NUR 514 CLC – When Patient Advocacy Meets Policy: Lobbying for Health Care Change Presentation

NUR 514 CLC – When Patient Advocacy Meets Policy: Lobbying for Health Care Change Presentation

Introduction

Affordable Care Act (ACA) is one of the major healthcare policies passed to improve healthcare delivery to Americans. The policy was implemented in the year 2010 by President Obama’s administration to solve the challenges brought about by the lack of accessibility to healthcare services. Imperatively, APRNs are lobbyists and advocates who champion for better healthcare through enactment of effective policies and healthcare laws for the benefit of patient populations and community. The current healthcare reforms offer APRNs an opportunity to lobby and advocate for policies as well as take their position or stance on such issues. APRNs should engage and lobby in the legislative process as a participant and patient advocate by identifying current health care issues that impact these roles, their setting, and scope of practice as well as the population in the communities that they serve (Chen et al., 2016). As such, this presentation discusses the Affordable Care Act that was enacted in 2010 and its effects on nursing role, the practice environment, and scope of practice. The presentation also considers the effects of the ACA on the population in the community where nurses serve.

ACA & APRNs Role, Setting, Scope of Practice and Community Population

Advanced Practice Registered Nurses (APRNs) and nurse leaders have the obligation to ensure that patients and population communities attain better and quality services. Also, they have the responsibility to ensure improvement in the nursing processes and interventions through effective resource allocation in their practice setting. Through this, APRNs can enhance their scope of practice, especially practicing to the full extent of their education and qualification.  APRNs have a responsibility as patient advocates to lobby for more resources to community populations where they practice and serve. The ACA enactment improved access to health care allowing APRNs to become primary care providers in certain settings like through the nurse managed health organizations (NMOs) which impacted the scope of practice for the providers. The implication is that the ACA supports APRNs roles in improving care delivery to all patients and populations through effective allocation of healthcare resources. The ACA mandates establishment of different care models to enhance primary delivery of healthcare services. Through the Affordable Care Act, APRNs get the opportunity to improve their skills and knowledge in healthcare delivery.

Proposed Legislation and Group’s Stance

The core aspect of ACA is to reduce the cost of care through the provision of affordable health insurance coverage. The legislation focuses on improving quality of care through effective allocation of resources (Chen et al., 2016).  ACA enhances accessibility and allows individuals to get primary care services in different healthcare settings. As such, this group believes that the Affordable Care Act is an essential legislation with comprehensive benefits for health populations and individuals. The policy allows APRNs and other health care professionals to improve quality service delivery and ensure that the reforms benefit those who require it the most (DeNisco& Barker, 2016). However, efforts to amend the policy has focused on its scrapping which will mean that millions of Americans lose their health insurance because critics want to remove compulsory mandates and weaken its overall implementation in the long-term that has been effective for the past ten years. The act should stay and ensure that new legislation on the policy focus on removal of restrictive acts in states with restrictions to allow many to access healthcare. Secondly, the legislative processes should focus on ensuring that quality services lead to enhanced customer satisfaction which improves overall reimbursement. Lastly, ACA ensures that there is fair and equal treatment for all individuals irrespective of their socioeconomic status.

Methods to Track the Bill

Several regulations have been enacted such as the 2010 Patient Protection and Affordable Care Act, that set fourth the inclusion of more rules and regulations. The selected implementation change showcases the complexity of healthcare insurance programs for various US citizens (Mahmoodi & Khoddam, 2020). These are managed as well as regulated by various federal as well as state agencies, with the inclusion of the Department of Health and Human Services, the Centers for Disease Control, the Center for Medicare and Medicaid Services, the Veterans Administration, the Food and Drug Administration, and the Agency for Healthcare Research and Quality (Ljuboja et al., 2016). From policy to changes and all involved metrics, the healthcare system continues to change. Aspects such as aging populations, technological changes, coupled with illness trends greatly affects the envisioned change. There is greater need for tracking societal shifts and gaining more awareness where healthcare is headed through updated evidence-based research.

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Participating in Lobbying Efforts

Effective communication is crucial within the healthcare framework mostly for organizations. Defining leadership roles can help in the creation of a task-fixated context that dwells on the set goals and objectives, which increases the aspects of being well-organized (Mahmoodi & Khoddam, 2020). The proposed change requires the selection of a team leader who will run the project through the entirety of the change process to the finish line. Aspects of thoughtful planning and dwelling on the intended goals may be essential for offsetting staff engagement and possessing the focus as well as force of the will for making it succeed within the required timeframe. Collaborative coordination with various stakeholders will be key to ensuring stakeholder engagement for extending internal as well as external research for identifying present as well as future healthcare insurance coverage costs together with training needs. The community can also be involved via defining, documenting, as well as communicating the results together with achievement criteria for an effective change selection and implementation.

Effective lobbying for the change necessitates for newer ways of thinking. Shifting the culture of practice from dwelling on illness episodes to the promotion of affordable and quality care across the continuum is of significance(Threatt et al., 2019). Forming partnerships with various healthcare sectors, healthcare professionals, the government, communities and other stakeholders helps seek more understanding of the social contexts and increases engagements within effective strategies for change (Salmond & Echevarria, 2017). This in turn ensures patient-centered outcomes. Integration of work functions, documentation of tasks, and provision  of effective training would ensure task completion, project coordination, as well as timely information dissemination geared towards attainment of the set goals and objectives.

Bill’s Intent, and Goal

The decision of the Supreme court to support the president Barack Obama’s Affordable Act (ACA) was formidable.  The ACA created an avenue for every American to access healthcare despite there demography or financial background (Hoyt & Proehl, 2012).

