to the code of ethics in several ways. 

• When patients are in charge of their healthcare, this can pave the way for more open lines of communication, eliminating misunderstandings about treatment choices and reducing confusion (Haddad & Geiger, 2022).
• Moreover, patient autonomy can enhance comprehension because patients have input into the healthcare therapy strategy (Haddad & Geiger, 2022).
• When a patient feels treated fairly, it can shape a healthy and positive working relationship with healthcare providers, enhancing their confidence in the nursing home (Haddad & Geiger, 2022).

Following this concept of the code of ethics, nurses shall not engage in any conduct based on or suggesting bias towards any individual or group of people. The nurse is expected to provide the same level of care to all patients irrespective of age, sexuality, religion, or culture. To avoid violating the principle of nonmaleficence, medical staff members will seek the least detrimental treatment available. Measures like nonmaleficence in care coordination can foster trust between patients and their healthcare professionals. In nursing homes, this can result in improved patient outcomes and satisfaction (Haddad & Geiger, 2022).

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Healthy People 2030: Prioritizing Social Factors Affecting Health for Better Health Outcomes

The social factors of health are essential to consider when assessing the overall well-being of individuals and communities. These determinants are the various socioeconomic and environmental factors that majorly affect people’s health, such as where they live, work, and play. Some of the key social determinants of health include:

• Economic Status
• Education Levels
• Social Background
• Environmental Conditions

For instance, individuals living in poor housing conditions or inadequate sanitation facilities are more likely to suffer from various diseases, such as respiratory infections and waterborne illnesses. Similarly, individuals with limited access to education and economic opportunities may experience an increased prevalence of debilitating conditions, including diabetes and cardiovascular disease, due to lifestyle factors such as poor nutrition and physical inactivity. Given the significant impact of social determinants of health, addressing these factors in public health initiatives and policies is crucial. Healthy People 2030, a U.S. national initiative, recognizes the role of socioeconomic determinants of health in promoting health equity and eliminating health inequalities. This initiative emphasizes the need to improve economic opportunities, increase access to education, and create healthier environments for all individuals and communities (Healthy People 2030, 2022).

Factors Contributing to Ongoing Healthcare Disparities

The issue of healthcare disparities is a complex one and can be attributed to a variety of factors.

Lack Of Access to Quality Education

 One of the key factors contributing to disparities in health outcomes is the lack of access to quality education. When people do not have access to educational opportunities, they may not have the health decision-making knowledge and competencies, which can lead to poorer health outcomes (CDC, 2020)

Limited Resources and Income

Limited resources and income are also major contributors to healthcare disparities. People living in poverty or with limited financial resources may struggle to afford healthcare services or healthy foods, leading to poorer health outcomes (CDC, 2020).

Unhealthy Environment

 Living in an unhealthy environment, such as an area with poor air quality or limited outside areas that are secure enough for exercise, can contribute to poor health outcomes (CDC, 2020).

Reduced Availability of Healthcare

Limited access to adequate quality medical care services can also contribute to healthcare disparities. People who live in areas with few healthcare providers or who cannot afford healthcare services may delay seeking medical care or receive suboptimal care, leading to poorer health outcomes (CDC, 2020).

Addressing social determinants of health and promoting health equity requires a concerted effort from policymakers, healthcare providers, and communities. This may involve improving access to educational opportunities, providing financial assistance to those in need, promoting healthy living environments, and ensuring that all people have access to, and use, high-quality healthcare services, irrespective of one’s ability to pay or location (CDC, 2020).

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Conclusion

In conclusion, the discussion of care coordination’s moral and policy implications highlights the critical role that government measures play in improving patient care standards. While initiatives such as the ACA and the HRRP have shown positive outcomes, it is important to acknowledge the ethical considerations involved in implementing these policies. Additionally, policies must not discriminate against certain patient populations or neglect the needs of vulnerable groups. While some federal and state regulations can positively impact care coordination, they can also create ethical dilemmas. Healthcare providers must navigate these complexities while maintaining ethical principles and providing the best possible care for patients. By doing so, we can ensure that patients receive high-quality care that is both effective and respectful of their individual needs and preferences.

References 

Agency for Healthcare Research and Quality. (2018, August). Care coordination. Ahrq.gov. 

https://www.ahrq.gov/ncepcr/care/coordination.html

Bishop, S. M. (2021). The role of the supreme court in shaping the Affordable Care Act. The Affordable Care Act as a National Experiment, 57–62. 

https://doi.org/10.1007/978-3-030-66726-9_8

CDC. (2020, November 24). Health disparities. Centers for Disease Control and Prevention. 

https://www.cdc.gov/healthyyouth/disparities/index.htm

Centers for Medicare and Medicaid Services. (2022). Hospital readmissions reduction program (HRRP). Cms.gov. 

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program

Edemekong, P. F., & Haydel, M. J. (2022, February 3). Health insurance portability and accountability act (HIPAA). Nih.gov; StatPearls Publishing. 

https://www.ncbi.nlm.nih.gov/books/NBK500019/

Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care perspectives from FQHC administrators in Arizona, California and Texas. BMC Health Services Research, 21(1), 1–9. 

https://doi.org/10.1186/s12913-021-06961-9

Faubion, D. (2022). The 9 nursing code of ethics – A must know for every nurse. Nursing Process. 

https://www.nursingprocess.org/nursing-code-of-ethics-and-interpretive-statements.html

Flaks-Manov, N., Srulovici, E., Yahalom, R., Perry-Mezre, H., Balicer, R., & Shadmi, E. (2020). Preventing hospital readmissions: Healthcare providers’ perspectives on “impactibility” beyond EHR 30-day readmission risk prediction. Journal of General Internal Medicine, 35(5), 1484–1489. 

https://doi.org/10.1007/s11606-020-05739-9

Gai, Y., & Pachamanova, D. (2019). Impact of the Medicare hospital readmissions reduction program on vulnerable populations. BMC Health Services Research, 19(1). 

https://doi.org/10.1186/s12913-019-4645-5

Haddad, L. M., & Geiger, R. A. (2022). Nursing ethical considerations. National Library of Medicine; StatPearls Publishing. 

https://www.ncbi.nlm.nih.gov/books/NBK526054/

Healthy People 2030. (2022). Social determinants of health. Healthy People 2030; U.S. Department of Health and Human Services. 

https://health.gov/healthypeople/priority-areas/social-determinants-health

Nursing Home Resource Center | CMS. (2022). Cms.gov. 

https://www.cms.gov/nursing-homes

Thomas Hebdon, M. C., Phan, C. T., Phillips, C., Wan, S., Doyon, K., Gray, T., Johnson, L., & Fischer, S. M. (2022). Ethical and policy implications of financial burden in family caregivers. Journal of Hospice & Palliative Nursing, 24(5). 

https://doi.org/10.1097/NJH.0000000000000887

U.S. Centers for Medicare & Medicaid Services. (2022). Affordable Care Act (ACA). HealthCare.Gov; U.S. Centers for Medicare & Medicaid Services.

 https://www.healthcare.gov/glossary/affordable-care-act/