NURS 8100 Technology and Cost Containment
NURS 8100 Technology and Cost Containment
A significant challenge to containing health care costs is the price of the equipment and medications needed to diagnose and treat patients and the lack of adequate reimbursement. Bodenheimer and Grumbach (2020), speculate that “the price of prescription drugs in the United States is 50% higher than that in other countries” (p. 94). IN my world the charge for delivering a baby is around $7,500.00. Private insurance companies pay approximately 2/3 of the delivery fee compared to Medicaid covering on average about 20%. This is not sustainable if a hospital operates in a community with high Medicaid rates. Additionally, the quality of health care is directly tied to reimbursement. A hospital that operates with a low-profit margin makes cuts in staffing, replaces needed equipment, and struggles to attract physicians and care providers that provide high-quality care.
One way that Bodenheimer and Grumbach (2020), describe technology being utilized to decrease costs is a broader use of robotic surgeries. Gall bladder surgery, specifically described in the reading from this week can be performed in less time if robotics is used, is less invasive for the patient which decreases the length of stay, and requires less payout to providers who perform the surgery related to the decrease in time.
It is hard to say if I agree or disagree with the policymakers on reducing health care costs. I would say that it depends on how collaborative policymakers are with the individuals who provide healthcare. A few years ago Colorado tried to pass a bill (www.coloradoindependent.com) that was well-intended in the effort to provide broader coverage for the public but wanted to introduce the idea that all hospitals would be reimbursed at Medicare and Medicaid rates to accomplish this. The governor was convinced that hospitals were price gouging and so in his mind reimbursing hospitals at a lower rate made sense. Fortunately, the bill lost momentum with the Covid-19 pandemic and has not resurfaced.
The concept of patient-centered medical homes (PCMHs) according to Rosenthal et al. (2010), continues to be a popular idea. The notion of a PCMH is to provide care to patients in a more coordinated fashion to reduce inefficiencies. One provider guides all of the care of the patients. Although specialists, subspecialties, and acute and long-term care may be needed, the overseeing provider organizes all of this.
Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach. McGraw Hill.
The Colorado Independent. (March, 2020), Update: Colorado’s public/private healthcare option clears first hurdle. Retrieved at https://www.coloradoindependent.com/2020/03/12/colorado-public-option-healthcare/
Rosenthal, M., Beckman, H., Forrest, D., Huang, E., Landon, B., & Lewis, S. (2010). Will the patient-centered medical home improve efficiency and reduce costs for care? A measurement and research agenda. Medical Care Research & Review, 67(4), 476-484.
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In the world today technology is inevitable in all industry sectors. Health care is not an exception. There is an added cost in trying to make technology secure. There are however other costs that are challenging to the health care system and one such cost will be addressed in this discussion.
Significant Challenge to Containing Health Care Costs.
The cost of health care in the United States can be attributed to many reasons. A glimpse of the cost is mentioned as a summation of over four million dollars in the year 2020 alone (Centers for Medicare and Medicaid Services, 2021). Unnecessary emergency room (ER) visits in United States is one of the challenges that make containing health care costs a hard task. According to Rubin, (2021), in the year 2017 alone there were over one hundred and forty-four million ER visits that costed over seventy-six billion. This statistic is alarming.
Health care cost reduction can be achieved by eliminating of unnecessary ER visits (Walden University, Producer (2011). The root cause of these visits can be attributed to numerous factors including underpaying health care providers who opt to send their patients to ER instead of taking care of them in an outpatient clinic.
Cost containment is therefore easier said than done because to reduce ER visits means to have an effective system of health care delivery. One way this would be achievable would be to manage chronic conditions like hypoglycemia without involving ER visit. Knowing how expensive going to the ER can be has led to different interventions being put in place to reduce these visits.
According to Lyons, Olson, Palmer, Horwitz, Mandl & Fine (2017), those who frequent the ER can be identified but unfortunately there are those who use multiple ERs. These patients who visit different ERs may lead to duplicative and unnecessary care.
Policy Makers Envision of Technology
Technology has made it possible for clinicians to access health information from different sources. In the ERs clinicians sometimes have to make quick decisions and with technology it would be possible to have knowledge regarding previous care. Simple information like allergies would be accessible to clinicians. Having history and physical information in a data base that would be accessed at the ER would make the visit less time consuming. According to Ojetti, Covino, Brigida, Petruzziello, Saviano, Migneco, Candelli & Franceschi (2020), sometimes the ER is is viewed by patients as a place to have solutions to health care problems. With technology, the ER clinicians can determine after having access of health care information if a patient needs to be triaged to the next level of care or needs to be discharged.
