Practices for Credentialing Post-acute Providers as Part of Integrating Acute and Post-acute Services - Thesis Proposal Example

Best Practices for Credentialing Post-acute Providers (SNF, LTAC, HOSPICE and Home Health) as Part of Integrating Acute and Post-acute Services alongthe Care Continuum Name: Course: Health Sciences and Medicine Date: Chapter 1: Introduction Problem Statement Post-acute care is the highly-skilled therapy and nursing care that is normally offered after and inpatients have completed their admission in a hospital. The care is provided in different settings including Skilled Nursing Facilities (SNF), Long Term Acute Care (LTAC), Hospice and Home Health. Usually, post-acute is offered in care delivery continuum with the aim of shortening the hospital stay of an inpatient. Unfortunately, the care is conducted across many care providers who do not provide accurate and consistent information to all the people concerned with the treatment of the patient. This is because the care is fragment into many services across the care continuum. Moreover, some care providers are offered some financial incentives that compromise the quality of the post-acute care services they give to the patients (Alexander, 2011). Health care is not often delivered in the mostefficient, effective, or clinically appropriate manner. Worse still, the post-acute care services are not provided in a cost-effective care setting. The major reason behind this is that post-acute care is mostly delivered in more intensive care settings. Normally, Medicare payments are higher in the intensive care settings. Contrary to this, efficient, effective and appropriate care can be provided in a setting with lower intensity. Reforms that have been attempted on the post-acute care providers have ended up not being effective. The reforms are derailed by colliding interests that compromise the implementation of changes to the post-acute care providers (Alexander, 2011). Financial issues are one of the reasons that cause differences in the quality of the post-acute care service. In most cases, providers who charge higher amounts for the services offer better services that those that charge lower services. On the other hand, some post-care professionals work in more than one post-acute care providers. Such professionals may exercise negligence when handling patients when they are required to attend to other patients who are likely to offer higher payments. The spending patterns of different post-acute care providers vary greatly. Additionally, the facilities and equipment of different care providers are different. Moreover, the skills and competency of professionals working in these post-acute care providers differ greatly. The differences in skills and competency are due to the compensation differences among the care providers (Eisenberg, 2002). The differences in the quality of post-acute care and generally the care continuum is due to the ineffectiveness of the methods used in credentialing and evaluating the quality of the servicesoffered by care providers. Currently, the services have not been standardized to create a clear framework for credentialing post-acute care providers. Post-acute care providers (SNF, LTAC, HOSPICE and Home Health) often provide services with varied qualities because there is no effective method of credentialing them to offer the services. In other cases, laxity and complacency affects the quality of the care adversely. For this reason, there is need to devise and implement the best practices for credentialing post-acute providers as part of integrating acute and post-acute services along the care continuum (Quigley, 1996). Significance of the Project Many legal regulations have been passed over the years to regulate medical services provision including post-acute care. However, the regulations have not eliminated the incompetency that has resulted into low quality post-acute care services offered by some providers. Some of the regulations include the Patient Protection and Affordable Care Act (PPACA) that was enacted into law in 2010. One of the major changes indicated in the law was provision of medical services even to the underserved people. It alsothe spending by Medicare increased abuse and fraud protections.Additionally, the law required all Americans to have health insurance covers. PPACA was immediately followed by the Health Care and Education Reconciliation Act in the same year. The Act made many small, but significant alterations to PPACA in what was referred to as Health Care Reform. The Health Care Reform had many but substantial changes to PPACA and looked promising in terms of improving health care services provision. The reforms touched on all aspects of health care provision including credentialing of health care providers. However, up to this date, the services offered by health care providers including post-acute care are still not satisfactory. There are two factors hindering the prosperity of the post-acute care service provision. The first reason is the payment methodologies used to compensate professionals in the field. The quality of the post-acute care services offered by providers is influenced by the financial incentives offered by patients or employers. Secondly, changes in technology create differences in services offered to patients by care providers. The providers with greater financial capabilities can purchase and install the latest technologies needed for post-acute care thus offering better services (Somerville, Wilding & Bourne, 2007). From the observations made from the developments in the medical care, it is evident that establishment of strategies to evaluate the care providers is crucial. This paper explores various ways of bettering the credentialing of post-acute care providers. Using the developments and trends in the post-acute and acute care services provision, the research can identify strategies to evaluate the care providers. The research will review literature written about post-acute care and generally the care continuum to find out the challenges that hinder the integration of acute and post-acute care into the care continuum. The research will assist concerned authorities to make decisions on reviewing the credentialing of post-acute care providers. Effective credentialing of the care providers will make them provide quality services. Most importantly, the two major reasons for the low quality of the services offered by the care providers will be analyzed to create solutions to their impact on the care provision. Essentially, the research is not targeting post-acute care service providers. The research is aimed at enhancing professionalism in the provision of acute and post-acute care services. It is also intended to ensure that patients get the best care so that they spend less time in the hospitals. Therefore, the research is beneficial all the stakeholders of the care provision institutions as well as to the patients (Somerville, Wilding & Bourne, 2007). Principal Aims The project is