07-u4-t1-t2 

Financial Models Of Reimbursement And Effects On Patients And Healthcare Providers

The United States healthcare system is like a patchwork quilt. There are public and private third-party payers, cash payments, co-pays, deductibles, out-of-network treatments, in-network treatments, dental coverage, no dental coverage, uncovered drugs, generic drugs, Medicaid, Medicare, Workers’ Compensation, the No-Fault system, managed care, PPO’s and now, the Affordable Care Act. How the advance practice nurse fits into all of this, as well as the physician and other health care providers, can be complex.

There is an opportunity for the advance practice nurse to move into a position of providing some of the services that had formerly been provided by primary care physicians. There are gaps in care. These gaps can be filled by the nurse practitioner or the advance practice nurse.

There are a number of provisions in the Affordable Care Act where interdisciplinary care is encouraged. An important function of interdisciplinary care is having interdisciplinary education.

•Analyze implications of managed care. •Assess the Affordable Care Act and cost shifting implications. •Identify health care policies that use cost shifting.

Direction:

Topic 1: Cost Shifting

Identify health care policies that use cost shifting. Argue the benefits of cost shifting. How might the Affordable Care Act decrease cost shifting within hospitals?

1 page, APA format, 6^th edition, 3 references within 5 years.

Topic 2: Managed Care

In what way does managed care actually manage cost? Does it do so without diminishing the quality of care? If so, how does it accomplish this?

1 page, APA format, 6^th edition, 3 references within 5 years.