Health Care Delivery Models and Nursing Practice

Reform of the U.S. healthcare delivery system Name Institution Course Instructor Date Reform of the U.S. healthcare delivery system Introduction Recently, the U.S. healthcare system has changed and reformed by introducing more integrated and advanced systems that are beneficial to the patient, more transparent, and cost-effective. One of these reforms is the policy of new laws and regulations that are relevant to different aspects of health care, including nursing practice. This paper aims to discuss one of the recent healthcare regulations, the influence of the given regulation on nursing, and the changes in the functions of a nurse in the current environment. CMS Interoperability and Prior Authorization Final Rule CMS Interoperability and Prior Authorization Final Rule, adopted in January 2021, is a relatively large-scale regulation primarily designed to optimize prior authorization systems and improve patient access to necessary care. This rule requires the utilization of prior authorization techniques in electronic form. It imposes specific timeframes for decision-making, eliminating delays that patients usually go through to have their required medical services authorized. Effects on Nursing Practice This regulation is fundamental in the scope of nursing practice. Nurses are primarily involved in prior authorization procedures, which they perform as facilitators between patients, doctors, and insurance providers. The new electronic prior authorization system presents more convenience to nurses while cutting the time they spend on paperwork, thus improving the time they offer to patients. Furthermore, fast-tracking decision-making procedures ensures that the patients get their treatment on time, improving their general health status and satisfaction. The shift towards interoperability will entail nurses working with the new technologies and electronic health record systems. This change presents a continuous learning need to the nurses so that they can master the handling of the systems and, in turn, harness them for better delivery of services to the patients. The possibility of exchanging patient records across contexts can improve the quality of care, decrease the rate of mistakes, and boost the overall results of treatment (Okolo et al., 2024). Quality Measures and Pay for Performance Quality measures and pay-for-performance (P4P) programs are intended to enhance healthcare quality by associating outcomes with financial rewards for healthcare providers (Kovacs et al., 2020). Such programs assess the providers on quality indicators such as the patient’s condition, guidelines adherence, and patient's perceptions of the care. Effects on Patient Outcomes and Nursing Practice Quality measures and pay-for-performance programs influence patient outcomes since they improve clients' understanding of evidence-based practices and providers' general attention to high-quality services. In these programs, skilled overseeing focuses on highlighting the abilities to put into practice comprehensive quality care as well as reaching principled standards of practice for nurses. It is required that nurses perform to the best practice expected of them, continue to update themselves in the profession, and support quality improvement processes in the facilities where they work. Concerning quality measures a...