A recent federal law that reforms healthcare in the United States would be the Sustaining Excellence in Medicaid Act of 2019 (HR 3253). This bill was introduced into Congress on June 13 2020 and signed into law on August 6 2020. The Michigan representative, Debbie Dingell, introduced and sponsored this bill. The bill seeks to restructure the Medicaid program by providing for some extensions in some of its provisions (KDP LLP, 2019). One of the changes made was allowing the appropriations of Medicaid through to the fiscal year 2024. Another reform in Medicaid authorized in this bill is allowing the state fraud units within the program to consider and examine complaints from the non-institutionalized patients. This reform is important because it eliminates some of the disparities that arise from the ignoring of the complaints from such patients, yet, legally, they qualify for cover under the Medicaid program.
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Another reform introduced by this bill is extending the Medicaid eligibility for individuals to protect them from spousal impoverishment or poverty. Sometimes, spouses from the lower socioeconomic backgrounds are denied cover given that Medicaid does not extend to them. This bill extends cover to such populations, including those who receive home-based and community-based medical services. In addition to these reforms, this bill repeals the requirements placed for the drug manufacturers to always include the prices for generic drugs when determining the price. It also excludes drug manufacturers from the definition of drug wholesalers to allow rebate calculations.
This bill affects the nursing practice by adjusting the nurse’s role and responsibility. For instance, since the bill extends Medicaid to cover the spouses and protect them from impoverishment, the nurse should ensure that they educate all patients about the new changes to this bill. A patient may be suffering from spousal poverty which limits their access to quality medical care. The nurse should be able to identify such patients, and educate them about the new changes to help them access quality medical care. Another way this bill affects the nurse’s role and responsibility is that it adds to the role of advocacy in nursing. The nurse should advocate for the non-institutionalized patients whenever they have complaints, and help them appeal to Medicaid in the event of denial of services. The new bill covers the patients and enables them to have their complaints reviewed, hence, increasing their chances of getting social justice. The nurse should be an advocate and help the patients access social justice by helping them lodge complaints.
How Quality Measures and Pay for Performance Affect Patient Outcomes
Pay for performance is a reward system that rewards practitioners financially for their performance based on certain criteria in medical practice. It is a performance-based compensation approach that aims to improve the quality and delivery of healthcare services to patients. As such, this model also punishes the practitioners for achieving poor results. For instance, a psychologist whose patient fails to quit smoking at the end of their sessions does not receive the financial rewards associated with her role. In some ways, this model improves patient outcomes because it motivates the physicians and nurses to offer high quality services to their patients to ensure that they receive the financial rewards associated with their roles and criteria used for performance analysis. However, there is a risk to poor patient outcomes associated with this reward system, where it encourages patient dumping. This concept means that those patients with more complicated healthcare issues that have high risks tend to be relegated to the periphery, because the physicians prefer to focus on cases that are likely to be successful, so that they receive their rewards and bonuses (Kyeremateng et al., 2019). This practice leads to negative patient outcomes because those in the periphery suffer from lack of sufficient and timely medical attention.
A nurse who finds him/herself in such situations should consider applying ethical principles such as non-maleficence, which means to cause least harm. By applying this principle, the nurse would encourage the physicians to admit and attend to patients with complex medical issues. Additionally, the nurse should remind the rest of the practitioners about the Hippocratic Oath, which binds them to the duty to save lives. Patient dumping is a severe violation of this oath and the nurses’ responsibility should be to remind the colleagues about these ethical applications.
Professional Nursing Leadership and Mana
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