Healthcare Reform Policy and Patient Safety and Quality - Research Paper Example

Healthcare Reform Policy and Patient Safety/Quality Program Supervisor September 10, Healthcare Reform Policy and Patient Safety/Quality To Err Is Human: Building a Safer Health System This document records that thousands of patients in the United States lose their lives to medical errors. Some of the medical errors identified in this document include improper transfusions and surgeries done on wrong sites. Emergency departments, intensive care units, and operating rooms are some of the places in which errors are highly likely to occur. Physical and psychological discomfort, loss of trust and reduction of satisfaction are some of the other complications that accrue from medical errors besides loss of life. The decentralization of healthcare system, accreditation, licensure, and lack of financial assistance are pertinent factors in medical errors. Availing adequate safety knowledge, establishing a reporting system, and having organizational level safety systems can help arrest the situation with medical errors (Poillon, 1999, pp. 3 - 4). The document gives me the impression that it is explaining that medical errors have serious repercussions, can be reduced, and can serve as learning points. It has underscored the fact that it is not entirely right to hold medical practitioners solely responsible for medical errors without considering the role of the completely healthcare system. The accomplishments of this document are remarkable and will continue to be relevant even in the future (Poillon, 1999, p.5). Crossing the Quality Chasm: a new health system for the 21st Century The document accounts that previously, improvements done on the healthcare system of the United States aimed at improving the quality of care. It is argued that an emphasis on quality has not solved the flaws of the system and several propositions have been made towards this end. These propositions include incorporating safety, efficiency, equity, patient-centeredness, timelines, and effectiveness into the system. These things would have benefits for both patients and clinicians. The document recommends that in such a system, healthcare should be guided by scientific knowledge, patients’ needs, sharing of knowledge and alliance between clinicians and patients. The laid down way on how to realize better results from the proposed healthcare system entails providing care guided by evidence, incorporating information technology, putting payment policies in tandem with quality improvement and streamlining nursing education, accreditation and licensing (Corrigan et. al., 2001, pp. 5 - 6). This document was created to offer insight into how the healthcare system can be integrated with much more than quality. The ideas proposed in it are easy and can help realize a better system at a relatively cheaper cost. The physician portfolios provided by healthcare organizations and physician groups that patients use in seeing care can be credited to the message of this document and are helpful (Corrigan et. al., 2001, pp. 6 - 7). Patient safety: Achieving a new standard for care This IOM document emphasizes on the need to have better information systems in the healthcare system that will help in the reporting and utilization of medical data. It proposes a care delivery system that anticipates and circumvents errors. The system has to allow clinicians to not only report but also share information. There is a proposition to expand the approaches made in previous IOM documents. It is recommended that patient safety be upheld concurrently with quality that will call for the contributions of all stakeholders. Available clinical data needs to be accessible at the point where healthcare is provided in order to make the information infrastructure useful. Standards that can help establish such an efficient information infrastructure are provided including knowledge representation and data exchange (Aspden et. al., 2003, p. 1). The document was meant to help enhance the usefulness of the information systems proposed in other IOM documents and its message is profound. Clinical data would require compiling, analysis, representation, and ease of retrieval. This document has had an indelible mark on the improvement of the information systems of healthcare organizations. Many of these systems are one-stop-shops for many pieces of information important to patients (Aspden et. al., 2003, p. 1). Impacts of Patient Protection and Affordable Care Act on patient safety/quality Positive impact The PPACA establishes the provision of health information on both public and private insurers. This protects the patient from being misinformed or extorted by unscrupulous insurers. Under the PPACA, patients are given sufficient information on their health and this enhances their competency in making decisions about where, when and from whom to seek care. Patients are also given information about the performance of their healthcare providers and this helps in the choice of the best physician. This protects patients from physicians who would pose as qualified in order to attract customers whereas they might not have the required skills. The Institute for Comparative Clinical Effective Research established by the PPACA protects patients by generating knowledge on the state-of-the-art means of healthcare delivery (Werhane & Tieman, 2011, p. 86). It is desirable that the PPACA has increased Medicaid and Medicare coverage so that patients who previously were not covered and who would not afford care can have access. The Act affects patients positively by ensuring that they get quality care through the mandate of penalties on healthcare organizations that do not comply. Patients are assured of quality of care under the Act because it requires healthcare organizations to invest in advanced medical