Reply to two of your classmates. In each of your replies, include new information related to your peer’s initial post or to the topic. Each reply should be 200 to 400 words. You should cite one to two sources in your reply posts that add new information in response to your classmate’s post, with at least one of those sources from the Week 2 Learning Materials.
Week 2 Learning Materials: (Can be found on google)
Shi, L., & Singh, D. A. (2022). Delivering health care in America: A systems approach (8th ed.). Jones & Bartlett Learning.
Chapter 4: Health Services Professionals
Chapter 7: Outpatient and Primary Care Services
Chapter 8: Inpatient Facilities and Services
Chapter 10: Long-Term Care
Initial Post Assignment (For context): Select one of the following topics to write about in your initial post. Please make it clear which topic you chose to write about in your initial post. Write 500 to 750 words related to:
Topic 1: Choose one sector of health care delivery and financing that interests you (outpatient and primary care services; inpatient facilities and services; or long-term care). What are two challenges facing the sector you have chosen? What are two policies that address those challenges? What are the politics of those policy recommendations, if any? Make clear in your entry whether the policies you cite are policies already adopted, proposed or under consideration, and/or ones that you would recommend.
Topic 2: Discuss two challenges facing the health professions. What are two policies that would address those challenges? What are the politics of those policy recommendations, if any? You can write about the health professions in general or choose a specific health profession to write about. Make clear in your entry whether the policies you cite are policies already adopted, proposed or under consideration, and/or ones that you would recommend.
Classmate 1:The purpose of this discussion post is to examine the outpatient and primary care services sector within the U.S. health care system by addressing the following questions: What are two challenges facing the sector? What are two policies that address those challenges? What are the politics of those policy recommendations? By identifying current challenges and proposing potential solutions, this discussion aims to enhance the understanding of primary care delivery to meet the needs of a diverse and growing patient population.
Outpatient care involves medical services provided without requiring an overnight stay in a hospital or other healthcare facility. Primary care serves as the first point of contact for patients, offering preventive care, diagnosis, and treatment of acute and chronic illnesses. Primary care providers (PCPs) play a crucial role in managing overall patient health and coordinating care with specialists and other healthcare services (Shi & Singh, 2022). One of the significant challenges in outpatient and primary care is the shortage of primary care providers, which impacts access to care, particularly in rural and underserved areas. The uneven distribution of healthcare professionals leads to longer wait times and can compromise the quality of care. Additionally, the increasing complexity of managing multiple chronic conditions requires effective care coordination, which can be challenging in divided healthcare systems. To address these challenges, several innovative models have been introduced, such as the patient-centered medical home (PCMH) and accountable care organizations (ACOs). These models emphasize coordinated, comprehensive care, and involve a team-based approach where primary care acts as the hub for managing patient health across various settings. Furthermore, the integration of electronic health records (EHRs) and telehealth services can enhance communication and continuity of care, making healthcare delivery more efficient and patient-centered. Telehealth can increase convenience and decrease overall cost of care, helping avoid or decrease costly emergency room visits. About 40% of ER visits are classified as low-acuity non-emergent care, which could be handled using telehealth (Manocchia, 2020).
Addressing Supply and Demand in healthcare workforce that includes a diverse range of professionals such as physicians, nurse practitioners (NPs), physician assistants (PAs), and allied health professionals. Training pathways for these roles vary, with physicians undergoing extensive education and residency training, while NPs and PAs follow shorter, more flexible training programs. There is a significant shortfall in the number of primary care physicians being trained to meet this demand. To bridge this gap, there has been a push to expand the roles of NPs and PAs. In addition, the Affordable Care Act (ACA) aims to increase access to health care which will raise the demand for primary care services. Studies have shown that the quality of care delivered by NPs and PAs is comparable to that provided by physicians, especially in managing chronic conditions and preventive care. Expanding the scope of practice for these professionals, especially in states with restrictive regulations, could significantly improve access to primary care (Donelan, 2024).
In addition to expanding the scope of practice for NPs and Pa’s, effective care coordination is also essential in managing patient health and ensuring continuity of care. Models like PCMH and ACOs facilitate collaboration and involve a range of healthcare providers working together to meet patient needs. Care coordinators also enhance continuity of care, helping patients navigate the healthcare system and ensuring that critical health information is communicated across different care settings. It is vital to address these challenges of provider shortages, enhancing care coordination, and expanding the roles of non-physician providers because outpatient and primary care services play a crucial role in managing patient health and preventing disease. By fostering interprofessional collaboration and leveraging technology, we can build a more resilient and responsive primary care system.
