Access, Cost, and Quality of Quality Environments and Initiatives for APNs

Access, Cost, and Quality for APNs
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Access, Cost, and Quality for APNs
Introduction
Several factors drive healthcare transformation in the United States (U.S.), including access problems, fragmentation, unsustainable costs, disparities, and suboptimal outcomes. Health care quality requirements and cost issues coupled with the ever-evolving social and illness-type demographics create the need for urgent changes. Other significant concerns in the healthcare system include caring for and reimbursing for medical treatments for clients with chronic illnesses. Obamacare (the Affordable Care Act) introduced programs via the Centers for Medicare and Medicaid Services to control costs and enhance quality. This paper discusses the access, cost, and quality of quality environments and recent quality initiatives in the U.S. healthcare system. In addition, the report reflects on the connection between quality measures, evaluation, and role development, including potential changes in the role of Advanced Practice Nurses (APNs) when the system lacks effective quality measures.
Access, Cost, Quality of Quality Environments, and Recent Quality Initiatives
Healthcare access is the ease with which an individual can obtain necessary healthcare. It is conceptualized as an individual’s opportunity to utilize proper services commensurate to medical care needs. An opportunity to obtain health care exists in the availability of services. However, such opportunities are constrained by other factors such as cultural, organizational, financial, and social issues. In this vein, the access levels impact the utilization of health care services and, thus, the population or individual’s health status. Even before the Covid-19 pandemic, access was a significant issue in the U.S. health care system. Today, evidence indicates that socioeconomic and racial disparities within the populations impacted by Covid-19 significantly contribute to reduced access and utilization of medical care services (Núñez, Sreeganga, & Ramaprasad, 2021). Consequently, inaccessible or inadequate access to medical care services exacerbates the existing structural disadvantages, exerting more pressure on the system.
Healthcare costs in the U.S have drastically increased over the past six decades to 2020. Regrettably, U.S. healthcare costs constitute one of the highest globally. The U.S. healthcare expenditure reached $4.1 trillion in 2020, averaging more than $12,500 per individual. The average healthcare cost per person in the Organization for Economic Co-operation and Development (OECD) is approximately one-third of the U.S. The constant rise in healthcare spending can be conceptualized as a utilization function (the volume of healthcare services used) and price (dollars paid for such services). The most notable underlying factors that augment utilization and price include healthcare prices and the aging population. The aforementioned factors boost healthcare expenditure (Peter G. Peterson Foundation, 2022). The cost of medical care services grows typically faster compared to the cost of other services in the economy, thus making price a significant driver of medical care expenditures in the U.S. In contrast, expenditure growth initially slackened after the introduction of Obamacare, and it has continued to accelerate once gained (Shrank et al., 2021). Shrank and colleagues further noted that the consequences of rising healthcare costs are well documented and include a rising national debt, stagnant wages, rising financial insecurity among the populations, and strained local, stage, and federal budgets.
Figure 1: National health expenditures (Peter G. Peterson Foundation, 2022).
According to the Institute of Medicine (IOM), quality is the degree to which medical care services for populations and individuals enhance the chances of attaining desirable outcomes and consistency with existing professional knowledge (Seelbach & Brannan, 2021). The healthcare system is tailored to offer ideal medical services from a competent provider within a proper environment for a given patient. The quality environment faces significant complexities and inefficiencies that undermine the overall quality outcomes of the healthcare system (Chemweno, 2021). It is increasingly challenging to deliver ideal care dues to poor access to medical care services, rising health care costs, and diminished competition among medical providers because of constrained diversity of services and shortage of nurse professionals (Bhatt & Bathija, 2018). Despite the U.S. leadership in cutting-edge medical technologies and medical research, the quality landscape faces significant problems, including poor amenable death rates, preventable healthcare mistakes, and lack of transparency and patient-centeredness in treatment. Americans also find it difficult to locate a competent physician (Chemweno, 2021). Chemweno further argued shortage of physicians, specialists, and nurses in health centers and hospitals has made it increasingly challenging for Americans to obtain the best quality health care they need.
Due to cost reduction and quality improvements efforts, the previous eight years were characterized by new reimbursement reforms initiatives. The Centers for Medicare & Medicaid Services has played a critical role in the shift to value-centered payment through various programs designed within the Affordable Care Act (ACA) framework (Maddox, Bauchner, & Fontanarosa, 2019). This entails instituting compulsory hospital-based plans such as Hospital Readmissions Reduction Program, ambulatory care reimbursement programs such as the Merit-based Incentive Payment System, and voluntary initiatives such as bundled payments and accountable care organizations (Maddox, Bauchner, & Fontanarosa, 2019). The ACA encouraged illness prevention and wellness, increased patient protections, and promoted evidence-based treatment approaches to enhance quality. In addition, there are efforts to develop cons...