NURS-FPX 4050 Ethical and Policy Factors in Care Coordination

Sample Answer for Title: NURS-FPX 4050 Ethical and Policy Factors in Care Coordination Included After Question

Select a community organization or group that you feel would be interested in learning about ethical and policy issues that affect the coordination of care. Then, develop and record a 10-12-slide, 20- minute presentation, with audio, intended for that audience.

Create a detailed narrative script or speakers notes for your presentation, 4-5 pages in length.

For this assessment:

 

• Choose the community organization or support group that you plan to address.

• Develop a PowerPoint with typed speaker notes (the script for your voice recording) and audio voice-over recording, intended for that audience. Video is not required.

Note: PowerPoint has a feature to type the speaker notes directly into the presentation. You are encouraged to use that feature or you may choose to submit a separate document. See Microsoft Office Software for technical support about the use of PowerPoint, including voice recording and speaker notes.

For this assessment, develop your presentation slides and speaker notes, then record your presentation. You are not required to deliver your presentation to an actual audience.

 

A Sample Answer For the Assignment: NURS-FPX 4050 Ethical and Policy Factors in Care Coordination

Title: NURS-FPX 4050 Ethical and Policy Factors in Care Coordination

Introduction

  • Care coordination is a key strategy to enhance safety in healthcare
  • Improves effectiveness & efficiency of the health care system
  • Well-designed, targeted care coordination can improve outcomes for all
  • It impacts- patients, providers, & payers
  • The presentation will include:
  • Ethical & policy issues affecting care coordination in nursing homes

The Institute of Medicine defines care coordination as a key strategy with the potential to enhance the healthcare system’s safety, effectiveness, and efficiency. A well-designed, targeted care coordination delivered to the appropriate patient population can improve outcomes for patients, providers, and payers. In this presentation, I will discuss vital ethical and policy issues affecting the coordination and continuum of care with respect to nursing homes.

How Governmental Policies Related To the Health and/or Safety of Nursing Homes Affect the Coordination of Care

  • State & Federal policies promote high healthcare standards & safety for residents.
  • Federal policies deal with inspections
  • All nursing homes must comply with the policies
  • Federal laws permit government officials to conduct annual surveys in nursing homes.
  • Medicaid policy requires nursing homes to adopt structured quality improvement initiatives.
  • Seeks to improve care coordination between PCPs & other facilities
  • Medicaid agencies are directed to enlighten families about the available care coordination services
  • Medicaid agencies need the medical home payment to fund a care coordinator within a medical home

Various individual state and Federal policies have been enacted to promote high healthcare standards and safety for residents in nursing homes. Federal policies deal with inspections with which all nursing homes must comply (Ouayogodé et al., 2019). Federal laws permit government officials to carry out annual surveys and take up complaint investigations.

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Federal Medicaid regulation fosters continued quality improvement and evaluation in care coordination. The policy requires managed care organizations (MCOs) like nursing homes to adopt structured quality improvement initiatives to improve care coordination between primary care providers and other facilities (Blackstock et al., 2021). In addition, the Medicaid policy impact care coordination in nursing homes. It requires that Medicaid agencies enlighten families about the available care coordination services for patients (Blackstock et al., 2021). Thus, nursing homes that are Medicaid agencies will need to inform patients and their families of the care coordination services they offer. Medicaid agencies also need the enhanced medical home payment to be committed to funding a care coordinator within the medical home.

  • OAA-collection of Federal laws for nursing homes
  • Aims to provide various services for the elderly
  • It directs the provision of grants for funding senior centers & nursing homes.
  • Nursing homes can have adequate resources to implement care coordination activities.
  • The HIPAA Privacy Rule
  • Care coordination as an activity meeting the criteria of a healthcare operation
  • HIPAA places restrictions on the exchange of PHI for care coordination
  • Covered health plans must have had a relationship with the patient
  • The covered entity only discloses PHI linked to the covered entity & patient’s relationship

The Older Americans Act (OAA) is a collection of Federal laws for nursing homes, which seeks to provide various services for the elderly. The policy directs the provision of grants that can be used for funding senior centers and nursing homes (Bangerter et al., 2019). Thus, this can impact care coordination in nursing homes since facilities will have adequate resources to implement care coordination activities.

The HIPAA Privacy Rule considers care coordination as an activity that meets the criteria of a healthcare operation. However, the rule places few restrictions on the exchange of protected health information (PHI) for care coordination. The covered health plans must at present or previously have had a relationship with the person who is the subject of the PHI (Qin, 2019). Besides, the covered entity should only disclose PHI linked to the objective of the covered entity and the patient’s relationship.

National, State, And Local Policy Provisions That Raise Ethical Questions Or Dilemmas for Care Coordination

  • Provisions elicit ethical questions for case managers & providers
  • Medicaid provision on improving care coordination in PCP practice
  • It is limited if Medicaid is the only payer that influences the practice
  • Raises ethical question on justice- fairness & equity
  • Need to implement systems that impact care for all despite the payer
  • The ACA gives provisions for care coordination
  • ACA provision on insurance coverage is limited to US citizens
  • Ethical question- Are non-US citizens & undocumented immigrants worthy of quality coordinated care?

