NURS-FPX 4050: COORDINATING PATIENT CENTERED CARE Ethical and Policy Factors in Care Coordination

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NURS-FPX 4050: COORDINATING PATIENT CENTERED CARE Ethical and Policy Factors in Care Coordination

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Transcript FPX 4050 assessment 2
Coordinating Patient Centered Care

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Capella University
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Coordinating Patient Centered Care (FPX4050)
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Carissa Floyd
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ETHICAL AND POLICY FACTORS IN CARE COORDINATION 1
Ethical and Policy Factors in Care Coordination
Carissa Floyd
Capella University
NURS-FPX-4050 Coordinating Patient-Centered Care
Cynthia Payne
June 21, 2022
ETHICAL AND POLICY FACTORS IN CARE COORDINATION 2
Ethical and Policy Factors in Care Coordination
The Agency for Healthcare Research and Quality defines care coordination as the
deliberate organization of patient care activities between two or more participants (including the
patient) involved in a patient’s care to facilitate the appropriate delivery of healthcare services
(Anderson, 2021). The American Nurses Association (ANA) states that care coordination is a
competency and core standard for which registered nurses are educated and qualified. Nurses
coordinate care guided by patient and family preferences and needs and play a critical role in
obtaining quality care, patient satisfaction, and effective but efficient use of healthcare resources
(Anderson, 2021).
Affected Organization
HopeHealth was founded in 1991 as an HIV/AIDS support organization. In 2004,
HopeHealth was designated as a Federally Qualified Health Center expanding its services to
include primary and pediatric care. HopeHealth now has 100 providers providing an array of
services to five counties in South Carolina. Those services include, in addition to HIV care,
primary care, pain management, behavioral health/ psychiatry, geriatrics, pediatrics, dentistry,
substance use treatment, women’s health, chiropractic, endocrinology, and rheumatology.
HopeHealth provides primary and specialty services to patients regardless of insurance status and
utilizes a sliding scale fee plan.
Policies Affecting Care Coordination
The Affordable Care Act (ACA) was signed into law by President Obama on March 3,

