Nursings ethical responsibilites in value based purchasing

Abstract

Since publishing To Err Is Human (2000), the Institute of Medicine (IOM) has pushed for improvement in workforce environments, patient outcomes, and patient safety (Institute of Medicine [IOM]). To Err Is Human (2000) focused on medication errors, while Crossing the Quality Chasm (2001) examined safety, effectiveness, patient-centeredness, efficiency, equitableness, and timeliness (IOM). In 2004, the IOM published Keeping Patient's Safe: Transforming the Work Environment of Nurses which explored the relationship between nursing practice environment and patient safety. Bringing these issues to public attention resulted in calls for healthcare reform among many stakeholders. One healthcare reform revolves around patient-centered care. Patient-centeredness has gained momentum with consumers and stakeholders, especially with the arrival of pay for performance (P4P) initiatives (Centers for Medicare & Medicaid Services [CMS], 2007). These P4P initiatives (more recently referred to as value based purchasing [VBP]) were instituted in 2013 (Moody-Williams, 2012). This program was brought about due to increased healthcare costs, high rates of adverse events, increased readmission rates and a perceived decrease in quality of care provided (Moody-Williams, 2012). The goals of the VBP program are to effectively lower healthcare costs while improving patient outcomes (Moody-Williams, 2012). The reimbursement initiatives outlined by CMS in the Report to Congress: Plan to Implement a Medicare Hospital Value-Based Purchasing Program (2007) has a relationship with nurses practicing in acute care facilities. While one purpose of this article is to inform the reader of relationships between the practice environment and VBP, the primary purpose is to guide the reader in gaining an understanding of the ethics involved in the relationship between nursing practice and VBP.