Ethical and Policy Factors in Care Coordination

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Hi, my name is — and today, I am presenting the policy and ethical factors that impact care coordination.

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Now, I will discuss care coordination, a major demand of the healthcare organization. According to the Agency of Healthcare Research and Quality (AHRQ), care coordination is the process in which the interdisciplinary team shares patient medical information with the relevant team members to deliberately manage the activities of patient care through better collective decision-making (AHRQ, 2018). Care coordination focuses on the needs of the patient to provide high-quality patient care services and better communication with healthcare professionals (Karam et al., 2023). In a healthcare setting, nursing staff needs to consider professional ethics and healthcare policies to avoid any ethical dilemmas and consequences. I have selected nursing homes as the targeted community to elaborate on policy and ethical issues that can be encountered while providing care coordination to them. 

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Governmental Policies Related to the Health and Safety of a Community

Governmental policies in the US are helping people access affordable healthcare services by providing them with healthcare insurance. Government policies are in favor of the community’s well-being and also protect people from healthcare disparities by ensuring everyone has access to safe and quality patient care services. In the US several policies are available that offer healthcare coverage to the community but the Affordable Care Act (ACA) is highly recognized (Gee & Waldrop, 2021). The targeted community is nursing homes, so the Nursing Home Transparency and Improvement Act is the second governmental policy that ensures community safety and health (Gee & Waldrop, 2021). The third policy is HIPPA (Health Insurance Portability and Accountability Act) for patient medical information protection (Sivilli, 2023). 

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Clear Examples of Specific Policies Affecting Care Coordination

ACA is known as the most comprehensive healthcare policy that has three primary goals. At first, the policy ensures affordable health insurance, expands healthcare coverage to people with low socio-economic opportunities, and supports the methods of patient care provision that reduce healthcare costs (HHS, 2022). In care coordination, ACA affects at multiple levels such as making healthcare quality improved by offering affordable health insurance to people. ACA also works for the wellness of society through disease prevention programs. 

In nursing homes, people have pre-existing diseases such as pneumonia, chronic obstructive pulmonary disease, high blood pressure, and cardiovascular diseases. People having pre-existing medical conditions can access high-quality healthcare services under the ACA. The patient can get treatment from skilled healthcare staff in nursing homes. ACA is affecting care coordination because people these days can afford healthcare services due to insurance and they prefer to not neglect healthcare conditions. It is helping in controlling the rate of diseases. In nursing homes, healthcare screening enables the patient to get on-time medical access which reduces the rate of mortalities and morbidities. 

ACA also introduced the Hospital Readmission Reduction Program (HRRP) to penalize organizations including all nursing homes for the high rate of patient re-admission (CMS, 2022). HRRP encouraged healthcare organizations to improve care coordination and communication for better caregivers and patient engagement in their hospital discharge plans which ultimately leads to a controlled rate of re-admissions (CMS, 2022). In the American Healthcare system, HRRP brought an improvement because it also incentivized healthcare systems to improve their care coordination practices by engaging patients in their post-discharge planning (CMS, 2022).

In nursing homes, the major complexity is to make sure that everyone is getting high-quality healthcare services and good communication with the healthcare providers. The Nursing Home Transparency and Improvement Act affects care coordination and brings reform in nursing homes by improving the transparency of patient medical information (Nursing Home Lawyers, 2020). The policy ensures the accountability of the nursing home’s patient care providers for the offered healthcare services. Patients can question the standard of healthcare the nursing homes offer. The policy also implements ethical programs to evaluate administrative and civil violations in nursing homes along with performance and quality improvement programs (Grabowski, 2022). 

In 1996, the federal government of the United States passed HIPAA compliance to safeguard the confidentiality of patient’s health information by forbidding the dissemination of such information without first obtaining the patients’ permission (Sivilli, 2023). HIPPA regulations are introduced to prevent medical data privacy breaches or other improper use of medical records. In care coordination, HIPPA is affected by keeping patient medical information safe, ensuring the safe transfer of patient information between healthcare providers, and making strict penalties against patient data privacy breaches (Sivilli, 2023).

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National, State, and Local Policy Provisions that Raise Ethical Questions

Now, I will discuss the two local and state policy provisions that helped the community but raised some ethical questions. The first policy under discussion is ACA and the second policy is HRRP (Hospital Readmission Reduction Program) (USA Gov, 2019).

