Providing Cost Effective Care Without Limiting Access – Care Example

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"Providing Cost-Effective Care Without Limiting Access" is an engrossing example of a paper on care. According to the American College of Physicians (2009), the United States spends more on healthcare than any other country in the world. It is expected that by 2017, health care spending will reach $13,101 per person making total spending of $4.3 trillion (ACP, 2009). Physician and clinical services account for 21 percent of total health care spending. The United States has built a culture that expects diagnostic certainty, despite the knowledge of Bayesian theory and the limitations of specific diagnostic exams.

There is enough evidence that a significant proportion of diagnostic tests conducted in the U. S. are potentially avoidable based on the patient’ s clinical condition and the best available evidence (Pines, Carpenter, Raja & Schuur, 2012). These authors further classify the inappropriate use of diagnostic tests into categories of underuse, overuse, and misuse. The underuse of diagnostic tests refers to the failure of medical practitioners to provide healthcare service when there was evidence that would have produced favorable outcomes for the patient. Overuse occurs when a diagnosis is ordered without any medical justification or evidence to support its use in the condition of the patient.

Misuse refers to situations where there is a significant trade-off among the available options. Nurses have a role in diagnostic testing does not place an unbearable burden on the patient (Pines, Carpenter, Raja & Schuur, 2012). When conducted appropriately, diagnosis exam, such as tomography for abdominal pain, can help reduce cost by identifying patients who do not need hospitalization or further diagnosis. It is the role of every nurse practitioner to provide quality healthcare at the lowest cost possible.

Diagnostic exams greatly help in therapeutic decision-making; however, they contribute substantially to the cost of medical care. Even if diagnostic testing is necessary in most cases, it should be properly used in order to reduce the burden of healthcare costs on the patient. Nurses often find diagnosis tricky due to their inherent uncertainty. Most nurses as well as other medical practitioners argue that it seems more difficult to stop investigating a patient than to start. Summerton (2007) admits that failing to diagnose a disease in an accurate and efficient way causes severe consequences for the delivery of high quality and cost-effective healthcare.

Inaccuracy means not identifying the true disease state. Inaccuracy results in false positive or false negative diagnoses. Inaccurate diagnosis may be in three forms; it may be missed, it may be delayed, or it may be incorrect. Inefficiency prompts the clinicians to have more tests or procedures that may exceed those that are required to make a diagnosis making the process to be very costly. Failure to make accurate and efficient diagnoses places a cost burden on the patient.

Many patients bear the cost of inflated hospital bills resulting from unnecessary diagnostic tests. Therefore, the need for specific cost-effective guidelines is more critical than ever. Hospitals need to practice cost containment in the diagnosis rooms. Factors affecting healthcare delivery include decreased quality of healthcare and increased cost of healthcare delivery. Healthcare practitioners should change their focus from the process of delivering care to cost-effective patient outcomes. Interdisciplinary collaboration is critical to providing optimal care while conserving financial resources. The costs of medical care depend critically on medical practitioners.

Nurse practitioners order diagnosis exams and decide whether other tests are necessary. The diagnosis exams have extended the economic dimensions of medicine thus giving medical practitioners many choices to generate income using the new technology (Relman n. d.). In diagnosis exams, the right thing is simply a matter of opinion. It is imperative for nurses to understand that any new diagnostic test should aid in providing high quality and cost-effective care to patients. The bottom line is this – less expensive and more effective diagnosis.

The American Association of Critical-Care Nurses (AACN) emphasizes greater efficiency, cost-effective, quality of life, and patient satisfaction (Stacy & Lough, 2013).   Promoting wellness and preventing illness is a significant part of nursing practice; therefore, the nurse must be aware of potential complications to intervene appropriately on the patient’ s behalf and at the same time avoid ordering unnecessary tests. Therefore, nurses should use critical thinking skillset to help them arrive at a diagnosis and to provide efficient, cost-effective care to their patients. Nurses need to avoid ordering tests that are unlikely to affect their medical decision-making.

