In the fee-for-service healthcare system, healthcare professionals are incentivized to perform more services, regardless of whether they are necessary. However, with the transformation to a value-based care system, healthcare professionals must adjust their roles to provide high-quality, patient-centred care. This requires focusing on outcomes and patient satisfaction rather than the service volume. Healthcare professionals must collaborate, and share the necessary information and resources, to ensure that each patient receives comprehensive and coordinated care. This shift in focus requires a change in mindset and skill set for all healthcare professionals, but it also can lead to improved patient health and satisfaction (Park et al., 2022). This paper examines the changing roles of nurses and other healthcare professionals in a system shifting from fee-for-service to value-based. It also examines the impacts of recent policy changes and the shared power between nurses and physicians.
Role of Nurses as Healthcare Moves from Fee-for-Service to Value-Based System
The healthcare system is undergoing a significant transformation as it shifts from a traditional fee-for-service model to a more patient-centred, value-based approach. This change requires healthcare professionals, including nurses and physicians, to work together more closely and effectively to provide high-quality care (Mjåset et al., 2020). Nurses are playing a prominent role in this new system. For instance, nurses are now assuming more responsibilities and being recognized as integral care team members. Nurses have always had a unique perspective on patient care, as they spend more time with patients than physicians. In the value-based model, this perspective is even more valuable, as nurses can provide valuable insights into the patient experience and help coordinate care across different providers.
On the other hand, physicians are taking on a more collaborative role in the value-based model. They are working more closely with nurses and other healthcare professionals to provide comprehensive and coordinated care to patients. This requires a different mindset and skill set for physicians, who may need to adjust to working in a more team-based environment. Other healthcare professionals, such as physician assistants, nurse practitioners, and social workers, are also playing increasingly important roles in the value-based model (Mjåset et al., 2020). They bring unique perspectives and skill sets to the care team and are critical to ensuring that patients receive comprehensive and coordinated care
A value-based healthcare system aims to improve the quality of care for patients while reducing costs. This is achieved by focusing on outcomes and patient satisfaction rather than the service volume. In a value-based system, healthcare providers are incentivized to work together to provide comprehensive, coordinated care that meets each patient’s specific needs (Mjåset et al., 2020).
Why a Value-Based System May Improve Health Care in the U. S
One of the key benefits of a value-based system is that it encourages healthcare providers to focus on prevention and wellness rather than just treating illnesses and injuries. This can help improve patient’s overall health, reducing the need for more costly and complex treatments down the line (Teisberg et al., 2020). Besides, a value-based system encourages healthcare providers to use evidence-based practices and continuously monitor and evaluate patient outcomes. This leads to better quality care and improved health outcomes for patients.
Another significant benefit of a value-based system is that it reduces unnecessary and redundant tests and procedures, saving both time and money. In a fee-for-service model, healthcare providers are incentivized to perform more services, regardless of whether they are necessary (Teisberg et al., 2020). In a value-based model, providers are incentivized to provide only the necessary care to improve patient health and satisfaction.
Impact of Recent Policy Changes
In recent years, policy changes have significantly impacted the roles and responsibilities of nurses, physicians, and other healthcare professionals. One of the most significant changes has been the Affordable Care Act (ACA), which has played a critical role in transforming the healthcare system. The ACA expanded access to healthcare and introduced new payment models that incentivize value-based care.
One of the key provisions of the ACA was the creation of the Center for Medicare and Medicaid Innovation (CMS). This organization is responsible for testing and scaling new payment models that aim to reduce costs and improve the quality of care. One such model is the Medicare Shared Savings Program (MSSP), which encourages providers to coordinate care for patients with Medicare (Genieys et al., 2022). This program offers financial incentives for providers who achieve high-quality, cost-effective care, which helps to ensure that patients receive comprehensive and coordinated care.
The ACA and the CMS have had a significant impact on the way that healthcare professionals work together to deliver care. In the past, healthcare professionals often worked in silos, with little collaboration or coordination between different specialties. Today, however, the emphasis is on interdisciplinary care teams that work together to ensure that patients receive the best possible care (Genieys et al., 2022).
Nurses, in particular, have seen a significant expansion of their roles and responsibilities in recent years. Nurses are now often responsible for coordinating care, communicating with patients and other healthcare professionals, and making critical decisions about patient care (Genieys et al., 2022). This expanded role for nurses has helped improve patients’ quality of care and has made the healthcare system more efficient and effective.
Distinction Between a Fee-for-Service System and a Value-based Care System
The distinction between a fee-for-service system and a value-based care system is the driving force behind how healthcare providers, including physicians, deliver patient care. A fee-for-service system is one in which healthcare providers are paid for each service they provide, regardless of its quality or impact on patient outcomes (Park et al., 2022). This system incentivizes healthcare providers to deliver as many services as possible, as they are reimbursed based on volume rather than value.
On the other hand, a value-based care system prioritizes quality over quantity. In this system, healthcare providers are reimbursed based on the quality and effectiveness of their care and its impact on patient outcomes. This system incentivizes healthcare providers to deliver the proper care at the right time rather than just the most care possible (Park et al., 2022). A value-based care system aims to improve the overall quality of care and achieve better health outcomes for patients while reducing costs.
