Major Challenges and Opportunities to Providing Cost-Effective Health Services - Essay Example

Mt. Sinai Hospital Board of Directors Staff Advisor February 18, RE: Major Challenges and Opportunities to providing cost-effective, high quality health services during the coming 3 to 5 years I believe you are aware of the fact that many individuals in the U.S. are unable to access health care services as a result of the ever rising cost of care. You are also aware that a large proportion of Americans cannot afford health insurance thus the inability to access quality and affordable care. Figures from the Kaiser Family Foundation (2015) shows that approximately 41 million individuals in the U.S. were not covered by health insurance in the year 2013. This, as you can see, presents a worrying trend and conversely has negative effects on the general health of the society. There is need for formulation and implementation of strategies aimed at providing cost-effective and high quality care to our clients, and for identification of opportunities that could help address this problem. Major Challenges One of the challenges affecting the provision of quality care relates to information technology. Electronic Health Records (EHR) pose the greatest challenge in our institution and the health care sector in general. Though the use of EHR has improved effectiveness of services, our physicians spend much of their time entering patients information in these systems. This significantly reduces the amount of time the physicians spend with their patients. Quality of care also depends on the relationship between physicians and their patients. EHR elevates the likelihood of breach of confidentiality as multiple personnel can access sensitive patients information at the same time. In cases where patients have a distrustful relationship with their physicians and other care providers for fear of breach of confidentiality, quality of care is compromised and the patient may withhold crucial information. Secondly, quality and affordability of health care services is compromised by access to Medicaid. A methodical investigation conducted by the Heritage Foundation showed that individuals under Medicaid receive lower quality services (Blase, 2011). This is attributed to the fact that individuals under Medicaid pay lower rates and are therefore allocated to physicians with less advanced skills. Expert physicians and surgeons on the other hand are allocated to individuals who can afford specialized care. Health care providers are also reluctant to take-in patients under Medicaid due to the huge paperwork associated with reimbursements (Paradise and Garfield, 2013). Since Medicaid has been expanded under Obamacare, the number of individual depending on the few physicians available has increased in proportion. As a result, medical errors have increased and quality of care has therefore been compromised. Thirdly, low reimbursement rates have greatly affected the quality and affordability of health care services. A study conducted between 2004 and 2005 by the Heritage Foundation notes that "Only about half of American physicians accept all new Medicaid Patients. Of those physicians accepting new patients, 51 percent receive more than 30 percent of their revenue from Medicaid patients" (Blase, 2011, para. 14). Under Obamacare, healthcare providers receiving reimbursements from Medicaid had their reimbursements cut by 43 percent for primary care (Blase, 2011). This has made it difficult for physicians to accept Medicaid patients hence making it difficult for such individuals to receive quality care. Opportunities As mentioned earlier, the proportion of individuals under Medicaid depending on the low number of physicians available has made accessibility to quality care impossible. To realize affordable and quality care, one area of opportunity relates to the nurses attending these individuals. Before explicating how nurses can help improve quality and affordability of care, it would be important to note the challenges faced by nurses. Joel (2013) asserts that nurses lack access to education systems that allow them to advance their skills and advance in terms of levels, and also lack opportunities to act as partners. In the next 3 to 5 years, nurses will need these skills and opportunities if quality and affordable care is to be achieved. Nurses are considered the primary care givers. In this regard, implementing programs that allow training of new nurses, advancement of skills, and action plans that allow nurses to collaborate with the few number of physicians will greatly improve service delivery. There is also an opportunity in terms of information technology. People are increasingly embracing technology all over the world with an estimated 2.8 billion people using the internet today (Joel, 2013). This presents an opportunity. Healthcare providers in the next 3 to 5 years will need to take advantage of the increasing number of people using the internet to access them in terms of giving prescriptions electronically as well as giving advice through e-mails and other social networking sites. Improving access to health information, for instance healthy lifestyles can help reduce the health status of the community and hence a reduction of the number of people visiting health clinics. Fewer number of patients translates to improved quality as the available physicians can spend more with each patient. Source: http://www.futuretimeline.net/subject/computers-internet.htm To achieve affordable and quality care in the next 3-5 years, it would also be important to employ better techniques of data collection and structuring better information systems (Joel, 2013). Data collection as an opportunity directly relates to information technology. It should focus on actionable information and hence form the basis for eradication of disproportionate delivery of services. Implementing better data collection methods in the next three years could also present actionable data to the government and other policy makers and as well drive healthcare reforms to allow individuals to access quality care at affordable rates (Joel, 2013). In relation to breach of confidentiality, distrust between physicians and patients can be countered through employing effective security systems to protect patients information from being accessed by third parties (Joel, 2013). In this regard, the opportunity for quality improvement involves data security. In our institution for example, EHR should be protected using passwords. Accountability in relation to these passwords ought to lie on a few individuals proved to have high moral or ethical standards. Patients are more likely visit clinics where security of their medical information is guaranteed. Another area of opportunity involves shifting from a fee-for-service system to systems that encourage and reward providers who give quality care. In the next few years, patients must conform to the requirements of paying for quality as opposed to paying for services. Insurance companies also ought to focus on rewarding or giving incentives to providers who deliver quality care. Conclusion As the Board of Directors, you should ensure areas that pose challenges to provision of quality care as well as issues that may lead to an increase in healthcare costs are addressed. Challenges to providing quality and affordable care include breach of confidentiality resulting from improper use of technology, Medicaid, and low reimbursements. Medicaid for example has led to an increase in the number of people depending on the few available physicians. As a result, the few physicians find it difficult to handle the soaring number of patients contributing to increased medical errors and reduction of time spent with each patient. This contributes to poor quality of services. Medical errors also increases cost of care as the hospital must incur extra expenses to correct the errors. Training more nurses, shifting to more effective data collection methods, and securing patients information can help improve delivery of services and conversely reduce costs and improve quality. References Blase, B. (2011, May 5). Medicaid Provides Poor Quality Care: What the Research Shows. The Heritage Foundation. Retrieved from http://www.heritage.org/research/reports/2011/05/medicaid-provides-poor-quality- care-what-the-research-shows Joel, L. A. (2013). Advanced Practice Nursing: Essentials of Role Development (3rd ed). Philadelphia, PA: F. A Davis Company. Kaiser Family Foundation. (2015). Key Facts about the Uninsured Population. Retrieved from http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ Paradise, J., & Garfield, R. (2013). What is Medicaids Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight. Retrieved from http://kff.org/report-section/what-is-medicaids-impact-on-access-to-care-health- outcomes-and-quality-of-care-setting-the-record-straight-on-the-evidence-issue-brief/ Read More