P7A AND P7B

4 hours ago

Amy Miller

RE: Discussion - Week 7

Collapse

NURS 6050C: Policy and Advocacy for Improving Population Health

Main Question Post. The Patient Protection and Affordable Care Act of 2010 created several positive healthcare policies such as affordable health care, lifting the preexisting health condition clause from health insurance, requiring facilities to make healthcare charges public knowledge, and enforcing healthcare providers to become active in improving quality and health outcomes for patients (Library of Congress, n.d.). The act addressed a combination of the health care drivers of cost, quality, and access. According to a report released by the White House Press Secretary on April 17, 2014, “The Affordable Care Act is working. It is giving millions of middle class Americans the health care security they deserve, it is slowing the growth of health care costs and it has brought transparency and competition to the Health Insurance Marketplace.” (The White House, 2014). However, the price some healthcare providers had to pay a heavy financial - forcing some providers out of business. The negative side of the act is seldom portrayed in the news and media.

Section 3131(a) of the act required payment for home health services to be rebased over a period of four years (Centers for Medicare & Medicaid Services, 2013); resultant in a 2.8% reduction beginning in 2014 for four consecutive years totaling a reduction in payment of 11.6%. The reductions were placed along with mandates for quality reporting, new forms, and new processes resulting in increased administrative overhead costs while shouldering the burden of financial reductions.

Initiating a Change in Policy Process

Living in a rural community, I witness firsthand the lack of access to care as there are limited numbers of primary care providers. Couple the limited access to providers with the amount of paperwork and forms that must be signed by a physician and patients are not referred to home health services as often as one should be – the result is the patient presenting to the emergency room or a hospitalization to have one’s health care needs met. Currently, Medicare and Medicaid do not allow physician assistants or advanced practice registered nurses (APRNs) to sign the necessary orders and plan of care for home health services – only a “doctor of medicine, osteopathy, or podiatric medicine” may sign for services (Government Publishing Office, 2014, p. 693). I would like to use the knowledge gained as an APRN to legislate for this mandate to be changed and allow both physician assistants and APRNs to sign for coverage of home health services.

The Kingdon Model would be utilized for the legislation process by finding the three streams of problem, policy, and politics to coordinate with the above-mentioned issue (Milstead, 2019, p. 24). The problem would consist of the burdensome amount of paperwork imposed upon physicians to cover home health services coupled with the limited amounts of physicians in the area serving as primary care providers. The policy portion would be to establish a law or mandate that removes the current mandate imposed by the Centers for Medicare and Medicaid Services that precludes non-physicians from signing for home health coverage. The politics portion would involve aligning with the appropriate lobbying group to get a legislator on board to create a bill to bring the topic to the floor for a vote. Finding the right time to bring the issue to the forefront would assist in ensuring the bill passed with the appropriate number of votes. Now is the time as government continues to search for ways to balance the budget and lower the cost of healthcare. Services by an APRN are less costly than services provided by a physician.

References

Centers for Medicare and Medicaid Services. (2013, November 22). MLN matters home health

prospective payment system (HH PPS) rate update for calendar year (CY) 2014.

Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-

Network-MLN/MLNMattersArticles/Downloads/MM8515.pdf

Government Publishing Office. (2014). Code of federal regulations 2014 CFR. Retrieved from

https://www.govinfo.gov/content/pkg/CFR-2014-title42-vol3/pdf/CFR-2014-title42-vol3-

sec424-22.pdf

Library of Congress. (n.d.) H.R.3590 - Patient Protection and Affordable Care Act. Retrieved

from https://www.congress.gov/bill/111th-congress/house-bill/3590/

Milstead, J.A. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA:

Jones and Bartlett Publishers.

The White House Office of the Press Secretary. (2014, April 17). Fact sheet: Affordable Care Act by the numbers. Retrieved from https://obamawhitehouse.archives.gov/the-press- office/2014/04/17/fact-sheet-affordable-care-act-numbers