One example of use of technology is one that is required in the state of Maryland. Chesapeake Regional Information System for our Patients (CRISP). This is the state of Maryland designated health information exchange. As a provider especially in the ER one has to log in to CRISP and is able to see all the scheduled medications that the patient is taking, the last refill, the provider who wrote the prescription and the pharmacy that the medications were filled. This information is critical because there are some patients who visit the ER expecting to be given narcotics when they already have current supply for a month.
Agree or Disagree with the Policy Makers.
The long term effect of using technology remains positive from the point of view of the provider. It is therefore fair to be agreeable with the stakeholders. According to Fereydon, Roghayeh, Ahmad & Mohsen (2020), technology has the ability of having a positive impact in health care improvement in regards to quality, safety, and efficiency. It is however important to acknowledge there would be a cost related to training and implementing and sustaining technology. However, in the ER technology offers critical information for patients that is urgently needed to aid in treatment modalities. This information sharing saves time which in turn saves the cost of treatment.
Centers for Medicare & Medicaid Services. (December, 2021). National Expenditure Data https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical
Fereydon ,E., Roghayeh, S., Ahmad, J., & Mohsen, S. (2020). The Use of Health Information Technology by Nurses in Healthcare. Preventive Care in Nursing and Midwifery Journal, 9(1), 36–39.
Lyons, T. W., Olson, K. L., Palmer, N. P., Horwitz, R., Mandl, K. D., & Fine, A. M. (2017). Patients Visiting Multiple Emergency Departments: Patterns, Costs, and Risk Factors. Academic Emergency Medicine, 24(11), 1349–1357. https://doi.org/10.1111/acem.13304
Ojetti, V., Covino, M., Brigida, M., Petruzziello, C., Saviano, A.,Migneco, A., Candelli, M & Franceschi, F. (2020). Non-COVID Diseases during the Pandemic: Where Have All Other Emergencies Gone? Medicina, 56(512), 512. https://doi.org/10.3390/medicina56100512
Rubin, R. (2021). The Costs of US Emergency Department Visits. JAMA, 325(4), 333. https://doi.org/10.1001/jama.2020.26936
Walden University, LLC. (Executive Producer). (2011). Healthcare policy and advocacy: Cost containment. Baltimore: Author.
In the healthcare industry, nurses’ turnover is a significant challenge to contain health costs. It was ranked third of the top three industries with high turnover, with the nurses’ turnover becoming a rapidly growing human resource problem that affects the healthcare sector worldwide (Cohen, 2019). Its world rate is considered very high, ranging from 15 to 44%, resulting in a significant impact on a hospital’s profit margin, with the average cost of turnover for a nurse ranging from $37,700 to $58,400, and hospitals losing $5.2 million to $8.1 million annually (Lockhart, 2020).
According to the 2019 National Healthcare Retention & RN Staffing Report, it costs between $40,300 and $64,000 to replace one clinical nurse, with the average hospital losing $4.4 million to $6.9 million each year (Lockhart, 2020). The turnover rate for RNs continues to rise, 43 percent of new nurses working in hospitals leave their jobs within three years, and additionally, 33.5 percent resign after two years, and 17.5 percent work only one year (Lockhart, 2020). Nursing turnover is extremely costly for healthcare organizations, which struggle to keep experienced and novice nurses alike, but 18% percent of new nurses change jobs or even professions, within the first year after graduation, and an additional one-third leave within 2 years (Lockhart, 2020). Nationally, the nursing turnover rate averages 19.1% and rising, leaving a nursing vacancy rate of 8%, and the average period it takes to fill a nursing position is 85 days, with more than three months, for a specialized nursing position (Lockhart, 2020).
The hospital managers state that nurse turnover disrupts hospital service operations, staffing processes, managerial processes, hospital revenue, loss of experienced and trained nurses, nurse shortages, and an imbalanced composition of new and remaining nurses, which increases the costs for recruitment and training cost for new hires (Dewanto & Wardhani, 2018). The turnover negatively affects hospital services, revenue is disrupted, due to the decreased work productivity of the new nurses, increased expenses related to new hires’ recruitment, mentoring training to placement, and, because the new nurses require an orientation process, as their skills do not meet the expected standards (Dewanto & Wardhani, 2018). These staffing problems cause issues in setting schedules, necessitating increased overtime, low morale of existing nurses, the less-than-optimal service provided, because of communication, and, barriers between the senior and the new nurses (Dewanto & Wardhani, 2018). The services are heavily impacted, leaving the patients frustrated with frequent replacements, mediocre treatment by a less competent new nurse leading to the patient’s decreased trust, satisfaction, and increased complaints about nursing service (Dewanto & Wardhani, 2018).