aimed at exploring the factors that impact on the quality of the post-acute care services. The two major factors are financial issues and the dynamic nature of technology that requires regular updating and upgrading of machines, equipment using for the post-care services. After detailed analysis of the two major factors as well as other factors, the research will make recommendations on how credentialing and evaluation of post-acute care providers can mitigate and eliminate the adverse effects of these factors. Improvement of the health care and public health requires consistency and efficiency in the health care systems. Among the issues that need to be streamlined include the provision of low-cost but high-quality care for patients. For this reason, this paper is focused on establishing a framework that can be used to improve all aspects of acute care, post-acute care, and the entire care continuum. Therefore, all the roles played by different stakeholders in the care provision will be analyzed to seek and expose the accountability of the stakeholders to flaws noted in the health care provision especially in the post-acute care provision. A significant and vitalelement of the health care system is the professional workforce that controls the operations of the system. The research is thus not only focused on the post-acute care providers as an individual entity, but also the human element that controls the system significantly. Therefore, the procedures involved in educating and training the clinical professionals who execute the post-acute care service provision will be assessed. Furthermore, the research will examine the credentialing process that gives the clinical professionals permission to offer post-acute care services. The credentialing process has both individual institutional and components. The paper is aimed at finding the distinction in the procedures used in credentialing both components. This way, the problems in the system can be solved easily since they have been separated and categorized. Patients must undergo several treatment and care procedures so that they can recover fully. In most cases, the services cannot be provided in one health care facility. Usually, different health care facilities specialize in certain treatment and care services. Therefore, patients may be referred to other health care institutions to seek further treatment or care especially those in need of making follow-ups to their treatment and care. Unfortunately, the health care facilities may give inconsistent and confusing information during the transitions from one hospital to another. The miscommunication by the health care professionals can put the patients at risk of getting wrong diagnosis leading to further complications. For this reason, this research aims at exploring ways in which the health care services can be coordinated so that the patient is not inconvenienced. For instance, a patient may be treated but develops complications due to the ineffectiveness the post-acute care services given to the patient. Acute and post-acute care should be integrated along the care continuum to facilitate effective treatment of the patients. It is thus the aim of this paper to explore how the SNF, LTAC, Hospiceand Home Health can be controlled and monitored to offer proper treatment and care. Chapter 2: Background and Literature Review History of the Credentialing of Health Care System Documented credentialing of health professionals and institutions can be clearly traced from 1966 when the American Nursing Association (ANA) allowed creation of certifications boards through amendment of its bylaws. The laws underwent several changes until 1974 when first certification examinations were offered to the interested nurses. ANA continued administering certifications for about 17 years. Later in 1990, ANA created a subsidiary named the American Nurses Credentialing Centre (ANCC). In the early 1970s, other credentialing organizations were created such as the National Commission for Health Education Credentialing (NCHEC). NCHEC is not primarily intended for medical care but health education (Barr &Mattioli, 2014). Credentialing of the healthcare services provider not only focuses on professionals, but also organizations providing healthcare services. Two major accreditation organizations are tasked with the accreditation of healthcare centers in the United States. The Joint Commission (TJC) which was established in 1951 provides accreditation services to health centers nationally. The TJC accredits health centers by evaluating their standards and then goes ahead to inspire them to improve continuously. The organization provides improvement information to the centers. It is considered the oldest accreditation body that not only, accredits healthcare organizations, but also sets standards for improvement of the healthcare. Another accreditation body is the Accreditation Association for Ambulatory Health Care. The organization provides assessment; consultation, education, and accreditation to ambulatory health care providers to assist them reach higher standards (Alexander, 2011). Healthcare has changed in the last five decades due to changes in technology and the knowledge required for treating modern day ailments. In the twenty-first, century, the healthcare system has faced many challenges despite its advancement in terms of research and technology. The challenges includedecreased resident work hours,nursing shortage, advancing age of the population, primary care physician shortage, and issuesconcerningthe equalization of access to health care. These issues have prompted the shifting of the Nurse Practitioner (NP) role to the provision of acute and post-acute care setting. However, NPs have encountered barriers to experiencing full privileges in the acute and post-acute care provision. The reason behind the restrictions is because of the complexity of handling acute and post-acute patients. The NPs are thus credentialed by organizations such as the American Nurses Credentialing Centre (ANCC). Despite being credentialed by ANCC and other organizations such as NCHEC, the NPs still portray incompetency in providing acute and post-acute services (Barr &Mattioli, 2014). Current Practices and Trends in Healthcare Credentialing Credentialing process is the officially recognized way of permitting healthcare professionals to practice healthcare services provision such as acute and post-acute care. The process is mostly conducted with another process known as privileging. Credentialing is the process of examining and verifying education, certification, and licensure to practice as an advanced professional. For instance, a nurse can be credited as an advanced practice registered nurse (APRN).The nurse has authority to practice stipulated healthcare practices in a registered healthcare center. On the other hand, privileging involves the giving of authority to a professional to perform specific aspects of patient care.For a healthcare services provider to be accredited by