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University of Phoenix HSN 476 Patient Advocacy and Cost Controls Discussion

This is a discussion post from another classmate. Please respond in a minimum of 100 words:

Even in the reading we have done so far for this course, it seems difficult to determine how to both provide the best care as well as control costs effectively. There seem to be plenty of changes that have been brought about, even since the beginning of Medicaid and Medicare, that look to address both of these parts of the equation. And yet when looking at healthcare today I don’t think anyone would be convinced that we have this figured out. Personally, I struggle in my day-to-day career with that same relationship. We are asked to contain costs whenever possible, and certainly there are things we try to do such as a focus on productivity when making staffing decisions. As a charge nurse, the ask is that we would shoot for greater than 100% productive at any point in time. Essentially saying, we should try to work with less than what would be the set or required amount for our current census. I understand in one sense why we obviously need to save money where we can in healthcare, but this concept has often puzzled me. The simple fact that it is an ICU, and people are acutely ill and dying, often speaks to me more than the desire to save money. I have made that comment before in a situation where a staff member messes up something with a product of some sort and has to use additional resources (i.e. placing a straight catheter, and needing to do multiple attempts). At the end of the day, this patient needs care and we are there to provide it. Trying to be diligent where we can is great, but I’d always rather my staff give the best care, and keep that as the primary focus. An interesting study that was published in 2021 focused on providing care for HIV patients, and the relative cost-effectiveness with the interventions in place. Interestingly, this study found that there are programs that specifically focus on HIV patients in need of care-whether that be a new diagnosis, someone who has never had treatment, or who has stopped getting care (Shade, et al., 2021).

The goal of these navigation programs is to get the patient to the point of viral suppression, and while there was a cost associated with reaching out to and treating these patients, I cannot imagine the cost had those patients not been seen, and I’m sure would likely have far worse issues. “Patient navigation programs were associated with improvements in engagement of patients in HIV care and viral suppression. Cost per outcome was minimized in states that utilized surveillance data to identify individuals who were out of care and/or those that were able to identify a larger number of patients in need of improvement at baseline (Shade, et al., 2021).”

This seems to carry the same focus, of simply providing the care that these patients truly need. And while there was some up front cost attached to that, you have to wonder at the cost that is saved in the long run of this highly at risk population. If there is a real, focused and concrete way to provide great care and simultaneously cut costs, I have yet to see it truly flushed out.

Shade, S. B., Kirby, V. B., Stephens, S., Moran, L., Charlebois, E. D., Xavier, J., Cajina, A., Steward, W. T., & Myers, J. J. (2021). Outcomes and costs of publicly funded patient navigation interventions to enhance HIV care continuum outcomes in the United States: A before-and-after study. PLoS Medicine, 18(5), 1–18.


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