The advancements in technology and their implementation can alleviate some of the turnovers by improving workflows and making patient care easier. Technology use can reduce medical care costs. reduce the burden on nurses, motivate more clinicians into the workforce to mitigate the shortage, and improve the transparency of medical records between healthcare organizations (Cohen, 2019). The development of innovative nursing practice models with increased computer technology, to be used for all documentation of patient care, and generation of the electronic medical records (EMRs) is an example (Moore, 2000). There are several other technologies which include including telehealth, artificial intelligence, texting, blockchain credentialing, mobile staffing apps staff augmentation, and artificial Intelligence being some of the tools, which make daily workflows easier for nurses and nurse practitioners amid a shortage of clinicians (Agbo et al., 2019). These tools can help to alleviate the shortage’s effects on nurses and NPs, by improving efficiencies in their daily workflows and how they provide care for patients. Many providers and patients were initially uncomfortable with telehealth, however, the pandemic not only increased adoption but also led to a rise in comfort levels, for those using the technology, allowing nurses and NPs to see more patients in a day (Rojahn, et al., 2016). Blockchain credentialing is an app that allows for a nurse’s credential data to be stored on multiple servers, rather than just a single server, allowing organizations to see entries in real-time, which creates a public electronic ledger, making it easier for healthcare organizations to look up a nurse’s credentials and speed up approvals (Agbo et al., 2019). The mobile staffing apps and staff augmentation, modulate the staffing based on patient volume and acuity, allowing nurses and NPs to see the hospital’s schedule, sign in, swap a shift, or pick up holidays (Mayer et al., 2019). It also allows healthcare organizations to supplement their support staff, through third-party staffing to ensure operations run smoothly, with the clinicians being to able to focus better on patient care and complete their day-to-day tasks efficiently (Mayer et al., 2019). Artificial Intelligence is often applied within healthcare to make sense of clinical data by identifying trends, that can lead to better patient outcomes, and can be used to assess fall risk, or detect tuberculosis in x-rays (Mayer et al., 2019).
I agree with policymakers that technology needs to be more introduced as mainstream in health care because healthcare policies and insights, need to be revolved around a multifaceted approach to address nurses’ shortage and turnover. One insight is the introduction of the electronic medical record (EMR) and other technological advances, which can also affect nurses staying in or leaving the organization (Haddad et al., 2022). Another insight is the electronic scheduling tool, which allows nurses to sign up for individual shifts they are qualified to cover, as well as trade shifts with other nurses with the same skill set when needed, this has the ability not only helps with work-life balance, flexibility but also makes scheduling easier for both nurses and management (Haddad et al., 2022). Social media on job recruitment platforms have become major sources of information for nurses looking for jobs as they provide an opportunity for the organization to communicate, introduce and explain the kind of environment they have, through the reviews provided by both workers and patients (Haddad et al., 2022).
Agbo, C. C., Mahmoud, Q. H., & Eklund, J. M. (2019). Blockchain Technology in Healthcare: A Systematic Review. Healthcare (Basel, Switzerland), 7(2), 56. https://doi.org/10.3390/healthcare7020056
Cohen, J. K. (2019). Tech helping to alleviate nurse shortage, experience gaps. Modern Healthcare, 49(32), 14.
Dewanto, A., Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC Nurs 17, 5. https://doi.org/10.1186/s12912-018-0317-8
Haddad, L. M., Annamaraju, P., &Toney-Butler, T. J. (2022). Nursing Shortage. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/
Lockhart, Lisa. (2020). Strategies to reduce nursing turnover, Nursing Made Incredibly Easy: March/April Volume 18 – Issue 2 – p 56 Doi: 10.1097/01.NME.0000653196.16629.2e
Mayer, M. A., Rodríguez Blanco, O., & Torrejon, A. (2019). Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study. JMIR MHealth and UHealth, 7(11), e15195. https://doi.org/10.2196/15195
Moore P. (2000). Perspectives. How can we help to alleviate the nursing shortage? ONS News, 15(5), 14.