accreditation organizations, its staff must be credentialed. The credentialing is important since the human resource is a crucial component of the healthcare organization (Barr &Mattioli, 2014). The credentialing of professionals to practice healthcare is determined by state practice acts, education,license, training, individual institutional regulations, and certification. The process of credentialing and privileging must reflect state rules, regulations, and statutes. The process considers education requirements, title recognition, and licensing. The current specifications by the Joint Commission stipulate that healthcare institutions should have a system that enhances systematic review of the qualifications of the applicants. The Joint Commission outlines that the credentialing process should enable licensed practitioners such APRNs, chiropractors, psychologists, physician assistants to practice healthcare in the organization (Alexander, 2011). Current credentialing processes for professionals in healthcare institutions involve several procedures that must be fulfilled before credentialing. The first step involves the verification of identity of the applicant. The second step requires the applicant to provide the evidence of being a registered professional in the field. Since most systems are accessible online, the registration of the applicant can be checked online. In other cases, a registration certificate is required to verify the registration. Alternatively, the registration board can be contacted directly to confirm the registration details of the applicant. The third step is the assessment of qualifications where tertiary are examined in either originals or certified copies. Thereafter, the training undergone by the applicant is evaluated in terms of past and ongoing professional development. In the next step, the specialist accreditations of the applicant are examined. These accreditations are issued by universities or colleges. The last steps of the process include referee checks, driving license check, and police check. The steps can provide a comprehensive of assessment of the suitability of the applicant to be certified (Barr &Mattioli, 2014). In some skilled nursing facilities (SNFs) and hospitals, post-acute services providers are referred to as “vendors”. These hospitals and SNFs require the post-acute services providers to adhere to the policies and procedures associated with “vendors.” The policies and procedures include the requirement that the representatives of post-acute services providers to sign in upon they arrival at the hospitals and SNFs. This is meant to coordinate services in the Purchasing Departments of the hospital. Contrary to this, post-acute providers including hospices, and home medical equipment (HME) companies should not be referred to as “vendors” nor treated in the same manner. These post-acute services providers perform the same post-acute services as the SNFs and hospitals. For this reason, the post-acute services providers should be properly credentialed to demonstrate their expertise in practicing post-acute care. Gaps in Post-acute Providers Credentialing Since most post-acute service providers are not credentialed by recognizable organizations, they face restrictions when they have been called to attend to their patients. The post-acute service providers can see their patients if they have fulfilled two conditions. The first condition is when the post-acute patient sends referral for the providers. Secondly, the providers can attend to a patient if they were taking care of the patients immediately before their admission to the institution. Under the two circumstances, the post-acute providers should be granted the permission to attend to their patients, their families, and all the information about the patient to plan for the discharging process(Alexander, 2011). It is worth noting that referrals for post-acute services do not necessarily have to come from a physician. Thereferrals can come from the patients themselves, their families, case managers, physicians, discharge planners, or from other people. The referrals can be sent to the post-acute providers either in writing or verbally. From the current practices used in handling post-acute providers, it can be deduced that they are not recognized professionally by the institutions providing healthcare services. Moreover, the role played by the post-acute providers in the recovery of the patient is not highly regarded by healthcare institutions. Such issues have attracted many scholars to research on the essence of the post-acute providers in providing care for patients. It has also led to many people questioning the effectiveness of the credentialing authorities(Alexander, 2011). Chapter 3: Conceptual Framework Effective credentialing of post-acute care providers has not been given optimal attention for many years since its necessity has not been straightforward to many healthcare stakeholders. However, the perceived benefits of credentialing the post-acute care providers should be considered. For instance, credentialing of the post-acute providers can advance the safety of health care delivery. It can also improve the quality and processes of health care delivery since all institutions and professionals are evaluated before being credentialed. Another benefit of credentialing of post-acute providers is that it can clarify and define the roles of the post-acute providers (Barr &Mattioli, 2014). To clearly establish causation, the relationship between credentials and outcomes should be defined and explained. Essentially, there should be a clear distinction between the impact of organizational and individual credentialing. Building upon the work represented in the ANCC model, Figure 2 includes a more fully developed framework with potential causal pathways explicitly identified to better characterize “Intervening Variables” and the role of the environment. To implement this framework in research on credentialing, researchers will need to expand the range of concepts incorporated into each cell in the conceptual framework, identify measures for each of the concepts, and develop strategies for obtaining data that allow the measures to be constructed. References Alexander, B. (2011). Fundamentals of health law. Washington, D.C.: American Health Lawyers Association. Barr, S., &Mattioli, M. (2014). Accountable care and integration: A challenge for credentialing and risk management. Journal Of Healthcare Risk Management, 34(1), 28-36. doi:10.1002/jhrm.21147 Eisenberg, D. (2002). Credentialing Complementary and Alternative Medical Providers. Annals Of Internal Medicine, 137(12), 965. doi:10.7326/0003-4819-137-12-200212170-00010 Quigley, R. (1996). Hospital to home. [Elizabeth Vale, S. Aust.]: Northern Domiciliary Care. Somerville, L., Wilding, C., & Bourne, R. (2007). Credentialing, competency, and occupational therapy: What does the future hold?. Australian Occupational Therapy Journal, 54, S98-S101. doi:10.1111/j.1440-1630.2007.00679.x Read More