Capella 4050 Assessment 2

Capella 4050 Assessment 2 Ethical and Policy Factors in Care Coordination

Name

Capella University

NURS-FPX 4050 Coord Patient-Centered Care

Prof. Name

Date

Ethical and Policy Factors in Care Coordination

Hello. I _______, as a care coordinator at Hilltown Community Health Center, Huntington, Massachusetts, would like to welcome you to today’s presentation. This presentation focuses on the ethical and policy factors influencing patient care coordination and health outcomes. As the representatives of the American Heart Association (AHA), a prestigious organization working to improve cardiovascular health for diverse communities, you must understand these ethical and policy implications to improve your services and provide better, coordinated care to the communities served.

Presentation Roadmap

This presentation will cover:

The concept of care coordination and its importance.
Impact of health and safety policies established by the government on care coordination.
The ethical dilemmas for care coordination and their implications interlinked with national, state, or local-level policies
Influence of nursing code of ethics on coordination and continuum of care.

Care Coordination

Patient care coordination is the systematic arrangement of healthcare practices and communication among all stakeholders for sharing information related to patient care. This coordinated effort helps stakeholders achieve desired patient outcomes (Agency for Healthcare Research and Quality, n.d.). It ensures that patients receive appropriate care through proper measures, avoiding the duplication of services and fragmentation of care and preventing medical errors. Patients with complex healthcare needs, such as those suffering from chronic diseases or elderly patients with extensive therapies, benefit from coordinated care, as it enhances communication between healthcare providers. This effective communication streamlines care transitions and promotes patient engagement.

AHA and Care Coordination

The American Heart Association (AHA) is vital in coordinating patient care. They provide education, resources, and standardized guidelines for healthcare professionals and patients regarding cardiovascular diseases and stroke. Moreover, they advocate for international forums for healthcare policies and provisions to improve patient health and outcomes, especially cardiovascular health. Through various initiatives, AHA promotes evidence-based practices and quality improvement in managing heart-related conditions, enhancing care coordination among healthcare teams. By fostering interprofessional collaboration and patient encouragement in managing heart health effectively, the AHA contributes to better cardiovascular care delivery and improved patient outcomes (Warner et al., 2020).

Policies Affecting the Care Coordination

Several governmental policies related to communities’ health and safety impact care coordination. The Affordable Care Act (ACA) significantly influences care coordination as it emphasizes preventive care, accessibility of healthcare services, care quality, and cost-effectiveness. Through various initiatives like Accountable Care Organizations (ACOs) and bundled payments, this policy encourages healthcare facilities to coordinate care across multiple healthcare settings and provide healthcare services to all individuals, regardless of socioeconomic status (Navathe et al., 2021). These initiatives promote better health outcomes and effectiveness of care through collaboration and integration of various team members. The ACA’s provisions permit AHA to promote evidence-based cardiovascular care practices by encouraging cooperation between healthcare providers. It facilitates the adoption of standardized protocols and guidelines, enhancing care coordination to ensure patients receive optimal cardiovascular care across various settings.

Another governmental policy that impacts care coordination is the Medicare Access and CHIP Reauthorization Act (MACRA). This policy initiated value-based payment models, such as the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs), to incentivize healthcare professionals for top-notch quality of care. This policy encourages teamwork among providers, standardization of protocols, and focus on patient-centered care, aligning with care coordination goals (Abodunde et al., 2021). This team collaboration and standardization of protocols is connected with the mission of AHA to provide effective cardiovascular care to achieve better patient outcomes.

Finally, the Health Insurance Portability and Accountability Act (HIPAA) is another influential policy that obligates the protection of patients’ privacy and security of health information. This policy provides guidelines for coordinated care teams during information sharing (U.S. Department of Health and Human Services, 2023). AHA must comply with HIPAA guidelines while disseminating educational resources, collaborating with various teams, and sharing patient information. Thus, implementing secure communication channels and data-sharing practices while safeguarding patients’ confidentiality and privacy should be a priority.

Ethical Dilemmas for Care Coordination

Various US-based, state-based, and local-level policy provisions generate moral questions/concerns for care coordination. These ethical dilemmas impact the role of AHA, requiring comprehensive efforts to mitigate the concerns for patient safety and better health outcomes. The HIPAA guidelines, as the national-level policy, raise ethical questions regarding patient privacy and information sharing in care coordination. While HIPAA postulates the protection of patient confidentiality and privacy of sensitive health information, its strict regulations impede efficient communication among healthcare providers.

These regulations potentially compromise the quality of care as healthcare professionals may encounter challenges while sharing vital patient information, leading to fragmented care (Qin, 2019). The American Heart Association plays a crucial role in addressing the ethical dilemma of patient privacy and information sharing by advocating for procedures and policies that balance both aspects, emphasizing effective care coordination. AHA can help healthcare providers with guidance and resources for navigating HIPAA rules by secure information-sharing channels, promoting ethical practices, and patient-centered care coordination.

