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-bas

 Nursing Leadership and Management

Discussion Topic

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After reading chapters 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) 

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 and 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 ADDITIONAL 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 between 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 in the same nursing unit? Would there be a concern that these patients were being offered different levels of support at home?

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 what 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.

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

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?

 As a reminder, all discussion posts must be a minimum of 350 words initial and, references must be cited in APA format 7th Edition, and must include a minimum of 2 scholarly resources published within the past 5 years.