The solution to the Problem
Introduction
The objective of achieving inexpensive and quality care for all has been hindered by the rising costs of health care. Experts assert that if the government fails to intervene and bring down the cost of health care, the mounting charges will limit the ability to provide other services such as education and job creation (Stanton & Rutherford, 2006). Research indicates that the high spending by the government does not automatically translate to quality health care and strategies must be devised to cut down the costs. The high government expenditures have not been effective in guaranteeing quality health care to the citizens, and it is only based on the assumption that increasing medical funding will boost innovation, which may translate into excellent care. This paper will explore the strategies that could be implemented to bring down the mounting costs of health care in various facilities while at the same time ensuring that quality is guaranteed.
Background for the Selection of the Solutions
The recommended solutions are based on research findings documented in the currently available literature. Various researchers have embarked on research to establish their effectiveness in lowering the cost of medical care in the US (Olsen & Young, 2010). Different experts and economists concur that the recommended solutions may go a long way in cutting down the cost of care that has exhibited an increasing trend over the past few decades. The huge government expenditures on health are likely to deter the ability to provide other crucial services to the citizens. Therefore, effective solutions should be premised on the various recommendations by experts and financial analysts.
Bundled Payments
This strategy involves paying a lump sum amount for the entire services given to a patient as opposed to separate payments. Under the traditional system, payments are made separately to the various units involved in the provision of care (Stanton & Rutherford, 2006). For a patient requiring cardiac bypass surgery, for example, the first payment is made to the facility in which the services are offered, the second to the surgeon, and the last is made to the anesthesiologist. Breaking down the payment provides an incentive for the medical practitioners to earn more thus increasing the cost of care. Most insurance companies have adopted a strategy that makes a single payment for all the services given to a patient. Making a lump sum payment ensures that the medical practitioners work towards reducing the overall cost.
Implementation Process
The implementation of this strategy involves obtaining consent from all the stakeholders involved in the provision of care. The main stakeholders in this strategy are nurses, physicians, and insurance companies (Olsen & Young, 2010). Medical practitioners’ role includes ensuring that the actual costs do not exceed the budgeted ones. In maintaining the cost of care low, medical experts must ensure that the quality is not compromised. The strategy involves cooperation between caregivers and insurance companies to implement it successfully.
The Role of Nurses
Registered nurses are the primary stakeholders in the implementation of the mentioned strategy. They are directly involved in the provision of care to patients. Information collected by the nurses in the course of dispensing their mandate is useful in determining the cost to be paid by insurance companies for certain services (Price III, 2012). In addition, nurses are directly responsible for regulating the medical budget. Hence, the involvement of registered nurses in the implementation process is of great essence.
Accountable Care Organizations (ACO)
This strategy involves the partnership between healthcare providers and medical insurance companies with the aim of cutting down the cost of care. The partnership is premised on an agreement of sharing the responsibility of ensuring that a certain population of patients receives quality clinical care at a reduced cost. In some cases, healthcare personnel agrees to take responsibility in case the actual costs exceed the budgeted outlay. This ensures the successful regulation of expenditures (Price III, 2012). Under the plan, all the stakeholders entailed benefited from a share of the surplus.
Implementation
The first step in ACO involves determining the cost of providing medical services to the population concerned. This is done through the evaluation of the information gathered by nurses and other health practitioners in the process of providing care. The estimated cost is then screened, and a budget formulated. The costs are paid by an insurance company, and all the stakeholders are apprised of their role in ensuring reduced charges (Price III, 2012). The surplus is shared among the stakeholders upon successfully providing quality services to the target patients.
Nursing Role
The role of nurses in ACO cannot be overlooked since they are crucial stakeholders in the implementation of the strategy. Nurses assist in determining the costs to be paid by an insurance company. This is enhanced by their knowledge regarding individual patient needs. According to Olsen and Young (2010), the details gathered by nurses from their direct engagement with patients are helpful in budget formulation. Such information acts as the basis on which costs are determined.
Conclusion
The topic of the solution to the rising cost of care in the US has ignited a heated debate among financial analysts. Various experts propose varying solutions to the problem. Bundled payments and ACO are the two solutions that have been identified in this study. The two are appropriate measures of cutting down the costs of care. They involve the formulation of the financial plan prior to the commencement of the process of providing care and ensuring that the actual cost does not exceed the budgeted one.
References
Olsen, L., & Young, P. L. (2010). The healthcare imperative: lowering costs and improving outcomes. Washington, D.C.: National Academies Press.
Price III, J. F. (2012). The new frontier of healthcare: Accountable care organizations and the changing interplay among quality, cost, and peer review. The University of Detroit Mercy Law Review, 90(1), 121.
Stanton, M. W., & Rutherford, M. K. (2006). The high concentration of US health care expenditures. Rockville, Maryland: Agency for Healthcare Research and Quality.