Capella 4050 Assessment 2

On a state level, the Certificate of Need (CON) program, known as Determination of Need (DoN) in Massachusetts, births ethical questions regarding the allocation of resources and healthcare accessibility. The CON programs are developed for states to obtain approval before expanding or establishing new healthcare facilities or services. Thus preventing duplication of services and promoting effective care coordination (National Conference of State Legislatures, 2023). While CON aims to control healthcare costs and ensure equitable distribution of resources, it also limits innovation and patient’s preferences for access to specialized care. Therefore, AHA plays a crucial role by collaborating with stakeholders to ensure CON regulations promote fair competition, innovation, and equitable access to cardiovascular care services.

Policies at the local level, such as zoning regulations, can pose ethical dilemmas for care coordination regarding the placement and accessibility of healthcare services. These laws may restrict the location of healthcare facilities, affecting patients’ ability to access timely and convenient care and increasing healthcare disparities. AHA can address these ethical dilemmas by advocating for equitable access to cardiovascular care facilities and services in the local community. Engaging with local authorities and community stakeholders, AHA can promote establishing cardiovascular care facilities in areas of significant need, ensuring all residents have access to quality care.

Code of Ethics and its Role in Care Coordination and Continuum of Care

Patient advocacy, cultural sensitivity, patient-centered care, privacy and confidentiality, patient beneficence, and justice and equity are some core principles in the nursing code of ethics. These principles help nurses and other healthcare professionals deliver effective patient care, maintaining care coordination and continuity of care. As frontline healthcare providers, nurses are significant care coordinators, ensuring seamless transitions between healthcare settings and addressing patients’ diverse needs along the continuum of care. For patients with complex healthcare needs, such as cardiovascular problems, nurses play a crucial role in safeguarding their rights and delivering patient-centered care to make the healthcare journey less harmful and more beneficial (Karam et al., 2021).

Nurses perform these actions under the guidance of a code of ethics. Moreover, nurses, guided by the code of ethics, advocate for equitable access to healthcare services by addressing factors that lead to healthcare disparities. These factors are named Social Determinants of Health (SDoH) by the Healthy People 2030 initiative. These include socioeconomic status, education, healthcare accessibility, and environmental factors (U.S. Department of Health and Human Services, n.d.). Nurses collaborate with interdisciplinary teams to identify and mitigate these barriers to care, promoting health equity and reducing healthcare disparities. Additionally, the nursing code of ethics emphasizes cultural competence and patient-centered care. While integrating SDoH into their nursing practices, nurses address patients’ unique needs through comprehensive patient care to promote coordination and a continuum of care.

Conclusion

Therefore, we conclude that care coordination is an essential aspect of patient care and requires a systematic approach to address the implications of ethical and policy factors. The American Heart Association plays a crucial role in mitigating the negative impacts of the policies and ethical dilemmas generated to provide effective, patient-centered, and coordinated care to promote cardiovascular health and wellness in communities. I hope this presentation was helpful for you as the representatives of AHA and you will further disseminate the information within the organization. We’re hopeful that AHA will perform its vital role in advocating for patients’ benefits. Thank you for listening patiently to my presentation.

References

Abodunde, B., Slater, C., & Coustasse, A. (2021). MACRA and Accountable Care Organizations: Is it working? The Journal of Ambulatory Care Management, 44(2), 148. https://doi.org/10.1097/JAC.0000000000000350

Agency for Healthcare Research and Quality. (n.d.). Care coordination. https://www.ahrq.gov/ncepcr/care/coordination.html

Karam, M., Chouinard, M.-C., Poitras, M.-E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing care coordination for patients with complex needs in primary healthcare: A scoping review. International Journal of Integrated Care, 21(1), 16. https://doi.org/10.5334/ijic.5518

National Conference of State Legislatures. (2023, January 1). Certificate of Need state laws. Www.ncsl.org. https://www.ncsl.org/health/certificate-of-need-state-laws

Capella 4050 Assessment 2

Navathe, A. S., Liao, J. M., Wang, E., Isidro, U., Zhu, J., Cousins, D. S., & Werner, R. M. (2021). Association of patient outcomes with bundled payments among hospitalized patients attributed to accountable care organizations. JAMA Health Forum, 2(8), e212131. https://doi.org/10.1001/jamahealthforum.2021.2131

Qin, F. (2019). The debilitating scope of care coordination under HIPAA. UNC School of Law. NCL Rev., 98, 1395. https://scholarship.law.unc.edu/cgi/viewcontent.cgi?article=6809&context=nclr

U.S. Department of Health and Human Services. (2023, February 27). HIPAA privacy rule and care coordination. https://www.hhs.gov/hipaa/for-professionals/regulatory-initiatives/hipaa-care-coordination/index.html

U.S. Department of Health and Human Services. (n.d.). Social determinants of health—Healthy people 2030 | health.gov. https://health.gov/healthypeople/priority-areas/social-determinants-health

Capella 4050 Assessment 2

Warner, J. J., Benjamin, I. J., Churchwell, K., Firestone, G., Gardner, T. J., Johnson, J. C., Ng-Osorio, J., Rodriguez, C. J., Todman, L., Yaffe, K., Yancy, C. W., Harrington, R. A., & On behalf of the American Heart Association Advocacy Coordinating Committee. (2020). Advancing healthcare reform: The American Heart Association’s 2020 statement of principles for adequate, accessible, and affordable health care: A presidential advisory from the American Heart Association. Circulation, 141(10). https://doi.org/10.1161/CIR.0000000000000759