Medicare and Medicaid relate to my practice area as the number of patients signing up for health insurance continues to rise. Medicare was established to help elderly and disabled aged 65 years and above pay their medical costs. Similarly Medicaid is designed to help low-income elderly patients aged 65 and above pay for medical expenses either in nursing homes or other long-term care facilities (Meyers, Durfey, Gadbois, & Thomas, 2019). Medicare is categorized into either Medicare Part A or Part B where Part A covers hospital insurance and Part B covers medical insurance. Medicare Part A is designed to help patients cover costs that arise during hospitalization either during skilled care, home health nursing or home health care. Part B on the other hand, helps patients over costs such as doctor visits, transportation, lab tests, screenings, clinical research and other services that facilitate effective patient diagnosis. Patient older aged 65 and above are often eligible for Medicare Part A if they have worked and paid their Medicare taxes in their early lives. However, for one to be eligible for Part B, other than the level of their income, their ability to pay monthly premiums is also checked. Given as Part B covers more extensive services, patients must be willing to pay these monthly fees. The higher the income the higher the amount of premiums charged.
Medicaid is a more comprehensive health insurance program as it allows eligible patients access to additional services and durable medical equipment. Although Medicare and Medicaid are government programs, each of these are executed differently depending of each state government. The compensation fees or any fees that may arise as a result of using the program depend of independent states. Eligibility also differs according to state as the age requirement alone is not enough. The income limit of $2,349 a month, for instance, dependents on whether the state is medically needy or not(Elmaleh-Sachs & Schneider, 2020). For medically needy state, even patients with an income above the limit may be eligible for Medicaid. Medicaid is designed to cover for additional services after those cleared by Medicare. A patient can therefore qualify for both Medicare and Medicaid simultaneously.
Although states are still resistant to implement Medicaid expansion, the 28 states that have so far adopted the expansion have seen an increase in the number of insured patients. With the expansion, states have seen a decrease in the average amount spent on healthcare. The expansion has also resulted in an increase in Medicaid revenues and created more opportunities for nurses. There is an increased demand for nurses to strike a balance in the increasing patient-nurse ratio. An increase in nurses guarantees reduce workload and ultimately reduced job stress and burn out for nurses (Elmaleh-Sachs & Schneider, 2020). When nurses work in a conducive work environment they are bound to deliver safe and quality care more effectively and efficiently. An increase in the number of healthcare workers also guarantees reduced cases of medical errors, which translates to reduced healthcare costs. Nurses must however, ensure that they are at the forefront of policy formulation, reforms and changes. Nurses must also stay updated on the latest policies and policy reforms to ensure they are well-informed on all issues affecting their practice.
Elmaleh-Sachs, A., & Schneider, E. C. (2020). Strange Bedfellows: Coordinating Medicare and Medicaid to Achieve Cost-Effective Care for Patients with the Greatest Health Needs. Journal of General Internal Medicine, 1-4.
Meyers, D. J., Durfey, S. N., Gadbois, E. A., & Thomas, K. S. (2019). Early adoption of new supplemental benefits by Medicare Advantage plans. Jama, 321(22), 2238-2240.
While searching the internet for policies that affect my practice, I was able to establish multiple policies that have been enacted to help improve care provision. One such policy is the CMS never events non-reimbursement policy. The aim of this policy is to improve patient safety. The act applies to all nursing departments and sectors. According to CMS, there are many avoidable issues that have resulted in the loss of money and put the patient’s health at risk. According to the policy, since some of these events are clearly identifiable, and preventable then they should be avoided at all costs (Bae, 2017). The nurse and facility should ensure that they identify such events and prevent them from occurring. When such issues or events take place, then it is seen as the fault of the facility and nurse. In order to curb these issues, the CMS imposed a non-reimbursement policy to a list of events called never events. The policy dictates that in case of a never event, then the nurse and facility will be liable and therefore should pay for the care of the patient. Any additional costs that may arise from such an event, then CMS will not reimburse funds to care for such issues.
The impact of the policy on nursing practice is different for different nurses. However, the overall impact for the nurses is that nurses have to be more careful in their nursing processes. The nurses have to perform their tasks with care to ensure that there are no mistakes made that can be avoided. The nurses must make sure that they are watchful for their actions and use evidence-based practice to ensure the best and safest results for the patients. When never events occur, it is seen to be the fault of the nurse and therefore care must be taken to ensure these events do not occur (Fehlberg, Lucero, Weaver, McDaniel, Chandler, Richey & Shorr, 2017). Hospitals and care facilities have had to improve their equipment and programs to ensure that never events that can occur are avoided. For example, facilities have installed rails in their hallways to provide patients with a place where they can hold on to in order to avoid falls. Falls are some of the most common never events but with the policy, more actions have been taken to avoid falls. Patient safety has become a core part of the nursing practice now. Nurses have had to undergo further education in such areas to ensure that they do not make any mistakes in the care process (Bae, 2017). Overall, both nurses and facilities have made various steps to ensure that never events do not happen under their watch. With patients suing for never events and CMS failing to reimburse for these events, nurses and facilities have to work together to ensure errors do not take place.
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