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Ethical Dilemma for ACA, its Implication and Consequences 

The ACA is one of the most popular healthcare policies in the US that provides healthcare coverage to millions of people (USA Gov, 2019). The provision of healthcare insurance is highly beneficial to providing healthcare services to lower socio-economic communities and unprivileged and disabled people (Sommers, 2020). The ethical concerns highlighted by ACA are linked to healthcare costs. ACA aimed to control healthcare costs and improve healthcare quality and coverage (Isola & Reddivari, 2021). ACA fulfilled the needs of insured people but for uninsured people, the healthcare cost remained unable to bear. Due to a lack of insurance, the patient faced the complications of partial treatments that were not available (Crowley & Bornstein, 2019).

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Ethical Dilemma for HRRP, its Implication, and Consequences 

The government’s hospital readmission reduction policy initiative is another measure with potential ethical concerns. The HRRP had a good idea at its core since it helped doctors and nurses to shape more meaningful and honest relationships with patients (CMS, 2022). HRRP reduced the rate of patient re-admissions, reduced healthcare costs, and enhanced patient satisfaction and healthcare quality (CMS, 2022). Nonetheless, this program gave rise to ethical concerns. The HRRP raises the possibility of miscommunication between patient and healthcare provider because the effort to control the rate of re-admissions reduced the focus and attention of the healthcare providers on better health diagnosis. It leads to incorrect diagnoses and hospital administration denial to admit patients for re-admission (Gai & Pachamanova, 2019). 

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Impact of the Nursing Code of Ethics on Coordination and Continuum of Care

In the nursing profession, the code of ethics is a guide to performing professional duty with proper consideration and honesty. American Nurses Association (ANA) is responsible for defining the nursing code of ethics. According to ANA the nursing code of ethics is highly essential to shaping nurse behavior and improving their performance in patient care services (Gaines, 2022). For a nurse adherence to ethical principles includes justice for healthcare equality, non-maleficence to prevent patient harm, autonomy for patient inclusion in medical decision-making, and beneficence to prevent the occurrence of any event that hurts a patient (Ilkafah et al., 2021).

Patients who are fully conscious and able to make decisions about their care are considered autonomous. For example, a patient can choose the healthcare intervention according to their personal preferences and ease and it ensures the autonomy of the patient.  The on-duty nurse’s role is to present all the possible options and provide the patient freedom to make a decision. Justice ensures that all patients are getting equal treatment no matter to what color, race, or culture they belong (Ilkafah et al., 2021).

Care coordination can benefit from adhering to the code of ethics in several ways. As the patient is in charge of his or her healthcare, this can pave the way for more open lines of communication. When patients can share their perspectives, this aids in care coordination by eliminating misunderstandings about treatment choices and reducing confusion. Moreover, patient autonomy can enhance comprehension because patients have input into the healthcare therapy strategy (Olejarczyk & Young, 2021). When a patient feels they have been treated fairly, it can shape a healthy and positive working relationship with healthcare providers. The confidence of the patients in the hospitals can be enhanced when they get treated fair and justly (Olejarczyk & Young, 2021). 

Following this concept of the code of ethics, nurses shall not engage in any conduct based on or suggesting bias towards any individual or group of people. The nurse is expected to provide the same level of care to all patients irrespective of their age, sexuality, religion, or culture. To avoid violating the principle of nonmaleficence, medical staff members will seek the least detrimental treatment available. Trust between a patient and their healthcare professionals can be fostered by measures like nonmaleficence in care coordination (Haddad & Geiger, 2020).

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Social Determinants of Health: Healthy People 2030

The social determinants of health are necessary to consider which include the economic status of the individual, the availability of education levels, the individual’s social background, and the available environment for living (Healthy People 2030, 2022). The health of the people is directly linked with the social determinants of health. For example, a poor living environment can cause the spread of multiple diseases in the lower socio-economic community (Healthy People 2030, 2022).

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Factors Continuing in Health Disparities 

In healthcare disparities, multiple factors are contributing such as people having very low educational quality and access, very limited resources and income, unavailability of a healthy living environment, and lack of access to good quality healthcare services (Osae et al., 2022). 

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Conclusion

In conclusion, better patient care standards may result from a variety of government measures that could affect care coordination. However, some federal and state regulations can create ethical conundrums. The presentation declared that the Affordable Care Act (ACA) provides extensive public health insurance and that HRRP is decreasing the number of hospital readmissions to nursing facilities.

References 

AHRQ. (2018). Care coordination. Ahrq.gov. https://www.ahrq.gov/ncepcr/care/coordination.html 

CMS. (2022, August 22). Hosp. Readmission Reduction. Cms.gov. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HRRP/Hospital-Readmission-Reduction-Program#:~:text=What%20is%20the%20Hospital%20Readmissions 

Crowley, R. A., & Bornstein, S. S. (2019). Improving the patient protection and affordable care act’s insurance coverage provisions: A position paper from the American college of physicians. Annals of Internal Medicine, 170(9), 651. https://doi.org/10.7326/m18-3401