1. Hader, Richard PhD, NE-BC, RN, CHE, CPHQ, FAAN

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Healthcare reform is forcing hospitals and other providers to change the care paradigm from episodic treatment to a continuum of care, which includes wellness and prevention, diagnosis and treatment, and rehabilitation or end-of-life care. Federal payers are suggesting that healthcare providers receive a flat payment to care for a specified population. This new payment methodology will place caregivers and healthcare organizations at financial risk to provide care that's both efficient and effective. Failure on any part(s) of the healthcare continuum will jeopardize the financial viability of healthcare systems and dramatically change the traditional model of patient care. How will this change affect the nursing care delivery model and what do healthcare leaders need to do to ensure that their organization is prepared to succeed in a rapidly changing financial environment?


In the near future, we'll become increasingly more familiar with a new concept of healthcare delivery. High-accountability organizations will supply a full continuum of service, including physician office care, throughout a patient's illness. The payment will be "bundled," meaning that one source of revenue will be provided for a full range of service. For example, if a patient is in need of cardiac surgery, one payment will be received to cover the internal medicine provider, the cardiologist, the cardiac surgeon, and all diagnostic and treatment services, inclusive of the entire hospital stay and rehabilitation. Financial agreements among providers will need to be negotiated to split this one source of revenue. Healthcare leaders will be challenged to facilitate these negotiations and establish acceptable parameters of care quality provided within a reasonable cost.

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Nurse leaders and physicians will be more engaged than ever to seek the best possible treatment plan for patients at the lowest possible cost. This will require an infrastructure to be developed that allows for healthcare providers to establish evidence-based protocols to produce positive results while simultaneously reducing or eliminating redundancy and unnecessary diagnostic tests in order to streamline care. Physical and psychological complications of patient care will need to be reduced or eliminated to minimize the financial risk to all providers. Nurse leaders will be increasingly more responsible and accountable to ensure that the care provided within their area of responsibility meets or exceeds expected outcomes at acceptable costs.


Translating the science of nursing care into practice will be the responsibility of every professional nurse, but the initiatives must be led by the nursing leadership team. Care should be directed, coordinated, and facilitated by nurse leaders who are proficient in interpreting scientific evidence in order to set goals for their area of responsibility. Failure to comply with best practice protocols could place the patient's health in jeopardy and increase the financial risk of the healthcare organization.


To financially succeed, hospitals and healthcare systems will need to develop care networks that effectively communicate with a variety of healthcare providers. An electronic health information system will be a necessary component so that care can be effectively communicated from one setting to another. Nurse informaticists will be called on to lead efforts to ensure that appropriate information is contained within the health record and that it's easily transferred between clinical settings.


There's no question that it'll be increasingly more important to coordinate care throughout the continuum of service. Administratively and clinically adept, nurse leaders need to be actively involved in this process as the principal coordinators of patient care.


Richard Hader

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