Course
NR517 Policy and Economics of Healthcare Delivery
Question (Discussion Prompt)
Talk with a leader who is involved with financial management or reimbursement within a healthcare organization or health-related agency. Ask the following:
How is the organization or agency impacted by governmental legislation, regulatory requirements, and reimbursement guidelines?
How do these variables influence nursing practice within the organization?
In what ways do these factors impact health outcomes and equity within the community?
How to Approach It:
Identify a Leader:
Target a CFO, finance manager, billing/reimbursement specialist, or administrator in a healthcare organization or agency.
Schedule a short interview, phone call, or email discussion if in-person isn’t possible.
Prepare Your Questions:
Break down the discussion prompt into the three specific questions.
Ask for examples, not just general answers.
Do Preliminary Research:
Review relevant legislation (e.g., Medicare, Medicaid, ACA), reimbursement models (fee-for-service, value-based care), and regulatory requirements (e.g., The Joint Commission, HIPAA).
Understand the basics so you can discuss intelligently and compare their responses with current standards.
Take Notes During the Interview:
Document key points on how policies and reimbursement affect organizational finances, nursing practice, and patient outcomes.
Analyze and Reflect:
Think critically about the relationship between legislation, reimbursement, and nursing practice.
Consider implications for health equity in the community served by the organization.
Organize Your Discussion Post:
Introduction: Describe the leader and organization briefly.
Body: Answer the three prompts with insights from the interview and supporting research.
Conclusion/Reflection: Summarize what you learned and how it could influence your nursing practice.
Key Concepts to Focus On
Governmental Legislation: How laws and policies (Medicare, Medicaid, ACA) impact healthcare delivery.
Regulatory Requirements: Compliance with agencies like The Joint Commission or HIPAA.
Reimbursement Guidelines: How payment models influence organizational decision-making.
Impact on Nursing Practice: Staffing, documentation, care protocols, and resource allocation.
Population Health & Equity: How financial and regulatory factors affect access, quality, and health outcomes.
Professional Advocacy: Role of nurses in shaping and implementing policy to improve care.
Sample Solution
How is the organization or agency impacted by governmental legislation, regulatory requirements, and reimbursement guidelines?
There are different governmental regulating bodies (state and federal) which mandate operations and funding to the facility, but the facility itself also has it’s strategies for funding and cost improvement. There is quality reporting with hospital-acquired conditions under Medicare policies.…..Click below to access the full sample solution (PDF)