In the value-based care system, physicians must work more closely with other healthcare professionals, such as nurses and pharmacists, to coordinate care and ensure that patients receive the proper care at the right time. This requires a more collaborative, patient-centred approach to care, as healthcare providers are incentivized to provide high-quality, cost-effective care that leads to improved patient health outcomes (Park et al., 2022). Additionally, value-based care systems often incorporate alternative payment models, such as accountable care organizations or bundled payments, which incentivize healthcare providers to work together to achieve high-quality, cost-effective care. These models also encourage healthcare providers to focus on preventive care, which can help to prevent chronic conditions and reduce costs in the long run.
Nurses play a critical role in a value-based care system, as they are often the first point of contact between patients and the healthcare system. Nurses are responsible for providing care and support to patients, monitoring their health status, and working with physicians and other healthcare professionals to develop and implement care plans (Park et al., 2022). In a value-based system, nurses are critical partners in delivering high-quality, cost-effective care, as they are often responsible for coordinating care and communicating with patients to ensure they receive the proper care at the right time.
Shared Power Between Physicians and Nurses
Shared power between physicians and nurses is a critical component of an effective healthcare system, as it allows for a more collaborative approach to patient care. Physicians held the majority of power and decision-making authority in traditional healthcare systems, while nurses and other healthcare professionals played a more supportive role (Owen & Ashcraft, 2019). However, this approach has changed as the healthcare system has become more patient-centred, emphasizing collaboration and shared decision-making.
Nurses, who are often the primary point of contact for patients, bring valuable insights and expertise to the care team, including a deep understanding of patient needs and preferences. When physicians and nurses work together in a collaborative partnership, they can deliver high-quality, effective care tailored to meet each patient’s unique needs (Owen & Ashcraft, 2019). Shared power also helps to ensure that patients receive comprehensive, coordinated care that addresses all aspects of their health and well-being. With physicians and nurses working together, patients can receive timely, effective care that is based on the latest research and best practices. This can lead to improved health outcomes, better patient satisfaction, and reduced healthcare costs.
Furthermore, shared power between physicians and nurses can help improve healthcare providers’ overall work environment. By working together, healthcare providers can share knowledge, expertise, and ideas, leading to increased job satisfaction, reduced stress, and improved job performance (Owen & Ashcraft, 2019).
How Shared Power Impacts Healthcare
Shared power between physicians and nurses in the healthcare system significantly impacts the quality and delivery of patient care. Collaboration between these two essential healthcare professionals can lead to improved patient outcomes, increased satisfaction, and reduced healthcare costs.
One of the critical benefits of shared power is that it allows for a more comprehensive approach to patient care. With physicians and nurses working together, patients receive a full range of services and treatments tailored to their unique needs and preferences (Owen & Ashcraft, 2019). This includes preventive care, diagnostic services, treatment, and rehabilitation, all coordinated to ensure patients receive the best possible care.
Shared power also facilitates improved communication and coordination between healthcare providers. With physicians and nurses working together, they can share important information about the patient’s health, treatment plan, and progress. This can help to avoid duplicated tests and treatments, reducing healthcare costs and ensuring that patients receive timely and effective care.
Further, shared power encourages the use of best practices and evidence-based medicine. With physicians and nurses collaborating, they can stay up-to-date with the latest research and advancements in their field, leading to improved patient outcomes and increased satisfaction. Shared power can also lead to improved patient engagement and satisfaction. With physicians and nurses working together to deliver care, patients are more likely to feel that their health concerns are being heard and addressed. This can lead to increased patient trust and improved patient-provider relationships, which are critical to delivering high-quality, effective care.
Overall, the shift towards a value-based system in the U.S. healthcare system is driven by a desire to improve the overall quality of care while reducing costs. The distinction between a fee-for-service system and a value-based system has significant implications for the roles of physicians, nurses, and others.
References
Genieys, W., Darviche, M., & Epperson, B. (2022). New policy elites and the Affordable Care Act: The making of long-term Insiders. Journal of Policy History, 34(1), 1-24. https://doi.org/10.1017/s0898030621000245
Mjåset, C., Ikram, U., Nagra, N. S., & Feeley, T. W. (2020). Value-based health care in four different health care systems. NEJM Catalyst Innovations in Care Delivery, 1(6). https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0530
Owen, D. C., & Ashcraft, A. S. (2019). Creating shared meaning: Communication between nurses and physicians in nursing homes. Research in Gerontological Nursing, 12(3), 121–132. https://doi.org/10.3928/19404921-20190315-01
Park, S., Chung, W., & Stimpson, J. P. (2022). Access to care and satisfaction with care among fee-for-service Medicare beneficiaries by the level of care needed. Disability and Health Journal, 101402. https://doi.org/10.1016/j.dhjo.2022.101402
Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care. Academic Medicine, 95(5), 682–685. https://doi.org/10.1097/acm.0000000000003122
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