References:
Donelan, K. (2024). Supply and demand. In United States health policy [Video]. Retrieved from Topic 3: Supply and Demand | Session 8.1: Health Care Workforce | United States Health Policy | edX
Manocchia A. (2020). Telehealth: Enhancing Care through Technology. Rhode Island medical journal (2013), 103(1), 18–20.
Shi, L., & Singh, D. A. (2022). Delivering Health Care in America: A Systems Approach (Eighth). Jones & Bartlett Learning.
Classmate 2: I decided to write about outpatient and primary care services and financing. The outpatient and primary healthcare sector have come a long way and has evolved in financing strategies. Outpatient healthcare constitutes all services not provided as an inpatient at a hospital. In the mid-1980s, a prospective payment system was instituted in inpatients, encouraging outpatient services, and due to technological advancements in the medical field, many procedures that initially would have been performed as an inpatient are now safely being performed as an outpatient, driving the growth in outpatient services (Shi & Singh, 2022). Examples of outpatient services include emergency department services, rehabilitation, and specialized clinics (Shi & Singh, 2022). Primary care services are essential to healthcare since they serve as gatekeeping and care coordination (Shi & Singh, 2022). These services are reimbursed through Medicare and Medicaid and private pay. However, certain free health services are provided at Free clinics that government agencies do not run, and trained volunteers provide health services; these facilities serve the poor and homeless populations (Shi & Singh, 2022).
Independent practices in primary care have appealed to many healthcare providers due to their increased independence in practice. However, they have to overcome many challenges. One challenge is the low reimbursement from Medicaid, which has been below the Medicare and private insurance reimbursement rates, affecting the number of Medicaid patients a physician might want to care for, if at all. A policy that addressed this issue was the 2013-2014 Medicaid free bump and the 2015 primary care incentive program provided under the Affordable Care Act (ACA) (Hsiang et al., 2020). These were two free increases for primary care physicians that were notably effective in increasing reimbursement, but they were short-lived since they were temporary and no longer active. The low reimbursement through Medicaid has left many physicians with no choice but to reject Medicaid patients, leaving many to struggle to access healthcare services. Therefore, an increase in reimbursement could help Medicaid patients access medical services.
A second challenge for primary care physicians is the surge in patient numbers since the implementation of the ACA. While many patients are now insured, there is a significant shortage of primary care physicians to cater to this increased demand. In 2022, President Biden passed The American Rescue Plan, a comprehensive healthcare initiative aimed at improving the healthcare workforce. This bill allocated 330 million to train primary care physicians and dentists in rural and underserved communities (USG, 2022). In addition to the investment in primary health education, this bill also addresses the disparities in access to healthcare in rural and underserved communities, a crucial step towards improving healthcare equity.
The evolution of outpatient and primary care services, alongside their financing strategies, emphasizes their critical role in modern healthcare systems. From the inception of prospective payment systems to the current challenges of reimbursement rates, the landscape has continuously shifted. While initiatives like the Medicaid fee bump and the ACA’s primary care incentive program have provided temporary relief, persistent challenges, such as low Medicaid reimbursement and physician shortages, persist. The recent investment in healthcare workforce training through initiatives like The American Rescue Plan shows promise in addressing these issues, highlighting the ongoing commitment to improving access and quality of care, particularly in underserved communities.
References
Hsiang, W. R., Gross, C. P., Maroongroge, S., & Forman, H. P. (2020). Trends in compensation for primary care and specialist physicians after implementation of the affordable care act. JAMA Network Open, 3(7). https://doi.org/10.1001/jamanetworkopen.2020.11981
Shi, L., & Singh, D. A. (2022). Delivering Health Care in America: A Systems Approach (Eighth). Jones & Bartlett Learning.
The United States Government. (2022, September 30). Fact sheet: Biden-Harris Administration announces American Rescue Plan’s historic investments in Community Health Workforce. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2022/09/30/fact-sheet-biden-harris-administration-announces-american-rescue-plans-historic-investments-in-community-health-workforce/
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