Assignment Ethical and Policy Factors in Care Coordination Essay

Assignment Ethical and Policy Factors in Care Coordination Essay

Assignment Ethical and Policy Factors in Care Coordination Essay

Slide 1: Introduction

Hello. Welcome to this presentation on ethical and policy factors in care coordination. Care coordination refers to the activities or processes that aim to bridge gaps in patient care. It aims at promoting appropriate and efficient delivery of healthcare services within and across healthcare systems. In this presentation, I will discuss how government policies affect the coordination and continuum of care in nursing homes. In addition, I will explore policy provisions that raise ethical questions or dilemmas for care coordination. I will also discuss the impact of the code of ethics for nurses on the coordination and continuum of care.

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Slide 2: How Governmental Policies Related To the Health and Safety of Nursing Homes Affect the Coordination of Care

The Federal and State governments are enacting new policies and modifying existing ones, which positively and negatively affect care coordination. Policies dictate how care coordination is structured and reimbursed in nursing homes. The Nursing Home Reform Act (NHRA) outlines the federal quality standards for nursing homes (Blackstock et al., 2021). Nursing homes must meet these standards if they are beneficiaries of Medicare or Medicaid. NHRA seeks to ensure that patients in nursing homes receive high-quality care.

Federal Medicaid policy promotes continued quality improvement and evaluation of care coordination in nursing homes. The Medicaid policy directs managed care organizations (MCOs), such as nursing homes, to implement structured quality improvement measures to enhance care coordination between primary care providers and other facilities (Blackstock et al., 2021).

Slide 3: How Governmental Policies Related To the Health and Safety of Nursing Homes Affect the Coordination of Care

Medicare payment policies target to improve the quality of coordinated care. Policies on reimbursement for care coordination significantly affect care coordination. An example is the Medicaid policy, which requires Medicaid agencies to enlighten patients and families about the available care coordination services and help them arrange treatment (Williams et al., 2019). For nursing homes to be refunded for care coordination on a fee-for-service basis, there has to be a Current Procedural Terminology (CPT) or similar code under which the facility can bill and be paid (Williams et al., 2019). Despite having codes for billing for some elements of care coordination, various state Medicaid programs fail to refund for services billed under the codes, negatively impacting the provision of care coordination in nursing homes.

Slide 4: How Governmental Policies Related To the Health and Safety of Nursing Homes Affect the Coordination of Care

In June 2019, the Office of Civil Rights (OCR) issued guidance on how PHI can be shared between health plans to support care coordination and continuity of care (the “guidance”). The guidance stated that HIPAA allows PHI to be utilized and disclosed for healthcare activities related to a second health plan for care coordination purposes (Qin, 2019).

The OCR modified the HIPAA Privacy Rule to:

1. Support people’s engagement in their health care.
2. Remove barriers to coordinated care.
3. Reduce regulatory burdens on the healthcare industry (Qin, 2019).

This is while continuing to protect patients’ health information privacy interests.

Slide 5: National, State, And Local Policy Provisions That Raise Ethical Questions Or Dilemmas for Care Coordination

Case managers and healthcare providers encounter ethical issues and dilemmas due to policy provisions that direct care coordination. The ACA has various provisions that highlight the implementation of care coordination programs. For example, the ACA has covered care coordination under quality improvement, payment reform, monitoring savings, and the section on special considerations of diabetics, full Medicare Medicaid beneficiaries, and health home members (Collins & Saylor, 2018).

Nevertheless, Medicare and Medicaid are limited to documented U.S. citizens and residents. Thus, the ACA provisions on care coordination raise an ethical question for case managers on whether to provide care coordination services to undocumented persons (Collins & Saylor, 2018). Case managers have an ethical duty to provide high-quality care to all persons regardless of race, ethnicity, or migration status. However, they face ethical dilemmas when the policy provisions dictate the type of care given to a person based on their migration status.

Slide 6:  National, State, And Local Policy Provisions That Raise Ethical Questions Or Dilemmas for Care Coordination

Various states have value-based contracts with providers or Accountable Care Organizations (ACOs) to share the financial risk for the full cost of care for Medicaid beneficiaries. The contracts usually include methodologies identifying how patients are attributed to providers (Katch, 2019). This establishes the providers who are financially responsible for managing a patient’s care. The contracts generally include a continuous coverage requirement of 6 to 12 months. Consequently, Medicaid beneficiaries with coverage gaps will probably never be attributed to a provider under these contracts. This raises ethical issues since the contract offers providers no financial incentive to manage their care (Katch, 2019). This can compound the adverse effects of coverage gaps on these patients’ care, even after regaining Medicaid coverage.

