RT is a 65-year-old who is a Medicare/Medicaid patient. This “dual eligible” status does not place them in a value-based contract
RT is a 65-year-old who is a Medicare/Medicaid patient. This “dual eligible” status does not place them in a value-based contract
After reading chapters 7, 8, 9, 10 and the assigned readings students answer the questions in the Case Scenario and then 1 of the following questions below (total of 2 questions for initial discussion due by Thursday, 5/18/23 by 11:59 pm and then two peer responses to Week 3 posting by Sunday, 5/21/23 by 11:59 pm.
Every student must answer Question 1 in relation to the Case Scenario and then students may choose which response they wish to answer to Question 2: either a OR b OR c (only 1 of these will be responded to). Note you MAY NOT USE the readings for this week as YOUR peer reviewed journals and references; you may include them as references but you must separately include two scholarly resources.
QUESTION #1: CASE SCENARIO
Healthcare Ethics: A Tale of Two Patients
RT is a 65-year-old who is a Medicare/Medicaid patient. This “dual eligible” status does not place them in a value-based contract. They are FFS for any hospital or provider who treats them. RT does not incur any out-of-pocket costs for medications. They have a primary care physician (PCP), but the PCP is private practice and is only loosely affiliated with several local hospitals. RT lives alone, is beginning to lose their sight, has no family close by, and has a case worker who runs their errands. RT has a history significant for chronic obstructive pulmonary disease (COPD) Gold Stage I, is on nebulizers at home as well as inhaled steroids, and goes on 3 L N/C of O2 at night. RT continues to smoke 1 pack per day and has for the last 50 years. No one pays any penalty if RT’s outcome metrics are poor. But Medicare/Medicaid incurs the cost of care, testing, medications, oxygen, transportation to repeat ED visits, and multiple hospital admissions as RT’s chronic conditions continue to deteriorate.
FS is a 67-year-old who has traditional Medicare. They have a PCP strongly affiliated with a local healthcare system. This healthcare system has contracted with Medicare to be in an “ACO.” This means that FS’s PCP and the health system are accountable for FS’s care and will only receive payment if FS stays out of the hospital and has good health outcomes. FS’s history is also significant for COPD Stage 1. FS is on nebulizers at home, takes an inhaled steroid, and uses 3 L O2 prn. They smoke 1 pack per day as well and are starting to have some significant deterioration of their COPD. If FS were to enter the hospital, the hospital will only receive a “bundled payment,” and if they re-enter the hospital in 90 days, the hospital will spend all the money they were given to care for FS just on this one episode. FS is also offered home care, respiratory therapy, and smoking cessation classes and coaching. FS says they cannot afford their inhaled steroid, so a pharmacist works with them to get the medications they need at a lower cost.
Discussion Question 1 (ALL STUDENTS MUST ANSWER THESE)
a. Would a bedside nurse know the difference in these two patients’ payor arrangements?
b. Should nursing be aware?
c. Should nursing continue to educate both patients on their disease?
d. What if these patients were on the same nursing unit? Would there be concern that these patients were being offered different levels of support at home going?
e. Clinically, what is the better way to care for the patient? Does that match the payor payment?
Discussion Question #2 (Answer one of the following below; students may choose they wish to answer)
a. Identify three common workarounds nurses in your practice area routinely do. Choose one and propose possible innovative solutions. Identify potential risks and benefits. Develop a plan for developing, implementing, and evaluating the innovation. Identify leadership styles, traits, and competencies that support or serve as barriers to innovation in care delivery.
OR/AND
b. What are the primary SDOH, and how do these factors impact individual, community, and population health? What role do nurses and nurse leaders play in addressing the SDOH? Why are nurses and nurse leaders ideally suited to this role? How important are nursing advocacy, community action, and policy campaigns in addressing the SDOH? How can nurses and nurse leaders promote better population and community health through these activities?
OR/AND
c. Describe some of the risks and opportunities that can arise with telehealth and how, as nursing leaders, we can address them. As a nursing leader, what tactics would you use to engage nursing employees to utilize telehealth?
Please be sure to adhere to the following when posting your weekly discussions:
1. Students are to write their name and the appropriate discussion number/discussion title in the title bar for each discussion. For example Discussion 1: Micheal Cabrera or Discussion 3: Sheila Smith. This is important in identifying that students are submitting original posts as well as response posts as required.
2. Students are to submit their discussions directly onto Blackboard Discussion Board. Attachments submitted as discussion board posts will not be graded.
3. As a reminder, all initial discussion posts must be minimum 250 words, references must be cited in APA format 7th Edition, and must include minimum of 2 scholarly resources published within the past 5-7 years (not part of the classroom coursework).
two peer response per discussion question is required. That means on the weeks when there is only one discussion question there will only be one peer response; however, on week’s like this Week 2; there are 2 original peer responses to each discussion question and then one peer response to each of these discussions which means that per discussion question there is one peer response.
Just be mindful and pay attention to the instructions weekly to be sure what the expectations are for that weekly posting. Response posts must be minimum 150 words each.
Recognize that peer discussions make up a total of 20% of your grade along with the IHI modules most of which will be integrated into your weekly discussions and it is expected that the responses are DETAILED, answer all the questions and concepts being asked in each discussion question, demonstrate understanding of assigned course readings (students, you will not be able to answer these in the manner expected without having reviewed the content for each week). The formatting must be done using APA (if you need a refresher resources have been provided to guide you in Blackboard).
Requirements: 250 or more
Nursing
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