1. :What impact did the Affordable Care Act have on the Centers for Medicaid and Medicare (CMS) in their effort to focus on both quality of care and cost reduction?
The Affordable Care Act (ACA) has had a significant impact on the Centers for Medicare and Medicaid (CMS) in their effort to focus on cost reduction and quality of care. The Affordable Care Act has helped save significant amounts of money on costs related to readmission. The Affordable Care Act has also played a significant role in encouraging value-based healthcare delivery(de Lancer Julnes & Choi, 2020). One of the key goals of the ACA was to shift the healthcare system from a fee-for-service model to a value-based care model. This meant that healthcare providers would be rewarded for delivering high-quality care that improved patient outcomes rather than simply performing more tests and procedures (Ercia, 2021). To achieve this goal, the ACA established several initiatives that CMS was responsible for implementing, including the Hospital Value-Based Purchasing Program. This program incentivizes hospitals to improve the quality of care they provide by tying a portion of their Medicare reimbursement to their performance on a set of quality measures (McIntyre & Song, 2019). Through the ACA, CMS also included the introduction of the Physician Quality Reporting System. This program provides incentives to physicians who report on their performance on certain quality measures, such as patient outcomes, patient safety, and patient experience. The ACA also saw the introduction of the Medicare Shared Savings Program. This program encourages accountable care organizations (ACOs) to work together to reduce costs and improve the quality of care for Medicare beneficiaries (Ercia, 2021). Overall, the ACA’s focus on value-based care has led CMS to prioritize quality improvement and cost reduction initiatives. By rewarding providers for delivering high-quality care that improves patient outcomes, CMS is helping to create a healthcare system that is more efficient, effective, and affordable for all Americans (McIntyre & Song, 2019).
2. How did the CMS Hospital Readmission Reduction Program (HRRP) impact disadvantaged populations?
The CMS Hospital Readmission Reduction Program (HRRP) was designed to reduce hospital readmissions and improve the quality of care for all Medicare beneficiaries. While the program was not specifically designed to target disadvantaged populations, its impact on these populations has been a topic of concern and research. De. Lancer Julnes & Choi (2020) found that the HRRP had a disproportionate impact on safety-net hospitals, which tend to serve a higher percentage of low-income and uninsured patients. These hospitals were more likely to be penalized for excessive readmissions than non-safety-net hospitals. The study also found that hospitals serving larger numbers of Black and Hispanic patients were more likely to be penalized than hospitals serving larger numbers of White patients (de Lancer Julnes & Choi, 2020). HRRP has also been associated with a reduction in readmissions for both Black and White patients, but the reduction is smaller for Black patients. The study also found that the reduction in readmissions was smaller for patients who were dually eligible for Medicare and Medicaid, which is a population that includes many low-income individuals (de Lancer Julnes & Choi, 2020). The HRRP has also been consistently found to contribute to reduced readmissions in the short-term but contribute to increased mortality rates among patients suffering from chronic conditions such as heart disease. The risk of mortality among patients under HRRP also seems to be higher among individuals from low-income areas compared to those from high-income areas (de Lancer Julnes & Choi, 2020).
3.How, if at all, did a nurse practitioner keep the patient out of the hospital? What can you do as a NP to help prevent readmissions?