Slide 7: The Impact of the Code of Ethics for Nurses on the Coordination and Continuum of Care

The code of ethics dictates the standard of ethics in nursing practice. It serves as a constant reminder of nurses’ commitment to society. ANA code of ethics supports coordination and continuum of care through provisions 2, 4, and 8. The code of ethics greatly influences coordination and continuum of care since it emphasizes nurses providing care coordination compassionately and appreciating each patient’s dignity, worth, and qualities (ANA, 2015). Besides, the code of ethics emphasizes that nurses keep the patient at the center of care, positively impacting care coordination as the patient’s needs are adequately met. The code of ethics further fosters high-quality and safe coordinated care because it seeks to protect patients’ health, safety, and rights.

Slide 8: The Impact of the Code of Ethics for Nurses on the Coordination and Continuum of Care

Healthcare disparities significantly affect care coordination in nursing homes and other healthcare settings. Various factors contribute to health disparities in care coordination, including access to care, poor quality of care, community characteristics (poverty, inadequate access to healthy foods, and violence), language barriers, and health behaviors. Under provision 8 of the ANA code of ethics, the nurse should collaborate with other healthcare providers and the public to protect human rights, promote health diplomacy, and lessen health disparities (ANA, 2015). The nurse care coordinator should be aware of the patient’s individual health needs but also of the wider health concerns that may affect care coordination and health outcomes.

Slide 9 Key Ethical and Policy Issues Affecting the Coordination and Continuum of Care for Nursing Homes

Case managers in nursing homes are mandated to uphold the foundational moral virtues, duties, and principles that are a cornerstone of the nursing profession. Nonetheless, it is becoming increasingly challenging for case managers in nursing homes to uphold integrity due to the complex moral dilemmas and pressures they confront. Case managers in nursing homes often struggle with ethical challenges when providing patient care and in care coordination activities. They face major ethical issues regarding protecting patients’ rights, informed consent, autonomy, advanced care planning, staffing, and surrogate decision-making (Williams et al., 2019). Furthermore, they face ethical issues related to patient confidentiality, patients’ right to privacy, and end-of-life decision-making, significantly impacting care coordination in nursing homes.

Slide 10: Summary

• Policies dictate how care coordination is structured and reimbursed in nursing homes
• Policies also influence the safety and qualty of coordinated care
• However, ethical questions arise on patients with no insurance
• ANA code of ethics supports coordination and continuum of care through provisions 2, 4, and 8
• Case managers in nursing homes struggle with ethical challenges

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.

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

Collins, B. L., & Saylor, J. (2018). The Affordable Care Act: 8 years later. Nursing Management, 49(8), 42–48.

Katch, H. (2019). Restrictive Medicaid Policies Will Impede Innovation to Improve Care and Reduce Costs. Center on Budget and Policy Priorities.

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

Williams, M. D., Asiedu, G. B., Finnie, D., Neely, C., Egginton, J., Finney Rutten, L. J., & Jacobson, R. M. (2019). Sustainable care coordination: a qualitative study of primary care provider, administrator, and insurer perspectives. BMC health services research, 19(1), 92. https://doi.org/10.1186/s12913-019-3916-5

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Ethical and Policy Factors in Care Coordination Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Explain how governmental policies related to the health and/or safety of a community affect the coordination of care.	Does not provide an explanation of governmental policies related to the health and/or safety of a community.	Attempts to provide an explanation of governmental policies related to the health and/or safety of a community.	Explains how governmental policies related to the health and/or safety of a community affect the coordination of care.	Provides an articulate, insightful explanation of how governmental policies related to the health and/or safety of a community affect the coordination of care. Provides clear examples of specific policies affecting care coordination.
Identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.	Does not identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.	Attempts to identify national, state, and local policy provisions not clearly associated with questions of ethics.	Identifies national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.	Identifies significant and relevant national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination. Makes a clear and persuasive argument for the ethical implications and consequences of specific policy provisions.
Assess the impact of the code of ethics for nurses on the coordination and continuum of care.	Does not assess the impact of the code of ethics for nurses on the coordination and continuum of care.	Attempts to assess an inconclusive assessment of the impact of the code of ethics for nurses on the coordination and continuum of care, derived from a simplistic or cursory examination of implications and consequences.	Assesses the impact of the code of ethics for nurses on the coordination and continuum of care.	Assesses the impact of the code of ethics for nurses on the coordination and continuum of care. Draws insightful evidence-based conclusions informed by careful consideration of the social determinants of health and a precise and accurate interpretation of the factors contributing to health, health disparities, and access to services.
Communicate key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group, using PowerPoint or other appropriate software. Both speaker notes and audio voice-over are included.	Does not communicate key ethical and policy issues affecting the coordination and continuum of care for a selected community organization or support group.	Communicates key ethical and policy issues in a presentation that exhibits a lack of preparation, coherence, focus, or is off-script. Speaker notes and audio voice-over recording are absent.	Communicates key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Either speaker notes or audio voice-over are included.	Communicates key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Delivers a professional, logically coherent presentation of main points, facts, and conclusions, well-supported by relevant and credible evidence. Both speaker notes and audio voice-over are included.