Reflection Learning
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week7.docx· Analyze how healthcare reimbursement influences your nursing practice.
Health care is significantly changing with time, and one of these changes is how health care facilities and providers are compensated for offering service. One of these ways is through reimbursement. Health care reimbursement is the payment given to a health care facility or a health care provider for offering medical service to a patient (Torrey, 2020). This cost is often covered by a patient’s health insurer or a government payer. In health care reimbursements are beneficial because they discourage DNP-prepared nurses from establishing their own independent practices. This is because at their own practices they would receive less reimbursement under their own number than under that of a physician. If the reimbursement rates were equal more DNP-prepared nurses would establish their own practices and this would increase competition.
Due to healthcare reimbursement, models that emphasize cost-effective decisions by DNP-prepared nurses are developed. These decisions are offer patients with quality medical care rather than sacrificing the patient service quality. Innovations such as price transparency tools as well as patient engagement apps help the nursing practice during the implementation of healthcare reimbursement. The patient outcome as well as the low-cost care provided by health care providers has an influence on the reimbursement received. Health care reimbursement tends to motivate health care providers because they earn more when the care they provide is of high quality as well as low cost.
DNP- prepared Nurses' role helps Nurse Practitioners to prepare for the advancement they will encounter in their nursing career in health care. This enables them to be more competent and have more knowledge when offering quality health care. The main goal of the health care reimbursement system is to pay health care providers based on their performance. This means that being more advanced and competent is beneficial for a DNP in order to provide high-quality care to patients. This simply means that if they offer high-quality care, the reimbursement will reflect this and they will be paid more. And if they are not competent, then the reimbursement will be vice versa.
2- Examine how the value-based insurance design (VBID) influences clinical outcomes and cost issues.
The aim of value-based insurance design is to increase the quality of health care while decreasing the cost by using financial incentives to promote cost-efficient health care services and consumer choices. In order to remove roadblocks as well as maintain and improve a person’s health, health benefit plans can be developed. These plans tend to save money by reducing future expensive medical procedures. They do this by covering treatments such as prescribed drugs at a low cost or no cost, preventive care as well as wellness visits (Lexchin, 2020).
The healthcare industry is making a shift toward value-based reimbursement models and away from volume-based care (Hazelzet & Van Weert, 2021). They are making this change because health care providers are reimbursed by value-based insurance design which is based on the quality of care that they provide to their patients. This tends to be different as compared to volume-based care which offers payment based on each procedure or test done. Value-based insurance design favors the quality of care offered to patients rather than the quantity. This tends to have a positive influence on clinical outcomes as well as cost issues. This is because value-based insurance design benefits the patient as well as the provider and health care facility. It offers high-quality medical care to patients at a lower and more affordable cost.
References
Hazelzet, J., & Van Weert, N. (2021). Personalized health care as value-based care. Personalized Specialty Care, 7-15. https://doi.org/10.1007/978-3-030-63746-0_2 (Links to an external site.)
Lexchin, J. (2020). Who assigns value in value-based insurance design? Canadian Medical Association Journal, 192(1), E15-E15. https://doi.org/10.1503/cmaj.73617 (Links to an external site.)
Torrey, T. (2020). How healthcare providers are paid by reimbursement. Verywell Health. https://www.verywellhealth.com/reimbursement-2615205
