NR 711 Week 7 Reimbursement Issues

NR 711 Week 7 Reimbursement Issues

Name

Chamberlain University

NR-711: Fiscal Analysis & Project Management

Prof. Name

Date

Reimbursement Issues Discussion

Purpose

The primary objective of this discussion is to evaluate the role of the Doctor of Nursing Practice (DNP)-prepared nurse as a critical member of the interprofessional healthcare team. A central responsibility of the DNP-prepared nurse is to design and advocate for systems that support effective reimbursement processes while maintaining a focus on improving the overall quality of patient care. This discussion emphasizes how reimbursement models influence nursing practice, impact patient outcomes, and shape healthcare costs.

Instructions

Reflecting on readings, clinical experiences, and current reimbursement practices, the following key questions are addressed:

1. Analyze if value-based insurance reimbursement influences clinical outcomes and healthcare equity.

Value-based insurance reimbursement (VBIR) directly impacts both clinical outcomes and healthcare equity. Unlike fee-for-service models, VBIR ties reimbursement to quality metrics and patient outcomes rather than volume of care provided. This approach encourages providers to deliver safer, more efficient, and patient-centered care.

For instance, VBIR models reward reductions in hospital readmissions, adherence to evidence-based guidelines, and improvements in preventive care. These outcomes not only lower costs but also foster equitable access to care, particularly for vulnerable populations. However, disparities may persist if organizations serving low-income or high-risk patients face structural barriers, such as limited access to technology or insufficient staffing. Overall, VBIR promotes accountability but requires continuous monitoring to ensure that healthcare equity is preserved.

2. Determine the role of the DNP-prepared nurse in influencing nursing practice with regard to reimbursement.

The DNP-prepared nurse serves a vital role in bridging clinical expertise with financial stewardship. Their role in reimbursement systems includes:

By taking on these roles, the DNP-prepared nurse ensures that nursing practice remains patient-centered, cost-effective, and aligned with evolving healthcare reimbursement structures.

Program Competencies

This discussion aligns with the following program competencies:

1. Integration of scientific underpinnings into clinical practice to improve patient outcomes (POs 3, 5).

2. Application of analytic methods to translate research findings into clinical innovation and evidence-based improvements (POs 3, 5).

3. Evaluation of information systems and health technologies to enhance care quality and efficiency (POs 6, 7).

4. Critical analysis of healthcare policies to advocate for social justice and equitable healthcare access (POs 2, 9).

5. Leadership in professional identity and systems thinking, enabling effective decision-making in clinical care implementation (POs 1, 4).

Course Outcomes

This discussion also addresses the following course outcomes:

1. Examine the role of the DNP-prepared nurse in financial leadership, particularly in planning and managing healthcare resources across settings (PCs 5, 8; POs 2, 4, 9).

2. Develop strategies for leading projects related to planning, implementation, and evaluation that enhance the delivery of high-value healthcare (PCs 1, 3, 4; POs 3, 5, 7).

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. AACN.

Centers for Medicare & Medicaid Services. (2022). Value-based programs. U.S. Department of Health and Human Services. https://www.cms.gov/value-based-programs

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

NR 711 Week 7 Reimbursement Issues

Rosenbaum, S. (2020). The impact of value-based purchasing on health care quality and equity. Health Affairs, 39(7), 1112–1119. https://doi.org/10.1377/hlthaff.2020.00275