ANCC NE-BCNurse Executive Board Certification

Correct: D. That value-based reimbursement may enhance process and outcome measures such as resource use and readmission rates, yet also introduces risks including patient avoidance behaviors or reduced services in non-incentivized areas

Why: Value-based payment structures can improve care coordination, patient safety, and operational efficiency by tying financial incentives to quality outcomes. However, research also shows potential downsides, such as providers steering away from high-acuity patients to keep costs manageable, or neglecting services not linked to performance bonuses. Nurse executives must weigh both sides and develop safeguards such as robust risk adjustment and protections for vulnerable patient groups. Assuming value-based reimbursement reliably improves outcomes and finances across all service lines is overly optimistic. Evidence shows considerable variability, with some departments thriving while others face challenges based on patient demographics or infrastructure. Calling for immediate elimination of fee-for-service is misleading. While FFS incentivizes volume, it can support quality when paired with appropriate accountability measures, and an abrupt transition would destabilize many organizations. Believing value-based payment eliminates financial risk is incorrect. In practice, it transfers risk to providers, particularly those caring for complex patient populations that may not align neatly with quality performance metrics.