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NURS 521 DB 2
As nurses, it seems that Christian worldview is an intuitive part of our trade. We deal day
in and day out making a difference in our patient’s lives and in the awareness within our
communities. Even though the word “incentives” can sound self-serving often times the
government agencies that incentivize reimbursements are enabling provider awareness of the
shortcomings with regard to patient care. As Christians we can couple our care with the
understanding that payment for sub-par care doesn’t represent being the hands and feet of Christ.
Following in Christ’s footsteps of healing, listening, and advising is our ultimate goal in
Christian healthcare.
Healthcare reimbursement is the process by which a provider delivers treatment to a
patient and then bills a private insurance company or government agency such as Medicare or
Medicaid. The amount billed and then paid is normally an amount that the provider and the payor
have agreed upon. With the use of technology how claims are completed, and reimbursements
distributed have accelerated and improved. Technology has shown improvement with healthcare
systems as they have an advantage through government-based programs such as the Meaningful
Use, Manage Care, or ACO Contracts (Nelson & Staggers, 2018).
The objectives in the Meaningful Use Program include “improve quality safety and
efficiencies and reduce health disparities, engage patients and families, improve care
coordination, improve population and public health, and ensure adequate privacy and security
protections for personal health information” (Nelson & Staggers PAGE #). When technology is
advanced, the government programs can define the parameters which helps achieve these
objectives. The motivation then becomes to provide a stable health environment that benefits the
patient which in turn will benefit the provider by a set and steady reimbursement. This type of
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incentive is a driving force for the provider and healthcare system to remain compliant to avoid
penalties (Houlihan)
Managed care popularized the value-based payment model. It is tied with patient
outcomes and avoidance of causing patient harm. Centers for Medicare and Medicaid Services
(CMS) has instituted reimbursement programs based on outcomes. It is grounded on value not
volume and was developed in a response to the rising costs of healthcare that was coupled with
poor outcomes (Rambur). Patient experience is another value-based program. Nursing is the
foundation of this program and its reimbursements. Hospital Consumer Assessment of
Healthcare Providers and Systems is a survey program that questions patients after discharge
with regard to their care and include how well they felt communication was conveyed, discharge
planning, responsiveness of staff and the condition of their environment.
References
Herrin, J., Mockaitis, K. G., & Hines, S. (2018). Hcahps scores and community factors.
American Journal of Medical Quality, 33(5), 461–471.
https://doi.org/10.1177/1062860618765977
Houlihan, J., & Leffler, S. (2019). Assessing and addressing social determinants of health.
Primary Care: Clinics in Office Practice, 46(4), 561–574. https://www-clinicalkey-
com.ezproxy.liberty.edu/#!/content/journal/1-s2.0-S009545431930065X
Nelson, R., & Staggers, N. (2018). Health informatics: An interprofessional approach (2nd ed.).
Mosby.
