The purpose of strategic planning in a health care environment is not only important in that setting but any business setting as this creates the foundation. It allows systematic approaches to any situation, especially with how complex or simple some procedures might be, this gives guidelines any of those situations. But as it can become more complex with each situation being different, there are planning committees that are available for each organization to help plan for any future issues. Factors that may affect future planning in an organization are budgeting, level of staff, time and level of care (Whitney, 2019). A useful tool in future planning is with the SWOT analysis, identifying the strengths, weaknesses, opportunities and threats to the the organization or the situation at hand. This can then help guide towards a decision that is needed to be made.
The United States has the most complex healthcare system globally. The complexity has led to slow reforms due to policies, environmental and technological factors. Nevertheless, the system requires a change to meet current illness trends, technological shifts, and doctor demographics (Emanuel, 2018). The purpose of this paper is to describe a current healthcare law and its impact on nursing practice and nursing roles. The paper will also outline the effects of pay per performance and quality measures on patient outcome, professional nursing leadership and management roles that have emerged and emerging trends and how nursing roles and practice will change in response to the upcoming trends.
The Medicare Access and CHIP Reauthorization Act (MACRA)
In 2015, The Medicare Access and CHIP Reauthorization Act (MACRA) became law. The bill came up with a quality payment program that repealed the Sustainable Growth Rate Formula and introduced the value-based payment reforms (Sayeed et al., 2017). The bipartisan legislation ensured that clinicians were no longer rewarded for volume but rather for value. Through the Merit-Based Incentive Payments System (MIPS) multiple quality programs were streamlined and bonus payment included for providers who participated in eligible alternative payment models (APMs). The bill proposes the removal of Social Security Numbers (SSNs) from Medicare cards to protect financial information, private health care, and federal health care benefits and service payments (Sayeed et al., 2017). The bill also aims at advancing quality measures that drive value in care, improve patient outcomes, and reduce the burden on clinicians. The bill will leverage the expertise and insight of the providers to build a truly value-based healthcare system.
MACRA Effects on Nursing Practice and Role
As part of Medicare providers and managed care professionals, nurses’ roles have been affected. MACRA affects how policy are developed, performance measures, reimbursements, care coordination and clinical-coding review. Nurses have to ensure that the MACRA principle of providing good care with the least cost and using HIT is met (Ma et al., 2018). MACRA makes providers more conscious of efficiency and outcomes which promotes care management styles. The act helps in reducing duplication of services, costs for individual, and unnecessary medical procedures. It addresses wasteful spending, the need for standard and available cost and outcomes data, and ineffective health interventions. The act fosters patient-centered care and thus enhances team-based care and the need to have clearly defined roles and responsibilities for team members (Ma et al., 2018). Responsive and respectful care is expected from nurses to meet individual patient values, needs and preferences. Equally al clinical decision should be based on patient values.
Pay For Performance (P4P), Quality Measures and Patient Outcomes
Pay for performance offers financial rewards or penalties depending on performance on measures of quality. P4P should, therefore, drive providers and health care systems to enhance the delivery of care, reduce expensive health care services, and enhance patient health outcomes. Patient outcomes should improve because providers will not rely on a high volume of services but will adopt procedure-based care (Mendelson et al., 2017). P4p reduce the cost of care and improve the patient experience. Research indicates that P4p improves initial hospital readmissions, boosts process-of-care performance, and has led to appropriate high blood pressure responses in the ambulatory settings. P4P follows the quality of measures and thus ensures that effective, efficient, equitable, safe, and timely care is provided.