Introduces the purpose of the reflection and addresses DNP Essentials (AACN, 2006) pertinent to scientific underpinnings for practice.
Include a self-assessment regarding learning that you believe represents your skills, knowledge, and integrative abilities to meet the pertinent DNP Essential and sub-competencies (AACN, 2006) as a result of active learning throughout this course. Be sure to use examples from selected readings, threaded discussions, and/or applications to support your assertions to address each of the following sub-competencies:
(a) “Integrate nursing science with knowledge from ethics, the biophysical, psychosocial, analytical, and organizational sciences as the basis for the highest level of nursing practice.
(b) Use science-based theories and concepts to: determine the nature and significance of health and health care delivery phenomena; describe the actions and advanced strategies to enhance, alleviate, and ameliorate health and health care delivery phenomena as appropriate; and evaluate outcomes.
Develop and evaluate new practice approaches based on nursing theories and theories from other disciplines” (AACN, 2006, p. 9).
An effective conclusion identifies the main ideas and major conclusions from the body of your essay. Minor details are left out. Summarize the benefits of the pertinent DNP Essential and sub-competencies (AACN, 2006) pertaining to scientific underpinnings for practice.
Look in this references pleases
Chism, L. A. (2016). The Doctor of Nursing Practice: A guidebook for role development and professional issues(3rd ed.). Burlington, MA: Jones & Bartlett Publishers.
• Chapter 4: The DNP: Expectations for Theory, Research, and Scholarship
Zaccagnini, M. E. & White, K. W. (2017). The Doctor of Nursing Practice essentials: A new model for advanced practice (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.
• Chapter 3: Clinical Scholarship and Evidence-Based Practice
Chamberlain College of Nursing. (2017). NR-700 Week 7: Emerging Roles for the DNP Prepared Nurse. [Online lesson]. Downers Grove, Il: DeVry Education Group.
In traditional fee-for-service Medicare, physicians are paid on a per-service basis. Payments are based on the “relative value units” of a particular service, reflecting the relative costliness of inputs.
How does the mix of services provided by primary care physicians affect their reimbursement relative to specialists? (2 points)
B –Describe the principal-agent problem in fee-for-service payment of physicians and physician-induced demand (also called supplier-induced demand).
-Describe the findings of Baker (2010).
-What does this imply about physician-induced demand? (3 points)
– Compare the structure of payment under the Alternative Quality Contract compared to fee-for-service reimbursement.
-How does this change the incentives for the volume of services provided by physicians?
-Are the findings of Song, et al. (2014) consistent with your theoretical prediction? (3 points)
D. What is a potential unintended consequence of “global budgets” such as that in the Alternative Quality Contract? How does the AQC attempt to mitigate this incentive, and was the attempt successful? (3 points)
E. In April 2015, Congress passed the Medicare Access & CHIPReauthorization Act of 2015 (MACRA). Under MACRA, starting in 2019 physicians will either be paid either based on: (a) fee-for-service reimbursement, with bonuses or penalties based on quality and resource use, or (b) they will receive regular 5% payment rate increases between 2019-2014 if they participate in alternative payment models.
It is yet to be finally determined, however, what will count as an alternative payment model. Below are two simplified scenarios from Hussey, Liu, and White (2017):
Scenario 1: Alternative payment models include both patient-centered medical homes (low financial risk, essentially fee-for-service, but physicians receive a “case management” fee) and accountable care organizations (physicians are at financial risk for spending above a target).
Scenario 2: Alternative payment models just include accountable care organizations (Hussey et al. 2017).
How might physician and hospital spending differ between Scenarios 1 and 2? Please explain your answer based on the lecture and course readings. (4 points)
Some policymakers have advocated for malpractice reform as a means for reducing health care spending.
Drawing from the readings and the lecture, describe conceptuallywhy malpractice and health care utilization may be related. (2 points)
Do you think malpractice reform would reduce unnecessary health care use? Cite empirical evidence for and against. (3 points)