Health outcomes typically depend on health care delivery models and population-based interventions for healthy living. Progressively, as situations necessitate, massive changes have been introduced to reform or restructure the U.S. health care delivery system to ensure better services to individuals and communities. These reforms have prompted many changes in the practice environment hence the need for nurses to understand current and possible developments in the future. Their roles in the changing environments will also be changing as reform occurs. The purpose of this paper is to examine changes introduced to reform health care delivery and the nurse’s role in the changing environment.
Current Health Care Regulation for Reforming Health Care Delivery
Federal regulations have been instrumental in health care reform to ensure people get accessible and affordable care. When the COVID-19 pandemic broke out, access to care was hampered as the government provided many directives for reducing transmission, including restricting movement and physical interaction. Since people still required health care services for other illnesses amid the pandemic, the US Centers for Medicare & Medicaid Services (CMS) authorized waivers to expand telehealth services for Medicare beneficiaries. Approved in March 2020, these waivers allowed more use of telehealth services, including in-home visits and care services in urban areas (Suran, 2022). The CMS further allowed audio-only interaction via telehealth for some health care services.
Health care reforms have significant effects on nursing practice. According to Suran (2022), the waivers by the CMS in 2020 intensified the use of telehealth services, implying an increased demand for remote health care services. In response to the increased demand for remote care, health care organizations should implement the appropriate technological infrastructure to support telehealth and related technology-related services. As Ford et al. (2020) suggested, a robust technology infrastructure is crucial to prevent risks associated with telehealth in patient care, primarily security and privacy breaches. As these developments occur, health care organizations should also expect more demand for remote health care services hence the need to adjust their delivery models to accommodate appropriate changes.
The nurse’s role and responsibility include appropriate adaptation, supporting technology-driven practice, and promoting a culture of change in the workplace. According to Triana et al. (2020), telehealth use is hampered by negative attitudes, particularly among providers without the appropriate technological skills to implement it safely and effectively. To reduce possible risks, nurses should embrace teamwork when offering tech-based services. A culture change is necessary to ensure that nursing teams are more open to change and can readily embrace new technologies to support patient care. Importantly, nurses should encourage and support patients to embrace telehealth for higher outcomes.
Quality Measures and Pay-for-Performance
Quality measures include processes and outcomes for assessing whether health care services achieve the desired outcomes. As a result, health care professionals use quality measures to assess performance and make decisions that increase the probability of achieving the desired outcomes (CMS.gov, 2021). On this premise, quality measures are a foundation of high-quality care since they guide nurses in improving outcomes. Pay-for-performance (P4P) encourages value-based care. In P4P schemes, health care providers are incentivized based on how they meet predefined targets for quality care (Kyeremanteng et al., 2019). Consequently, providers intensify measures for positive patient outcomes to get maximum incentives.
Quality measures and P4P promote high care quality, which is a core objective of the nursing practice. As their role stipulates, nurses should always be committed to delivering comprehensive care. Accordingly, they should focus on value, efficiency, and quality, among other elements that define satisfactory care (Kyeremanteng et al., 2019). Nurses should expect more pressure from stakeholders and patients to provide a higher value as time advances. Their primary role is to use quality measures as the reference for continuous quality improvement. Nurses should also promote P4P by increasing value through practices that reduce adverse events and allow them to use health care resources efficiently.
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