Health policy issues

Topic 7 DQ 1

Identify two major health policy issues that affect the current state of health care delivery and population health equity in the United States (may be state or federal). What impact do these population health policies and initiatives have on advanced nursing practice?

Sample student response one

 Policies at different levels impact how healthcare is delivered to populations. Policies can either impede or support healthcare initiatives depending on the intention and input of the stakeholders in the making of the specific policies. The first policy issue that has been in debate for quite a long time is the ballooning cost of care. One of the policies that revolutionized care delivery in the United States, with regards to cost, is the Affordable Care Act. The policy, while passed over ten years ago has its impact debated to date.

One of the significant provisions of the ACA was to enhance the provision of affordable care by increasing the budgetary allocation for the Centers for Medicare and Medicaid Services (Courtemanche et al., 2018). The ACA also had provisions that incentivized a value-based approach to care through accountable care organizations.

Therefore, the policy which impacted care delivery both on a federal and state level significantly impacted affordability, accessibility, and quality of care, especially in underserved populations, in turn, enhancing population health equity in the United States (Courtemanche et al., 2018).

The second policy issue involves nursing practice, more so, guidelines that affect the practice of advanced practice registered nurses (APRNs). One of the significant policy frameworks that touch on this issue is the APRN consensus model which provides guidelines that states can use to adopt uniform regulatory, accreditation, and licensure, certification, and education for APRNs (Buck, 2021).

This will allow APRNs to serve in any state that has endorsed the policy without requiring additional education or certification. Adoption of the framework would greatly enhance the provision of care by allowing APRNs to practice to the full extent of their skills, competencies, and education as recommended by the Institute of Medicine 2010 report (Barnes et al., 2018).

The two policy issues have significant implications on the roles of APRNs. The policy issues demand increased leadership from APRNs in guiding care delivery throughout the entire continuum. APRNs need to take center stage in controlling healthcare costs by providing and advocating for quality care with a value-based approach to care delivery as a guideline.

APRNs are also required to show great leadership in creating models that address the significant disparities within the healthcare system in accordance with the training, knowledge, and experience they have acquired over time. Therefore, the health policies have an increasing demand for advanced practice nurses to take the primary role in transforming healthcare delivery and enhancing equity in the provision of care.  

References

Barnes, H., Richards, M. R., McHugh, M. D., & Martsolf, G. (2018). Rural and nonrural primary care physician practices increasingly rely on nurse practitioners. Health Affairs, 37(6), 908-914.

Buck, M. (2021). An Update on the Consensus Model for APRN Regulation: More Than a Decade of Progress. Journal of Nursing Regulation, 12(2), 23-33. https://doi.org/10.1016/S2155-8256(21)00053-3

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2018). Effects of the Affordable Care Act on Health Care Access and Self-Assessed Health After 3 Years. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. https://doi.org/10.1177/0046958018796361

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Sample student response two

Two major policy issues that affect current state of health care delivery and population health equity in the United States are mental health and the opioid epidemic. Although both of these issues coincide with each other, they each individually are in a current state of crisis. Approximately 1 in 5 adults have experienced mental health issues in their lifetime. Those with mental health issues lack the support and resources needed to seek care. There is often a stigma to mental health that prevents some individuals from seeking the care they need (HealthPay24, 2020). Another issue is facing those with mental health issues if the rising cost of health care. 

For those individuals that do not have health care coverage there is a lack of health care providers offering low cost or free services. Those who do have coverage often cannot afford the co-pays or the rising cost of medications that are prescribed. Advance practice nurse can make a positive impact by providing care for mental health by offering patients more access, offering holistic approaches, and by incorporating mental health into primary care practice. Another advancement that will continue to have significant impact on getting those with mental health issues access to care is with the use of telehealth.

The Center for Disease Control and Prevention estimates that there were 75,673 deaths caused by opioid overdose from April 2020 to April of 2021 (CDC, 2021). This is a 34.9% increase from the same timeframe a year prior that had 56,064 deaths (CDC, 2021). Almost everyone at some point knows someone effected by an opioid addiction. It is not population or age specific, nor does it only effect one social economic class. Since the start of the Covid pandemic, there has been a significant increase of opioid use and addiction. As with mental health issues access to health care for those with drug addictions is a challenge. 

Resources are limited due to the increase of care from the increase of substance abuse. Facilities that treat these addictions are full and there are limited outpatient support to cover the rising need. Advance practice nurses providing care in this specialty are experiencing challenges with keeping up with caring for the patients that are in need of care. Looking at alternative approaches such as telemedicine will help some of the demand but then the challenge of having enough healthcare providers to provide care becomes an issue.

