The cost of care has in recent years become a focal point along which the quality of care can be determined. Cost effectiveness is today a major strategy in the metrics of care quality and the effective utilization of resources and it is regarded as a defining patient outcome. While the quality of care has significantly improved in relation to the advanced technologies, it is also without doubt that the determination of costs and values need to be based on affordability of these services by the population (Mountford, p.520). This does not necessarily mean that the costs of care have to be cut down substantially to reflect this position. Rather, it implies that the available resources have to be utilized and optimized in the best possible manner.
The role of nurses in optimizing the available resources in care facilities comes in handy. The nurses are expected to demonstrate a level of accountability and leadership in the management of resources availed to them by the respective authorities (Mountford,p. 520). In an era where most of the services within the healthcare sector are funded through the Medicare plan, the federal government which supports and funds this plan requires that care facilities and the healthcare providers show cause for all the funds availed to them (Mountford, p. 520). One particular method has been the coding of services to ensure that the healthcare providers do not collaborate with the insurance providers to con the government for services that have not been rendered. On the other hand and in reflection of the increased role of nurses in ensuring the sustainability of the healthcare sector, the Center for Medical Services has redefined the rules and regulations that govern the reimbursement of funds (Centers for Medicare & Medicaid Services, par.7).
Medical errors have been regarded as one of the areas in which the costs of care have significantly been on a rise. This is in spite of the fact that most medical errors are preventable. On the other hand, the government has spent a significant quantity of resources in education, training and facilitation of the policies and regulations on patient safety and thus demanding a return on investment of the same. In the realization that medical errors have been a channel on which the Medicare has been strained financially, the CMS then developed the new reimbursements regulations in which more accountability was demanded for the nurses and healthcare providers (Centers for Medicare & Medicaid Services, par.14). In this case, the CMS sought to transfer the responsibility of catering for these medical errors from the Medicare kitty to the financial kitty of each respective care facility. In this regard, this method would help shift more responsibility to the internal organs of the care facilities to help eliminate or minimize the occurrence of medical errors or never events by insisting more on policy adherence and taking legal, ethical and financial responsibility of the same (Centers for Medicare & Medicaid Services, par.8).
Never events in description are those conditions that the patient acquires while within the healthcare facility and have been ascertained as preventable when all measures of patient safety are active (Crist, 437). When the healthcare facilities fail to activate their patient safety platforms and measures and ensure adherence, then they have to take full financial responsibility. Apparently, this could be enough signals to the administrators and policy measures within these organizations that they have loopholes in their patient safety policy (Crist, p. 437). These reimbursements rules thus help increase the accuracy and precision of the nurses and the physicians while diagnosing the patient and therefore increase the chances of misses (Crist, p. 437). Further, in the knowledge that the patient’s subjective data would help eliminate the chances of misdiagnosis or misses, these reimbursements rules have further enhanced the relationship between the patient and the care provider all which is a positive step in the achievement in the context of patient-centered care (Centers for Medicare & Medicaid Services, par. 3).
Works Cited
Centers for Medicare & Medicaid Services. "2008-07-31 - Centers for Medicare & Medicaid Services." MEDICARE AND MEDICAID MOVE AGGRESSIVELY TO ENCOURAGE GREATER PATIENT SAFETY IN HOSPITALS AND REDUCE NEVER EVENTS. N.p., 2009. Web. 29 Jan. 2016.
Crist, John. "Never Say Never: Never Events in Medicare." Health Matrix 20 (2010): 437.
Mountford, James, and Kaveh G. Shojania. "Refocusing quality measurement to best support quality improvement: local ownership of quality measurement by clinicians." BMJ quality & safety 21.6 (2012): 519-523.
