Respond?to two?of your colleagues?by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address

Gretchen Breese

Peer 1

Competing Needs of Quality Verses Cost in Hospice- Main Post

For this discussion we take the difficulty of meeting healthcare quality standards in hospice and discuss the competing need due to increased costs with lower reimbursements.  Hospice is covered 100% through our Centers of Medicare and Medicaid Services (CMS).  Reimbursement is paid directly to the hospice organization at a flat rate for all four of the hospice care levels. The hospice organization then provides the patient and family's medical, emotional and spiritual care needs with specific employees for each discipline. Organizations also provide medical equipment and medication needs for anything related to the diagnosis that the patient is receiving hospice services. Spiritual needs are also provided for families up to one year after the death of a patient.  Because of this, cost and quality are difficult to balance. With the acuity of patent needs in today's aging population and the need for more involved clinical staffing, we are seeing a decrease in quality and an increase in costs.

Meeting quality metrics is difficult even with unlimited funds, as many hospice metrics are measured by patient perceptions in worst-case scenarios. Adding software that tracks clinical status changes is costly but helps to increase clinical care needs and patient perceptions of care (Huerta, 1995). Higher acuity patients require staff to stay in homes longer and the growing number of elderly patients in our population naturally gives way to a sicker hospice demographic. All of these factors cause an increase in costs for hospice organizations. However, CMS has decreased reimbursements in FY 2024, making quality care much more difficult to maintain, causing a huge competing need between cost and quality. Reimbursement rates decreased as much as 0.09% starting October 2023 for the 2024 FY (Centers for Medicare and Medicaid Services, 2023). This decrease is affecting staff salaries and offered services, along with an abrupt change in policies to meet the demand, which in turn is in direct correlation with a decrease in quality reporting. Competing needs cause decreases in quality care, work-life balance and lead to ethical dilemmas within our staffing. Stay longer, work harder, make less money and morally struggle if your patient population is not receiving the quality they deserve.

Nurses are known for their upstanding ethical values. The American Nurses Association, in the Code of ethics for nurses with interpretive statements (2015) has an entire provision regarding ethics, virtues and how nurses are held to a higher standard than the general public. Ethical awareness is important in nursing. It is important that nurses are able to identify ethical issues and act accordingly. “Awareness ideally leads the nurse to take action to practice in the most ethically acceptable way”(Milliken, 2018, Background section). Ethics gives way to quality and both come at a cost, yet reimbursement changes do not support the requirements of the industry. Making cost and quality a large competing need for nurses.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Retrieved March 10, 2024, from  https://www.nursingworld.org/coe-view-only Links to an external site.

Centers for Medicare and Medicaid Services. (2023). Mm13289 – hospice payments: Fy 2024 update [PDF].  https://www.cms.gov/files/document/mm13289-hospice-payments-fy-2024-update.pdf Links to an external site.

Huerta, J. A. (1995). The role of technology in rising healthcare costs. Journal of Clinical Engineering, 20(1), 48–56.  https://doi.org/10.1097/00004669-199501000-00012 Links to an external site.

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1).  https://doi.org/10.3912/ojin.vol23no01man01 Links to an external site.

Elsa Sosa Avila

Peer 2

Organizational Policies and Practices to Support Healthcare Issue

Competing needs, including those of the workforce, patients, and resources, can influence how a policy is developed because they should support the agenda that the policy is promoting.   To meet the needs of patients and the workforce while minimizing financial costs, for instance, a policy focusing on adequate nurse staffing is necessary.  In order to guarantee effective healthcare service delivery in terms of quality, quantity, and cost, Rudolph et al. (2021) asserts that the efficient deployment and use of the workforce is crucial. Inadequate deployment and utilization of the workforce could result in either an excess or deficiency of clinical personnel. For instance, excessive clinical staffing may lead to misallocated resources and cost overruns under the pretense of adequate staffing (Lasater et al., 2021). There are several detrimental effects of a staffing shortage, such as reduced care quality and quantity due to a lack of resources to provide basic services, work overload for nurses that remains, which ultimately jeopardizes patient safety, and longer wait times because of insufficient staffing, which results in avoidable patient deaths.

Particular competing needs that may affect workload as a national healthcare issue can be met by nursing staff in a way that serves patients' needs. To guarantee excellent patient services and safe, high-quality care while maintaining sustainable operating costs, organizations are investigating ways to strike a good balance between the nursing staff's experience, size, and needs (Barkowski & Meese, 2021). According to Rudolph et al. (2021), nursing capacity ought to be optimally reflected on patients' needs. This can be accomplished by allocating nurses in units sensibly and fairly, which will result in a workload that is split equally and feasible for the nursing team. This means that the needs of the patients and the nursing staff must be well-balanced. The management of nursing staff workload is one strategy for guaranteeing a suitable balance. This helps strike a balance between the resources that are needed and those that are available, preventing both overstaffing and understaffing, which can lead to higher costs and worse patient outcomes.

Workload affects an organization's resources as well as the needs of its employees and patients.  Burnout brought on by high results in mistakes and subpar patient outcomes. An excessive workload can also affect a nurse's intention to leave the profession, job dissatisfaction, and burnout. High turnover among nursing staff, which raises the cost of hiring temporary workers and onboarding new nurses (Rudolph et al., 2021). By guaranteeing the ideal nurse to patient ratio, which can enhance the number of nurses in organizations and boost patient care outcomes, a policy might potentially address these conflicting needs. The policy may specify a specific nurse-to-patient ratio based on the kind of unit in the medical facility.  One nurse will, at most, be tasked with five patients in a surgical and medical unit with a ratio of 5:1, whereas in an intensive care unit, the ratio may be as low as 2:1.  As Lasater et al. (2021) indicated, having a staffing policy in place can enhance the superiority and safety of care as well as the working conditions for the nursing staff.  In turn, lower turnover of nursing staff and less need for new nurse or temporary nurse training can offset the costs of sticking to the ratios.

References

Borkowski, N., & Meese, K. A. (2020).  Organizational behavior in health care. Jones & Bartlett Learning.

Lasater, K. B., Sloane, D. M., McHugh, M. D., Cimiotti, J. P., Riman, K. A., Martin, B., … & Aiken, L. H. (2021). Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes.  American Journal of Infection Control, 49(7), 868-873. https://doi.org/10.1016/j.ajic.2020.12.002

Rudolph, C. W., Allan, B., Clark, M., Hertel, G., Hirschi, A., Kunze, F., … & Zacher, H. (2021). Pandemics: Implications for research and practice in industrial and organizational psychology.  Industrial and Organizational Psychology,  14(1-2), 1-35. https://doi.org/10.1017/iop.2020.48

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