The ACA ensures that patient have the freedom to selection as to which provider or service best suits their needs. ACA fosters the establishment of New Models of Care which obliges providers to deliver not just the best quality of care but also evidence-based care and are reimbursed based on their efficiency and patient’s outcome. There is No limitation to patient’s health benefits unlike with the other insurers. This enables patients to seek medical care whenever necessary which in turn promotes preventative care.  The patient’s ability to choose their provider creates job opportunities for the APRNS as patients favors the services of the APRNs because they provide holistic care and not just medical (Hoyt, & Proehl. 2012)

To accommodate the patient’s Health needs and find solution to a frail health system, It is imperative that federal agencies remove restrictions that impedes the APRNs from practicing within their scope of practice and educational preparation in states that upholds such laws (DeNisco & Barker , 2016).  Accessibility to healthcare impacts on the cost therefore all efforts should be made to correct flaws within the Affordable Care Act. Abolishment of this act would be detrimental for most Americans especially those from the minority and low socio-economical group.

Implications if the law is not passed

APRNS are educated enough to provide 90% of the care provided by primary care physicians (Fraser & Melillo, 2018). Evidence shows that, compared to physicians, APRNs provided high quality clinical care that has resulted in proper diagnosis, treatment, appropriate management and improved health outcome (Fraser & Melillo, 2018). If the lobbying efforts are failed to uniform the state laws for the scope of practice for APRNS, patients cannot benefit from the valuable services provided by APRNS, especially those who are in the rural areas (Fraser & Melillo, 2018). ACA promotes preventative care and wellness visits which can be very well be managed by APRs. If the state laws require that APRNs to practice under supervision of PCPs, they cannot bill the Medicare/insurance companies for the services provided by them (Fraser & Melillo, 2018).  ACA recognizes nurse practitioners to participate in Accountable Care Organizations (ACOs) but under Medicare Shared Savings Program statutes prevents the beneficiaries who receive services from NPs to participate in ACO program. This prevents the NPs to establish their own ACOs (American Association of Nurse Partitioners, 2020).

 Increasing the scope of practice for APRNs can benefit the stake holders such as, employing institutions, insurance companies and  state government in saving millions of dollars (Fraser & Melillo, 2018). The fees for service provided by APRNs for minor ailments in comparison with service provided by PCPs are estimated to save 7 million dollars in Medicaid and 747,000 in state employee health insurance in Florida (Fraser & Melillo, 2018). When APRN moves from one state to the other, there can be confusion regarding the scope of practice in each state. The state-level restrictions can create a chaotic work environments for nurse practitioners in the healthcare organizations. Regulations that does not allow nurse practitioners to practice to the full extent of their education, is not utilizing the APRNs effectively to bring about better patient outcomes.

Conclusion

Only 22 states and District of Columbia have scope of practice regulations that allow NPs to deliver care to the full extent of their education (Poghosyan et al., 2020). Many Americans in rural areas can benefit with increased healthcare access when the scope of practice for APRNs is increased. When states and organizations allow NPs to practice to the full extent of their training, it provides them a better work environment and job satisfaction (Poghosyan et al., 2020).  NPs will be able to establish their own ACOs, especially in rural areas where healthcare access is scarce, and thus help millions of Americans to have access to quality healthcare and preventative medicine.

References

ØAmerican Association of Nurse Practitioners (2020). American Association of Nurse Practitioners State practice environment (2019) Retrieved from: https://www.aanp.org/advocacy/state/state-practice-environment

ØChen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical care, 54(2), 140. Retrieved from: 10.1097/MLR.0000000000000467

ØDeNisco, S. & Barker, A. (2016). Advanced practice nursing: Essential knowledge for the profession. Burlington, MA: Jones & Bartlett Learning

ØHoyt, , S. K., & Proehl, . (December 2012). Affordable Care Act: Implications for APRNs. Advance Emergency Nursing Journal, Volume 34 (Issue 4 ), p 287-289. http://dx.doi.org/doi: 10.1097/TME.0b013e3182729830

ØFraser, A. M., & Melillo, C. (2018). Expanding the Scope of Practice of APRNs: A Systematic Review of the Cost A… Nursing Economics, 36(1)

ØLjuboja, D., Powers, B. W., Robbins, B., Huckman, R., Yeshwant, K., & Jain, S. H. (2016). When Doctors Go to Business School: Career Choices of Physician-MBAs. American Journal of Managed Care, 22(6).

ØMahmoodi, G. R., & Khoddam, H. (2020). Knowledge implementation in health care management: a qualitative study. BMC Health Services Research. https://doi.org/https://doi.org/10.1186/s12913-020-5043-8

ØPoghosyan, L., Ghaffari, A., Liu, J., Jin, H., & Martsolf, G. (2020). State policy change and organizational response: Expansion of nurse practitioner scope of practice regulations in New York State. Nursing Outlook, 10.1016/j.outlook.2020.08.007

ØSalmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopedic Nursing, 36(1), 12–25. https://doi.org/10.1097/NOR.0000000000000308

ØTexas Legislature (2020) 86^th Legislature Regular Session. Retrieved from: https://capitol.texas.gov/

ØThreatt, T., Pirtle, C. J., Dzwonkowski, J., & Johnson, K. B. (2019). Using a custom mobile application for change management in an electronic health record implementation . JAMIA Open, 3(1), 37–43. https://doi.org/ https://doi.org/10.1093/jamiaopen/ooz048