Introduction
As a lead nurse practitioner (NP) for my local medical clinic, I have been asked to reflect on the impact of the equity-efficiency trade-off on the quality of care and positive patient outcomes in my community. “Equity-Efficiency Trade-off: The Hospital Readmissions Reduction Program and Disparities in Outcomes Among Vulnerable Medicare Heart Failure Patients in Pennsylvania” is a research article that explores the impact of the Hospital Readmissions Reduction Program (HRRP) on vulnerable Medicare heart failure patients in the state of Pennsylvania (de Lancer Julnes & Choi, 2020).
Impact of the Affordable Care Act on CMS’s Quality and Cost Initiatives
The HRRP is a program developed by the Centers for Medicare and Medicaid Services (CMS) as part of the Affordable Care Act (ACA) to reduce hospital readmissions and enhance the overall quality of care (de Lancer Julnes & Choi, 2020). The article highlights the challenges faced by the CMS in balancing the need for cost reduction with the need to provide high-quality care to patients, particularly vulnerable populations. Additionally, it emphasizes the importance of addressing social determinants of health to achieve health equity.
The CMS’s efforts to concentrate on both quality of treatment and cost reduction have been significantly impacted by the Affordable Care Act (ACA). The ACA placed a strong emphasis on the importance of reducing hospital readmissions as a means of improving care quality while reducing costs (de Lancer Julnes & Choi, 2020). It led to the creation of the HRRP at the CMS, which has had a substantial impact on underserved groups.
Low-income and minority patients are just two examples of the disadvantaged groups that the HRRP has been accused of disproportionately affecting. According to research, hospitals serving these neighborhoods may face more severe financial consequences because these populations have higher rates of hospital readmissions (de Lancer Julnes & Choi, 2020). As a result, these institutions may prioritize readmission prevention over delivering high-quality care. This is a prime example of the equity-efficiency trade-off in healthcare, where a focus on cost containment can lead to inequities in the treatment of those who are most in need.
I have personally observed how the HRRP has impacted individuals and healthcare professionals in my local neighborhood. I have noticed that some hospitals are devoting more effort to reducing readmissions than to ensuring patients receive top-notch treatment. Patients have either received early discharges or inadequate follow-up care, which might result in readmissions (de Lancer Julnes & Choi, 2020).
Effects of the Hospital Readmission Reduction Program on Populations
As a result of the emphasis on lowering readmissions, hospitals may decide not to admit some patients, even if they require care, to avoid fines. This may negatively impact patient outcomes and exacerbate existing health disparities in our community. Long-term healthcare expenses may also increase as a result of this strategy, as readmissions can be more expensive than providing sufficient care in the first place.
As an NP, I am aware of the importance of keeping patients out of the hospital. One way we can achieve this is by offering thorough, coordinated treatment that takes into account the patient’s social and economic needs in addition to their medical requirements. This can involve providing patients with access to social services and neighborhood amenities, such as housing and food aid, which can improve their overall health and well-being (Sandiford et al., 2018). We can lower the frequency of inpatient admissions while helping patients receive excellent care by tackling the social determinants of health.
Healthcare as a Right
After reading the article, I concur with the statement that health care is a civil rights issue. To attain health equity, it is critical to address the social determinants of health, which are highlighted by the disparity in outcomes among disadvantaged Medicare heart failure patients in Pennsylvania. Regardless of a person’s color, ethnicity, or income, everyone should have access to quality, affordable healthcare.
Conclusion
In conclusion, the HRRP has had a substantial negative impact on underprivileged groups. One of my key goals as an NP is to manage patient care effectively to prevent unnecessary hospital stays. To achieve health equity, the essay highlights the importance of addressing the socioeconomic determinants of health.
Providing comprehensive, coordinated treatment that addresses not only the patient’s medical needs but also their social and economic needs is crucial to enhancing the patient’s overall health and well-being. I concur that healthcare is a civil rights issue. Understanding the trade-off between healthcare cost reduction and fairness is crucial for healthcare professionals and policymakers, who should strive to strike a balance that prioritizes both.
References
de Lancer Julnes, P., & Choi, S. W. (2020). Equity-efficiency trade-off: The hospital readmissions reduction program and disparities in outcomes among vulnerable Medicare heart failure patients in Pennsylvania. Journal of Health and Human Services Administration, 43(1), 23-48.
Sandiford, P., Consuelo, D. V., Rouse, P., & Bramley, D. (2018). The trade-off between equity and efficiency in population health gain: Making it real. Social Science & Medicine, 212, 136-144. Web.