The existing national, state, and local provisions elicit ethical questions for case managers and healthcare professionals when providing care coordination. For instance, the Medicaid provision on improving care coordination in a primary care provider (PCP) practice is usually limited if Medicaid is the only payer aiming at influencing the practice (Blackstock et al., 2021). This raises an ethical question on justice that requires fair, equitable, and appropriate treatment of all individuals. Routine care coordination necessitates implementing systems in a practice that impact care for all complex patients despite the payer.

The Affordable Care Act (ACA) has a number of sections touching on new care coordination programs which pertain to geriatric care managers. The ACA gives provisions on care coordination concerning quality improvement, payment reform, tracking savings, and special considerations of persons with full Medicare-Medicaid beneficiaries, and health home members (Ouayogodé et al., 2019). Nevertheless, the ACA provision on insurance coverage is limited to US citizens. This elicits an ethical question on whether non-US citizens and undocumented immigrants are worthy of receiving quality coordinated care.

The Impact of the Code of Ethics for Nurses on the Coordination and Continuum of Care

  • Code of ethics- outline for how nurses should conduct themselves ethically
  • Outlines measures they should take in case of barriers
  • Nursing ethic codes: beneficence, nonmaleficence, autonomy, justice, & privacy/confidentiality
  • ANA acknowledges & promotes the integral role of nurses in care coordination
  • This enhances the quality of care & outcomes for consumers
  • RNs are considered competent & educated for care coordination

The Code of Ethics for Nurses by the American Nurses Association (ANA) is a guiding outline for how nurses should conduct themselves ethically within the profession and the measures they should take if they face barriers that hinder them from accomplishing their professional obligations. The five nursing ethic codes are beneficence, nonmaleficence, autonomy, justice, and privacy/confidentiality (Olson & Stokes, 2016). The ANA acknowledges and promotes nurses’ integral role in care coordination to enhance the quality of care and outcomes for healthcare consumers across patient populations and healthcare settings. Registered nurses (RNs) are competent and educated for the care coordination role, particularly with high-risk and vulnerable populations.

  • The Code of Ethics discusses intraprofessional collaboration within nursing.
  • It is crucial to address patients’ needs effectively
  • Nurses are expected to collaborate in the care coordination process
  • Coordination through a multi-disciplinary approach
  • Code recognizes nurses’ professional commitment to the advancement of professional practice

The Code of Ethics has a sub-section on collaboration that states that intraprofessional collaboration within nursing is crucial to address patients’ health needs effectively. Nurses are expected to collaborate in the care coordination process through a multi-disciplinary approach to address patients’ health needs (Olson & Stokes, 2016). The Code of Ethics also recognizes the professional commitment of nurses to the advancement of professional practice, quality health care for all, and achievement of national health goals.

Conclusion

  • The presentation has taught us:
  • How governmental policies affect care coordination in nursing homes
  • Medicaid policy fosters continued quality improvement & evaluation in care coordination
  • OAA directs the provision of grants to nursing homes
  • HIPAA requires privacy of PHI during care coordination
  • Provisions raise ethical questions on justice & access to care coordination
  • The Code of ethics promotes nurses’ collaboration

During the presentation, we learned how governmental policies affect care coordination in nursing homes. Medicaid is one such policy that fosters continued quality improvement and evaluation in care coordination and requires nursing homes to inform patients and their families of available care coordination services. The Older Americans Act directs the provision of grants to nursing homes, which can improve the delivery of care coordination. The HIPAA requires the privacy of PHI during care coordination. We have also learned that the provisions raise ethical questions on justice and access to care coordination services by non-US citizens. In addition, we have seen the impact of the Code of ethics in promoting nurses’ collaboration in care coordination. 

References

Bangerter, L. R., Fadel, M., Riffin, C., & Splaine, M. (2019). The Older Americans Act and Family Caregiving: Perspectives from Federal and State Levels. The Public policy and aging report29(2), 62–66. https://doi.org/10.1093/ppar/prz006

Blackstock, S. C., Richards, A. C., & Fleisher, L. A. (2021, October). Shaping Medicare’s Health Care Regulations. In JAMA Health Forum (Vol. 2, No. 10, pp. e213017-e213017). American Medical Association. doi:10.1001/jamahealthforum.2021.3017

Olson, L. L., & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive statements: Resource for nursing regulation. Journal of Nursing Regulation7(2), 9–20. https://doi.org/10.1016/S2155-8256(16)31073-0

Ouayogodé, M. H., Mainor, A. J., Meara, E., Bynum, J. P., & Colla, C. H. (2019). Association between care management and outcomes among patients with complex needs in Medicare accountable care organizations. JAMA network open2(7), e196939-e196939. doi:10.1001/jamanetworkopen.2019.6939

Qin, F. (2019). The Debilitating Scope of Care Coordination Under HIPAA. NCL Rev., p. 98, 1395.