One of the most effective strategies that a nurse practitioner can take to keep the patient out of the hospital would be implementing effective discharge protocols. The implementation of an effective discharge protocol and therefore go a long way in ensuring that the preparation for the discharge of a patient begins immediately after readmission. This can go a long way in preventing readmissions (Tracy & O’Grady,2018). Nurse practitioners (NPs) can also prevent hospital readmissions by implementing a range of strategies, such as patient education. NPs can educate patients and their families on self-care techniques and signs and symptoms to watch for that may indicate a need for further medical attention. This can include educating patients on medication management, wound care, and lifestyle modifications, such as diet and exercise. Nurse practitioners can also prevent readmissions by being involved in transitional care coordination. NPs can work with other healthcare providers to ensure that patients receive appropriate follow-up care after leaving the hospital, such as scheduling appointments with primary care providers or arranging for home health services (Pugh et al., 2021). Medication reconciliation is also an effective strategy that nurse practitioners can utilize to prevent readmissions. NPs can review patients’ medication regimens and ensure that they are taking the appropriate medications at the correct dosages. This can help to prevent adverse drug events and reduce the risk of hospital readmission. Nurse practitioners can also play a more active role in chronic disease management, which can go a long way in preventing readmissions (Pugh et al., 2021). NPs can work with patients who have chronic conditions, such as heart failure or diabetes, to develop individualized care plans and provide ongoing support and monitoring to help prevent exacerbations of their conditions. Nurse practitioners can also be engaged in risk assessment and screening which are effective strategies for preventing readmission. NPs can conduct screenings and assessments to identify patients who may be at higher risk for readmission, such as those with multiple chronic conditions or those who have previously been readmitted to the hospital. This can help to target interventions and resources to those who need them most (Pugh et al., 2021).
4. The article makes the statement that health care is a civil rights issue. 5. Do you agree or disagree with this statement after reading the article? Provide evidence for your position.
Yes, I agree with the statement that healthcare is a civil rights issue. It is, therefore, important to effectively deal with disparities in the delivery of healthcare services and healthcare outcomes that can be significantly affected by the social class of an individual. Healthcare is a civil rights issue because access to healthcare is a fundamental human right that is essential for individuals to live healthy and productive lives. When people lack access to healthcare, it can lead to poor health outcomes, reduced quality of life, and economic hardship (Mason et al., 2020).
Historically, access to healthcare has been unequally distributed along the lines of race, ethnicity, income, and geography. For example, people of color and low-income individuals have faced significant barriers to accessing healthcare, such as lack of insurance, inadequate provider networks, and systemic racism within the healthcare system. The Affordable Care Act (ACA), passed in 2010, was a major step forward in addressing healthcare disparities and expanding access to healthcare for millions of Americans (Ercia, 2021). The ACA included provisions that prohibit insurance companies from denying coverage based on pre-existing conditions, expanding Medicaid eligibility, and creating health insurance marketplaces to make it easier for individuals to compare and purchase insurance plans. However, there is still much work to be done to ensure that everyone has access to affordable, high-quality healthcare. Addressing healthcare disparities and ensuring access to healthcare for all is not only a moral imperative but also a necessary step in promoting social justice, equity, and economic prosperity. As such, healthcare is a civil rights issue that requires ongoing attention and action from policymakers, healthcare providers, and advocates (Mason et al., 2020).

References
de Lancer Julnes, P., & Choi, S. W. (2020). Equity-Efficiency Tradeoff: The Hospital Readmissions Reduction Program And Disparities In Outcomes Among Vulnerable Medicare Heart Failure Patients In Pennsylvania. Journal of Health and Human Services Administration, 23–48. https://doi.org/10.37808/jhhsa.43.1.3
Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California, and Texas. BMC Health Services Research, 21(1), 1–9. https://doi.org/10.1186/s12913-021-06961-9
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLOS Medicine, 16(2), 1–3. https://doi.org/10.1371/journal.pmed.1002752
Mason, D. J., Perez, A., McLemore, M. R., & Dickson, E. (2020). Policy & politics in nursing
and health care – e-book(8th ed.). Elsevier Health Sciences.
Pugh, J., Penney, L. S., Noël, P. H., Neller, S., Mader, M., Finley, E. P., Lanham, H. J., & Leykum, L. (2021). Evidence-based processes to prevent readmissions: more is better, a ten-site observational study. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06193-x
Tracy, M. F., & O’Grady, E. T. (2018). Hamric & Hanson’s advanced practice nursing – e-
book (6th ed.). Elsevier Health Sciences.