Resources:

HealthPay24. (2020, October 28). Policy and political issues impacting healthcare in 2021. https://www.healthpay24.com/blog/policy-political-issues-impacting-healthcare-2021

Centers for Disease Control and Prevention (CDC). (2021, November 17). Drug Overdose Deaths in the U.S. Top 100,000 Annually. Centers for Disease Control and Prevention. https://www.cdc.gov

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Topic 7 DQ 2

Select an effective current health policy that focuses on or affects population health. What components of this policy make it effective? Conduct research on its history and the factors that influenced its development.

Sample student response one

Population health is controlled by a set number of factors which include access, cost, and quality. There are several policies that aim to address these components individually or collectively. One of the policies instituted is the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 abbreviated as MACRA. It is a law passed in 2015 that shifts the payment for Part B Medicare providers from a volume-based model to a value-based model (Jones et al., 2019).

The aspect that makes MACRA effective, is that it makes reporting a requirement for reimbursement. The policy modernizes the way providers report information before they get paid with the intention being to reduce the cost burden to patients and taxpayers. Reduction of costs is also achieved through the Quality Payment Program (QPP) which emphasizes on quality over quantity. The QPP also repealed the Sustainable Growth Rate (SGR) formula which was intended to constrain Medicare spending by adjusting annual physician fee updates instead, it introduced the Merit-Based Incentive Payment System (MIPS) (Mullins, 2018).

           In essence, MACRA originated after increased concerns over the poor quality of healthcare and the challenges associated with the traditional fee-for-service approach and the Medicare SGR formula to control rising health care costs. Therefore, a policy solution had to be introduced to fix the listed shortcomings in the Medicare program, leading to the introduction of MACRA (Jones, 2019). The act is still a work in progress with new reports on the impact expected to show whether some of the intended objectives have been achieved.

References

Jones, R. T., Helm, B., Parris, D., Grubbs, S. S., Choy, H., & Kapetanovic, K. (2019). The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Made Simple for Medical and Radiation Oncologists: A Narrative Review. JAMA oncology, 5(5), 723–727. https://doi.org/10.1001/jamaoncol.2018.5631

Mullins, A. (2018). Making Sense of MACRA in 2018: Six Things You Need to Know. Family Practice Management, 25(1), 21-24. https://www.aafp.org/fpm/2018/0100/p21.html

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Sample student response two

The healthcare sector is controlled by a set of policies that aim at increasing the effectiveness and efficiency of healthcare. One of the most effective policies in healthcare information technology and privacy. Information technology significantly affects the healthcare sector by affecting how data is recorded, stored and retrieved. The policy controlling the health information technology is effective due to the essential guidance provided by the Health Insurance Portability and Accountability Act (HIPAA).

HIPAA is the federal guiding healthcare providers to handle patients’ data and ensure its privacy (Rosenbloom et al., 2019). The policy also contains resources and tools that provide all healthcare stakeholders with a wide range of security and confidentiality. The effectiveness of the policy also arises from its defined consumer rights and mechanisms. The approach is adopted since it gives the highest priority to patients and their families.

The procedure requires the protection of all information recorded electronically and on paper. Today, the HIPAA regulations on health information technology and privacy are the most effective policy due to the high adoption of technology in the healthcare sector.

The HIPAA policy emerged in the 1990s after the healthcare sector started extensive adoption of computerized medical records. Due to different technologies used in various healthcare departments, the industry required new strategies for managing healthcare data (Cohen & Mello, 2018). The required standards had to address the issues surrounding patients’ data and set and protect patients’ rights concerning the protection of their data.

The policy also had to ensure that they would maintain their healthcare coverage when an individual left a particular job. THEREFORE, the HIPAA law emerged and was signed by President Bill Clinton after the passing by Congress. Although the law was passed in 1999, most details were not ready for actualization, so the room was left for the future Congress to specify (Prince & Lovesum, 2020). The privacy rule, which was the primary concern of the HIPAA law, was finalized in 1999.

The Security Rule and the National Provider Identifier rule were followed later to complete the law on the privacy of healthcare data. In 2006, the developers of the HIPAA law concluded with the establishment of specifications on the Enforcement Rule that would guide the healthcare providers on ensuring the safety of patients’ data. 

References

Prince, P. B., & Lovesum, S. J. (2020). Privacy enforced access control model for secured data handling in cloud-based pervasive health care system. SN Computer Science, 1(5), 1-8. https://link.springer.com/article/10.1007/s42979-020-00246-4

Cohen, I. G., & Mello, M. M. (2018). HIPAA and protecting health information in the 21st century. Jama, 320(3), 231-232. doi:10.1001/jama.2018.5630

Rosenbloom, S. T., Smith, J. R., Bowen, R., Burns, J., Riplinger, L., & Payne, T. H. (2019). Updating HIPAA for the electronic medical record era. Journal of the American Medical Informatics Association, 26(10), 1115-1119. https://academic.oup.com/jamia/article-abstract/26/10/1115/5544256