technology. The PPACA protect patients from high costs of healthcare by making hospitals and healthcare organizations merge so that they are able to afford providing healthcare at low costs. The PPACA promotes the provision of quality healthcare by encouraging the giving of incentives to physicians for motivation (Werhane & Tieman, 2011, p. 86). Negative impacts The expansion of Medicare and Medicaid has increased the number of patients that the inadequate number of clinicians has to attend to and this overworks these clinicians. Overworked clinicians have higher chances of committing medical errors hence reduced quality of healthcare. All patients might not enjoy the good quality of care that comes with hospital mergers and acquisitions especially when these mergers and acquisitions monopolize the healthcare marketplace. PPACA has led to the retirement of a good number of elderly physicians leaving younger ones who are not as hardworking and dedicated hence threatening to reduce the quality of care that patients receive. The elderly physicians who retire do so for fear of inability of meeting the requirements of the PPACA and some go into alternative careers and professions (Sanner, 2013). The alternative methods available for paying for healthcare expenses might serve to entrench inequalities in terms of access. For example, some patients will afford same-day healthcare service appointments and will get timely care than those who might have to wait for a number of days to see a physician. Inequalities in access to healthcare might also arise from the ratio of physicians to residents so that states that have lower physician-to-residents ratios will end up faring better under PPACA in terms of morbidity and mortality rates. PPACA might make it difficult, in the medium term, for patients to access care because it limits the scope-of-practice for nurses (Sanner, 2013). Safety gaps in the Patient Protection and Affordable Care Act A safety gap exists in the provision of the PPACA that allows states to opt out of establishing Health Insurance Exchanges. This is because there lacks a corresponding tax credit legislative provision and this can make low-income earners from states that opt out to miss the federal subsidies. Getting employers of large corporations to provide the legally required essential coverage remains a safety gap because the non-deductible penalty of $2,000 is affordable to these corporations. As such, some of these corporations might prefer to be penalized than give coverage to their full-time employees who are above thirty in number (Werhane & Tieman, 2011, p. 87). There are people in some states who do not have coverage despite their eligibility for subsidies. This is because those states have not expanded their Medicaid program to cover those earning up to 138 percent of federal poverty level. The group that is eligible but is still uninsured is that of the people who earn below the poverty level but are above the threshold for Medicaid coverage. This safety gap is amplified when one considers that the safety-net hospitals that fail to expand Medicaid face more serious fiscal pressures than those in other states that have extended eligibility (Rosenbaum, 2011, p. 134). The current inadequacy of doctors poses a safety gap. This is because the implementation of PPACA continues to increase the number of patients who needs care but cannot find it because of the backlog that many doctors are facing. It is saddening to know that legislative attempts at expanding the scope of practice for the available medical practitioners in order to make up for the shortage have been failing. The other gap that exists in PPACA is the fact that some small businesses might fear expanding and growing due to fear of the burden of having to give cover to their employees once they get more than fifty employees. This would mean that the employees who work in those businesses would not enjoy the medical coverage benefits given to their counterparts from big corporations (Sorrell, 2012, paragraph 10). Consideration of the place of the public health system in the working of the PPACA reveals several safety gaps. The system can contribute in providing certain types of clinical preventive care but it has been underexploited. There is a gap in the PPACA in the aspect that public health agencies have not been incorporated to work with health professions training and residency programs in planning for the vast increase in demand for healthcare (Rosenbaum, 2011, p. 134). Finally, the public health system has not been involved actively in translating coverage reforms into improvements in healthcare services. The system could do this by working in conjunction with healthcare providers, insurers, and employers. References Aspden, P., Wolcott, J., Valdivia, D., Loeffler, R. & Corrigan, J. (2003). Patient safety: Achieving a new standard for care. Institute of Medicine, November 2003. Corrigan, J., Donaldson, M., Kohn, L., Maguire, S. & Pike, K. (2001). Crossing the Quality Chasm: A new health system for the 21st Century. Institute of Medicine, March 2001. Poillon, F. (1999). To Err Is Human: Building a Safer Health System. Institute of Medicine, November 1999. Rosenbaum, S. (2011). The patient protection and affordable care act: Implications for public health policy and practice. Public Health Rep., 126(1): 130 – 135. Sanner, A. (2013). PPACA’s newly insured to deepen doctor gap. BenefitsPro. Retrieved September 9, 2014 from http://m.benefitspro.com/2013/06/24/ppacas-newly-insured-to-deepen-doctor-gap Sorrell, J. (2012). Ethics: The Patient Protection and Affordable Care Act: Ethical Perspectives in 21st Century Health Care. The Online Journal of Issues in Nursing, 18(1). Werhane, P. & Tieman, J. (2011). Clearing the bush. Myths that surround the Affordable Care Act. Health Progress, 92(4): 82-87. Read More