2010. The goals were to ensure all Americans had greater access to care, increase the quality of
      care, and reduce healthcare spending (Collins & Saylor, 2018). The geriatric population has both
      benefitted and met challenges with this legislation. Medicare now provides full coverage for
      ETHICAL AND POLICY FACTORS IN CARE COORDINATION 3
      preventative services and expanded prescription benefits including discounted name-brand drugs.
      Medicare has also increased coverage for psychological health services to 80% but the ACA
      specification that private insurance must provide consistent treatment for both physical and
      mental illness does not apply to Medicare. The care of geriatric patients is more time-consuming
      due to their complex care needs, polypharmacy, and comorbidities. The benefit to providers who
      care for this population is decreasing. As a result, only 55% of psychiatrists accept Medicare,
      compared to a rate of 86% accepting private insurance, diminishing access to quality care for
      these patients (Collins & Saylor, 2018).
      The Health Insurance Portability and Accountability Act of 1996 (HIPPA) was written
      and included the privacy and security rules listing general restrictions for health information
      privacy. Healthcare providers who once relied on ethics in the handling of patient information
      now had law-binding guidance that established the right of privacy to all patients. The HIPPA
      privacy rule establishes standards for the protection of protected health information (PHI) and
      who can use and disclose this information (covered entities). The privacy rule also sets standards
      for patients’ rights to understand and control how their PHI is used. The security rule establishes
      standards to protect electronic PHI that is created, received, used, or maintained by covered
      entities. The security rule requires appropriate safeguards to ensure confidentiality, integrity, and
      security of electronic PHI (Health Information Privacy, n.d.). Most of the issues of care
      coordination related to HIPPA stem from misconceptions and perceived barriers about what kind
      of patient information can be shared in the coordination of care (Ezell et al., 2021). HIPPA is
      only meant to protect patient privacy. Since the patient has a right to control and understand how
      the PHI is being used, the patient can become more involved in developing their plan of care by
      controlling, choosing, and understanding where the PHI is being shared.
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      ETHICAL AND POLICY FACTORS IN CARE COORDINATION 4
      Ethical Considerations Affecting Care Coordination
      Nurses must adhere to the ethical principle of justice. Patients have a right to fair and
      impartial care no matter their insurance status or financial resources, gender identification, age,
      or ethnicity. Nursing decisions must be based upon fairness. Nurses coordinating care for elderly
      patients with Medicare face the challenges of ensuring patients receive the care they need. As
      previously noted, care of the elderly is more time-consuming for providers. Medicare
      reimbursement is often inadequate, leading many providers and systems to stop accepting
      Medicare, further decreasing access to safe, quality care for this patient population.
      Beneficence is doing what is best for patients. Between 2010 and 2030, the number of
      adults over the age of 65 is predicted to increase by at least 55%. Inadequate numbers of mental
      health providers are expected in the coming years but there is an even greater concern in the lack
      of providers for the geriatric population. Mental health issues among the elderly are associated
      with poor outcomes including nursing home placement, hospitalization, suicide, increased
      mortality, and higher costs (Kunik et al., 2016). One in five older adults is identified as having at
      least one mental health disorder (Collins & Saylor, 2018). There is a critical need for nurses and
      providers to specialize in geriatric care but there is little incentive to do so with geriatric
      practitioners frequently earning less than practitioners of other specialties (Collins & Saylor,
      2018). Nurses have a duty to advocate for what is best for patients. This can be challenging when
      policies create barriers to specialized care.
      Nursing Code of Ethics and the Continuum of Care
      The American Nurses Association (ANA) code of ethics consists of nine provisions to
      guide nurses in ethical decision-making and practice. Codes one through three speak to the
      nurse’s commitment to the patient and practicing with respect for the patient’s dignity and
      ETHICAL AND POLICY FACTORS IN CARE COORDINATION 5
      respecting the patient’s rights and safety. Every patient needs a plan that is coordinated and
      tailored specifically with their needs and wishes in mind. Provision four acknowledges the
      nurse’s obligation to act in a way that promotes optimal care of the patient. Nurses must
      coordinate care to ensure patients have the best chance at good outcomes. Provisions five and
      seven promote the nurse’s duty to maintain competency and continue professional growth, as
      well as use research to advance the profession. Care coordination requires staying up to date on
      emerging evidence, healthcare, and community resources to assist patients with their needs.
      Provisions eight and nine speak on the nurse’s duty to collaborate with other health professionals
      to promote health, reduce disparities, and integrate social justice into health policy. Centers for
      Disease Control (CDC) Healthy People 2020 initiative set goals: to attain high-quality, longer
      lives free of preventable disease, disability, injury, and premature death. Achieve health equity,
      eliminate disparities, and improve the health of all groups. Create social and physical
      environments that promote good health for all. Promote quality of life, healthy development, and
      healthy behaviors across all life stages. One of the social determinants of health is access to
      health care. If healthcare providers fail to provide more value to patients using fewer resources,
      access to quality healthcare may be diminished for older adults (Collins & Saylor, 2018).
      ETHICAL AND POLICY FACTORS IN CARE COORDINATION 6
      Click or tap here to enter text.
      Anderson, A. (2021). Care coordination: A concept analysis. AJN, 121(12), 30–38.
      Collins, B. L., & Saylor, J. (2018). The affordable care act. Nursing Management, 49(8), 42–48.
      https://doi.org/10.1097/01.numa.0000538917.37912.d4
      Ezell, J. M., Hamdi, S., & Borrero, N. (2021). Approaches to addressing nonmedical services and
      care coordination needs for older adults. Research on Aging, 44(3-4), 323–333.
      https://doi.org/10.1177/01640275211033929
      Gaines, K. (2021, July 22). What is the nursing code of ethics? Nurse.org.
      https://nurse.org/education/nursing-code-of-ethics/
      Health information privacy. (n.d.). U.S. Department of Health and Human Services. Retrieved
      June 21, 2022, from hhs.gov
      Kunik, M. E., Mills, W. L., Amspoker, A. B., Cully, J. A., Kraus-Schuman, C., Stanley, M., &
      Wilson, N. L. (2016). Expanding the geriatric mental health workforce through utilization
      of non-licensed providers. Aging & Mental Health, 21(9), 954–960.
      https://doi.org/10.1080/13607863.2016.1186150
      Social determinants of health. (n.d.). Healthypeople.gov. Retrieved June 21, 2022, from
      Https://www.healthypeople.gov/2020/topics/social-determiants-of-health
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NURS-FPX 4050: COORDINATING PATIENT CENTERED CARE Ethical and Policy Factors in Care Coordination