What Impact Does Value-Based Care Have on Nurses? Exploring the Effects
By Ashley Brooks on 02/10/2020
As a nurse, you’re a member of one of the world’s oldest professions. But the life of a modern-day RN looks nothing like the nurses who have helped patients throughout history. Advances in medicine and technology have changed the landscape of nursing more and more each year.
Now another sweeping change is making its way through the medical field: value-based healthcare.
What is value-based healthcare? Maybe you’ve experienced this new approach to healthcare firsthand, or maybe you’ve only seen the term in passing. Either way, you have plenty of questions about how value-based care could affect your daily work as a nurse.
This breakdown of value-based healthcare will help you understand the benefits and challenges of the new system and how it could impact nurses across the country.
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What is value-based healthcare?
Value-based healthcare (sometimes called “accountable care”) is all about offering quality care rather than seeing the highest quantity of patients. The Centers for Medicare and Medicaid Services (CMS) define value-based care as a reward system that gives incentives to providers based on the quality of care they deliver to people with Medicare.
These programs first came on the scene in 2008 and 2010, when legislation such as the Affordable Care Act (ACA) was passed, bringing a renewed focus to the quality of care. This legislation also authorized several value-based government incentive programs.
Then the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) created the Quality Payment Program (QPP). Prior to MACRA, providers were paid for delivering care to Medicare patients based on a formula that encouraged volume-based care—in other words, seeing as many patients as possible. Under the QPP, payments are based on performance, or the quality and value of care providers deliver their patients.
The goal of value-based healthcare
The CMS shares three goals of value-based care: better health for individuals, better public health in populations and lower costs of healthcare for everyone.
“Our value-based programs are important because they’re helping us move toward paying providers based on the quality, rather than the quantity, of care they give patients,” according to the CMS.
Rather than having patients undergo a variety of expensive tests and procedures that may be unnecessary or redundant, value-based care programs measure providers against proven best practices in various health scenarios. This both reduces healthcare costs and increases the quality of care for the patient.
Coordination of care is also a focus in value-based programs. This means that providers are rewarded when they show that they can seamlessly work with specialists in other departments or facilities to provide patients excellent care without the headache of missing health records or other miscommunications.
What value-based care looks like
What does high-quality, value-based care actually look like? Typically, it means meeting and documenting certain quality standards in a specific timeframe.
“Gone are the days where patients stay in the hospital for extended periods to ‘rest’ where they are at high risk for hospital-acquired infections or blood clots,” says Catherine Burger, RN and brand media specialist at RegisteredNursing.org. “The value-based focus is to get patients back to their pre-hospitalization baseline (or better) in as short a time as possible, without discharging them too soon.”
Nurses must attempt a tricky balancing act as they weigh a patient’s health outcomes against the quality standard benchmarks to determine the best course of action for each case.
The benefits and challenges of value-based care for nurses
Everyone can agree that a higher quality of care with lower costs is a great goal to strive for. However, value-based care programs are changing the landscape of nursing in both positive and negative ways.
“The shift from fee-for-service or volume-based care to value-based care can be a significant change for nursing,” Burger says. These are some of the ways value-based care is impacting nurses’ job duties and work environment.
Challenges in value-based healthcare and nurses’ job duties
One area where nurses may feel the squeeze due to value-based care is keeping up with electronic health records (EHR). Burger explains it like this: “If the standard of care for the measure is to remove the urinary catheter within 12 hours of surgery, it is up to the nurse to ensure not only that the catheter is out, but that the task is documented before the 12th hour.”
With EHR recording precisely when each keystroke is entered, nurses may have to choose between attending to a patient who needs care and entering documentation for a procedure that has already occurred.
“The challenge for this model is that executives may be focusing too much on the importance of the documentation of care versus the actual care being provided,” Burger says, recalling an incident where she was supposed to discipline a staff member for not completing an EHR on time, when the nurse in question had correctly prioritized helping a patient in the intensive care unit.
“There are many reasons why value-based care is the best delivery model,” Burger says. “Organizations need to come full circle with caring first for our patients and allowing the EHR to support the care and not always drive it.”
Benefits to value-based care and nurses’ job duties
One of the biggest benefits of value-based care is allowing nurses to get back to the priority that brought many of them into the field in the first place: helping patients stay healthy.
“This model promotes maintaining health and prevention, which ultimately decreases the occurrence of critical illnesses and hospital readmissions,” says Valerie Smith, RN and writer at Daily NCLEX Challenge.
This emphasis on wellness and illness prevention gives nurses the opportunity to share more health education with patients. Under the previous volume-based model of care, many RNs may not have had the time to do so.
“Patient education is a vital role of a nurse to explain to patients of self-care after discharge and prevent future recurrences or complications,” Smith says. Thanks to value-based care, more nurses are able to incorporate patient education into their daily job duties.
The impact on the nursing work environment
Value-based care has had a largely positive effect on nurses’ work environments. With hospitals aiming to discharge patients as soon as possible, and with fewer patients suffering from complications that require readmission, many nurses may find themselves assigned to fewer patients each shift.
“As a result, the nurse to patient ratio, workload and burnout continues to decrease,” Smith says. With fewer patients to care for, nurses will experience less stressful shifts and more opportunities to focus their attention on patients during essential procedures, leading to better care for patients and an increase in their own sense of well-being.
Over time, this reduced workload could benefit nurses in bigger ways. Smith predicts that fewer overtime hours and the “regulation of normal shift work” could be on the horizon for nurses, who currently may be asked to work 12-hour shifts with little downtime. And with lower healthcare costs, Smith sees the potential for nurses’ salaries to improve.
The emphasis of strong coordinated care in value-based programs could also improve the workplace for nurses. “Value-based care alleviates nursing hardships or frustration brought on with discontinuity of care between specialties,” Smith says.
The bottom line: It may take some time to work the kinks out of the system, but value-based care has the potential to improve healthcare for providers, nurses and patients alike. “Ultimately, the value-based healthcare model has many benefits to the nursing and medical professions when utilized correctly,” Smith says.
Value-based healthcare: The new frontier of nursing
Now you understand the ins and outs of value-based healthcare, including how this new frontier of nursing could affect you.
But some things about nursing never change, especially the goal of helping every patient be as healthy as possible. Nursing interventions are one strategy to make that happen. Learn more in our beginner’s guide to nursing interventions.