HJAR May/Jun 2024

42 MAY / JUN 2024 I  HEALTHCARE JOURNAL OF ARKANSAS NURSING COLUMN NURSING THE provision of healthcare is impacted by emerging trends through the healthcare provision space in the United States. Access, provision, and the challenging dynamic of federal regulations, evidence- based practice change, reimbursement, and healthcare system organization and reorganization create significant challenges and opportunities for clinical decision making throughout nursing and healthcare in general from local, national, and global perspectives. This article focuses on two specific trends and provides an in-depth analysis of how the trends impact clinical decision- making. The relevance of these trends to professional nursing leadership practice will culminate the narrative. Current and emerging trends There is a great deal of information in literature and professional communi- cations relative to emerging trends. The trends include, but are not limited to, pa- tients becoming more informed consum- ers, quality measurement and benchmark determination and goals, consolidations of health systems to drive revenue, provider payment restructure, specialty drug use, and information technology innovations. Two specific trends of interest for a de- tailed analysis were selected for the pur- poses of this narrative and are specifically related to quality measurement structure and patients becoming more informed consumers. Structured quality measures The specific quality measures con- structed originated as the core measures and focused on disease-specific pathways or clinical standards based on evidence to apply to particular subgroups. Quality over time is gaining greater focus from the financial area as reimbursements are di- rectly related to quality and patient expe- rience through the advent of value-based purchasing. Reimbursement has been tied for some time now to quality outcomes through value-based purchasing (VBP). Until recently, the metrics for inclusion in the program were patient satisfaction and core measures. Now, the Centers for Medi- care and Medicaid Services (CMS) have added additional outcome metrics such as mortality, infection rates, and readmis- sions to the mix. The metrics were estab- lished as national goals and are measured at the facility, local, regional, state, and national levels. These metric performance measures were incentivized by payment improvement or reduction based on per- formance in the Medicare and Medicaid reimbursement models by facilities. Informed consumers The public is becoming much more ad- ept at evaluating the quality of healthcare provision. The advent of public reporting and the plethora of access via social me- dia presents a unique opportunity for healthcare consumers to obtain informa- tion relative to quality and patient safety outcomes for the healthcare organization to which they may opt to utilize for care. Important to every patient is the experi- ence, the safety, and the quality of the care they or their loved ones will receive when selecting an organization to provide health services. Local, national, and global implications Quality performance and informed consumer access play a direct role in the provision of care and the viability of an organization relative to quality outcomes and financial operability. Consumerism and the ability to review safety and qual- ity ratings allows the consumer to make informed choices on selection of orga- nizations and providers of care based on this readily available information. 1 Perfor- mance relative to risk-adjusted expected rates of performance are tied directly to state and regional demographics and oth- er factors and provide for a like-situation EMERGING TRENDS: Impact for Nursing Leadership