Worse yet, they have a habit of repeating tests that have recently been performed and are unlikely to have changed. These diagnosis exams that add no useful information are a clear form of medical waste. These medical wastes are controllable by clinicians and physicians. Despite overwhelming evidence that many diagnosis exams are of little or no value, physicians and clinicians have found it difficult to change this practice. Improving the appropriateness of diagnostic exams is one of the ways that medical practitioners can reduce medical costs and improve value.

It is possible to reduce medical costs while improving the quality of patient care (Pines, Carpenter, Raja & Schuur, 2012). Augsburger (2005) categorized several diagnosis exams as unnecessary. These include exams that are done to evaluate the sensitivity, specificity, and predictive value of a new method or instrument, tests conducted without any regard to individual personal characteristics, and duplicate tests among others. Nurse practitioners often give justifications for these tests. Nevertheless, nurses need to minimize unnecessary testing in order to reduce the cost burden of treatment. According to the American College of Physicians (2009), the rate of increase in healthcare spending in the United States continues to exceed economic growth at an unsustainable pace.

The rate of increase in healthcare spending in the U. S. is undermining its long-term fiscal condition. Increased pressure to control healthcare costs necessitates that diagnosis equipment is used cost-effectively and equitably. Health care costs must be correlated with efficiency in the diagnosis in order to improve healthcare outcomes. Clinical procedures, therefore, need to be effective by identifying the problems with minimal testing in order to achieve savings. While practitioners order diagnostic exams to answer a specific question or to clarify an uncertain condition, the results sometimes do not answer the question specifically.

Practitioners can maintain cost-effectiveness and still get information for a diagnostic test without ordering unnecessary diagnostic exams. There are several steps at the clinician’ s disposal that can be taken to improve the appropriateness of their diagnostic test ordering. Learning and applying the best evidence to their frequent decisions around the diagnosis exam is one of the best practices to reduce diagnostic costs. This may include identifying good sources of information around diagnostic testing, regular reading, and application of enough knowledge at the bedside.

Currently, there is increased knowledge and evidence from handbooks and websites that can help in busy clinical situations. Nurse practitioners also have an important role to play in ensuring that they implement systems that can improve the appropriateness of test ordering. These systems include clinical decision support, standardized guidelines and pathways, and auditing practice with feedback to healthcare providers including data on the cost of testing. Pines, Carpenter, Raja & Schuur (2012) suggest the use of ‘ clinical decision rules’ to assist practitioners in deciding whether a diagnostic exam is needed.

Clinical decision rules are designed to be simple and provide a practical decision-making guide to differentiating patients who require diagnostic tests from those who do not. Clinical decision rules include three elements from the patient history, a physical exam, and simple ancillary tests that can guide them at the bedside in the emergency room.   Each step of validation should involve specific study designs and statistical analysis. However, these clinical decision rules are not necessarily binding.

Clinical decision rules have been in use for a period of 15 years (Pines, Carpenter, Raja & Schuur, 2012). These rules have contributed to significantly reducing the cost of healthcare provision. The benefits that have been associated with clinical decision rules include reduction of time in the emergency departments, reduced exposure to radiation, and reduced costs to both patients and the healthcare system.  


American College of Physicians (2009). Controlling Health Care Costs While Promoting The Best Possible Health Outcomes. A White Paper. Retrieved from

Arnold S.Relman. (n.d.). Cost control, doctors’ ethics, and patient care. Retrieved from

Augsburger, J. (2005). Unnecessary Clinical Tests in Ophthalmology. Transactions of the American Ophthalmological Society. Vol. 103, pp. 143-147.

Pines, J., Carpenter, C., Raja, A. & Schuur, J. (2012). Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules. New Jersey: John Wiley & Sons.

Stacy, K. & Lough, M. (2013). Critical Care Nursing, Diagnosis, and Management: Critical Care Nursing. Missouri: Elsevier Health Sciences.

Summerton, N. (2007). Primary Care Diagnostics: The Patient-centred Approach in the New Commissioning Environment. Oxon: Radcliffe Publishing.

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