Maria Hernandez

Main Post:

H.R. 977- Patient Access to Higher Quality Health Care Act of 2023.

Description: When a patient has health insurance, depending on which premium, they are made to use providers or hospitals that are “in-network” to avoid higher costs of services. This can often be an issue for patients because some providers are not in network with their health insurance, specifically Medicare recipients. The Patient Access to Higher Quality Health Care Act would “repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals” (Congress.gov, 2023).

Background: According to the American Hospital Association, “For decades, the Ethics in Patient Referrals Act (“Stark Law”) has protected the Medicare program from the inherent conflict of interest created when physicians self-refer their patients to facilities and services in which they have a financial stake” (AHA, n.d.). At one point, physicians were allowed to make referrals to hospitals with ownership within the entire facility; this gap was closed in 2010 when the Affordable Care Act was passed.  

Social Determinant: One social determinant is access to health care and quality care. Patients, regardless of their socioeconomic status, should receive high-quality care. The American Hospital Association states, “The Government Accountability Office (GAO), the Centers for Medicare & Medicaid Services and MedPAC all found that physician-owned hospitals’ patients tend to be healthier than patients with the same diagnoses at general hospitals” (AHA, n.d.). This would lead those with serious illnesses to rely on general hospitals for healthcare services.

Evidence: The growth of Physician-owned hospitals was prohibited in 2010 after the passing of the Affordable Care Act. According to Ehrenfeld, “a systematic review of 30 years of research demonstrating that physician-owned specialty hospitals or so-called “focused factories” offer higher-quality care at comparable or lower cost, while physician-owned community hospitals are no worse than their counterparts” (Ehrenfeld, 2023). If H.R. 977 is passed into law, it would allow physicians of physician-owned hospitals to extend their services to the community by opening new hospitals that would provide high-quality, efficient care and be affordable to patients. This would place competition against general hospitals at risk of losing market share, leading them to reform their services to stay in competition. This would benefit patients in being able to seek assistance in a variety of hospital or hospital-owned facilities. 

References:

American Hospital Association. (n.d.). Fact sheet: Physician self-referral to physician-owned hospitals. https://www.aha.org/fact-sheets/2023-02-27-fact-sheet-physician-self-referral-physician-owned-hospitals

Congress.gov. (n.d.). H.R.977 – 118th Congress (2023-2024): Patient Access to Higher Quality Health Care Act of 2023. https://www.congress.gov/bill/118th-congress/house-bill/977?q=%7B%22search%22%3A%5B%22HR+977%22%5D%7D&s=1&r=1

Ehrenfeld, J. M. (2023, August 10). End restrictions on physician-owned hospitals to expand Quality Care. American Medical Association. https://www.ama-assn.org/about/leadership/end-restrictions-physician-owned-hospitals-expand-quality-care

One is an individual plan of care. This can be a (personal plan of care based on your own culture or a culture of your choice).

In place of an APA ASSIGNMENT,  please draft an individual plan of care related to one’s personal culture or a selected population of interest. 

• The culture that is being recognized.
• Unique traits of that culture (language, preferences, family dynamics, dietary needs).
• Health problems associated with that culture.
• Corrective measures and community resources.
• Expected outcomes. 
• Include citations to support your presented data

PLEASE DO IT ON MEXICAN CULTURE

To prepare:

• Review the Module 4 Learning Resources with guidance for analyzing and synthesizing evidence from your literature review.
• Complete your analysis of outcomes and synthesis of evidence to inform a practice change.
• Consider the linkage between your practice problem, evidence to address it, and the need for a practice change initiative.
• Assess the strength of this linkage and how to present it to colleagues.

With these thoughts in mind …

Post an explanation of the results of your literature review and the connection to your practice problem. Then, explain your synthesis of evidence on which to base a practice change, and the need for a practice change initiative. Be specific and provide examples. PLEASE INCLUDE AT LEAST 3 REFERENCES

module 4 learning resources:

• Walden University Writing Center. (n.d.). Synthesizing your sourcesLinks to an external site.. https://academicguides.waldenu.edu/writingcenter/assignments/literaturereview/synthesizing

• Westlake, C. (2012). Practical tips for literature synthesisLinks to an external site.. Clinical Nurse Specialist, 26(5), 244–249. https://doi.org/10.1097/NUR.0b013e318263d766Links to an external site.

The purpose of this assignment is to explain how the Theory of Chronic Sorrow can be used as a framework for planning care and identifying resources in the following case: You are a case manager for a family with a young child diagnosed with cerebral palsy. Explain how the Theory of Chronic Sorrow can be used as a framework for planning care and identifying resources for this family.

PLEASE RESPOND TO THE FOLLOWING IN 50 WORDS OR MORE:

2. Nursing‐sensitive indicators are the criteria for changes in health status that nursing care can directly affect. Nursing‐sensitive indicators have been increasingly adopted as valid and reliable tools due to their features such as objective assessment, improvement of clinical practice, evaluation of nursing care quality and performance, and informed decision‐making capability for patients in selecting a hospital to receive care. The use of nursing‐sensitive indicators affects the outcomes of nursing care by defining the structure and processes of nursing care. Indicators can be used for quality improvement purposes in applied settings to monitor performance and progress and to support evidence-based decision making, to support informed policy analysis related to regulatory or accreditation requirements, workforce development, and reimbursement, and to research the role of nursing care in determining patient safety outcomes by examining structure-outcome, process-outcome, and structure-process-outcome relationships. I believe that no one nursing sensitive indicator is sufficient on its own for measuring the profession’s impact on patient care and outcomes. Rather, several elements must be considered together to provide a comprehensive view of nursing practices and results, such as patient falls with and without injuries, RN satisfaction survey, nosocomial infections, nursing hours per patient day. Indicators not included in the database statistics, but which professional nurses should consider, nonetheless are patient satisfaction with pain management, patient satisfaction with nursing care. For example, assessment and treatment of pain is complex, and optimal pain care remains elusive. Only 63-74% of patients report that their pain was well-controlled. Personal biases may interfere with healthcare’s ability to accurately assess pain management needs, but nurses who keep in mind the ethical principles of autonomy, beneficence, non-maleficence, and justice will be better equipped to make sound judgments. 

Reference:

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2021). Nursing-sensitive indicators for nursing care: A systematic review (1997-2017). Nursing open, 8(3), 1005–1022. https://doi.org/10.1002/nop2.654