On January 31, 2019, Senator Cardin (D-MD) and Senator Collins (R-ME) introduced the Home Health Care Planning Improvement Act of 2019 (S.296). Actnow.io (2019) explains that the S.296 has 15 bipartisan cosponsors and receives support from major nursing associations. Although Medicare recognizes four advanced practice registered nurse categories, only the physicians are allowed to certify a patient eligibility for Medicare home health services. This policy creates a barrier to the delivery of care and incurs additional costs to Medicare. Thus, the introduction of S.296 authorizes physician assistants (PAs), certified nurse midwives, clinical nurse specialists (CNSs), and nurse practitioners (NPs) to order Medicare home health care. The pro-patient legislation will enable timely accessibility home health care to Medicare beneficiaries and cost reduction to Medicare.
Medicare follows physician-focused certification requirements. However, this approach is not efficient as patients need to obtain certification from physicians who have not taken care of them. Calling a physician to certify for Medicare benefits result to disjointed care and insertion of a health profession without knowledge of the individual care of the patient. Moreover, policy entails risk of program integrity and quality of care. For example, shifting a patient from an NP to a physician leads to leakage of health information that otherwise would have remained confidential. Shifting is conducted only to certify patients for Medicare benefits. This process excludes other complicated services that PAs and NPs are required to perform.
Murphy (2019) argues that Medicare beneficiaries receiving face-to-face physician appointments are facing challenges considering that majority of them receive care from NPs or PAs as their primary caregivers. Referring these beneficiaries to a physician is sending them to a stranger who they are not comfortable with. In addition, if the beneficiary is homebound, then he/she needs to book another appointment. In certain remote regions, patients may not see a physician for months while waiting for approval of home health services and thus undergo delays. Lastly, additional paperwork are needed that require a physician in the certification of a home care plan, which can delay or deny care to vulnerable residents. This process is worsened by the face-to-face requirement procedure with the physician who causes backlogs in the health system. The rectification of these procedures is likely to result in a streamlined process to home healthcare services.
Background of S.296
According to the Medicare Law, a physician is authorized to certify the eligibility of a patient to home health services. After the enactment of Medicare in 1965, the act has faced several changes. The National Association for Home Care & Hospice (NAHC; 2019) argues that physicians are the authorized personnel to offer primary care. However, this concept has changed as highly skilled non-physician personnel such as CNSs, PAs, and NPs are allowed to handle primary care process. After offering the services, the professionals are required to follow the outdated Medicare certification requirements where the physician has to certify the eligibility of a patient to Medicare services. Non-physicians’ certification of patients was initially introduced during the 114th Congress and was reintroduced in January 2019 by passing a law. The passing included 15 bipartisan cosponsors (ProPublica Inc., 2017).
The bill gained opposing political debates, mostly from physicians. NAHC (2019) explains that physicians consider the bill as a threat to their profession and claim that PAs and NPs may harm patients. They argue that it is unethical for NPs and PAs to certify home care services as they do not receive similar pieces of training as received by physicians. According to physicians, lack of appropriate knowledge and skills will result in inappropriate decisions. Nonetheless, the arguments are unfounded as several NPs and PAs operate as primary care providers.
The Home Health Care Planning Improvement Act will reduce the per capita cost of accessing health care. In addition, it will improve population health. The act will also improve patient experience to care delivery. According to NAHC (2019), the act will eliminate the aspect of backlogs as patients wait for physicians to approve their stay. Mounting evidence illustrates the significance of qualified non-physicians personnel in the delivery of care to patients and the improvement of health outcomes and quality of care. However, political arguments assert that widening nurses’ range of practice will harm not only the physicians’ profession but also the quality of care received by patients. Enacting this act will benefit the Medicare beneficiaries as they will gain access to home healthcare treatment faster than while scheduling for a face-to-face meeting with a physician to certify the processes. If passed, the Act will introduce a win for Medicare, a win for providers, and a win for the patients.
The act faces many opponents, particularly from physicians. Lack of integration and collaboration among health workers is harmful to the health of patients. The present care system is misaligned to consumers’ needs.
Training and integration of education into the health industry can promote collaboration and integration of health professionals. An opportunity for an integrated health system is available. More needy patients will receive Medicare benefits, which results in promoting health. Partnership for Quality Home Healthcare (2019) explains that rural and undeserved communities will benefit from the Act as nurse practitioners and other non-physician professionals direct their care to Medicare beneficiaries. However, without the Act, the group is underscored from role of endorsing cost effectiveness admissibility for home health services.
Another opportunity is the introduction of other methods of payments such as Accountable Care Organizations. The traditional fee-for-service Medicare payments need to be replaced to promote quality and value through programs such as the Hospital Readmissions Reduction Program and Hospital Value-Based Purchasing Program and align patients to their care by actively involving them in decision-making processes. Increase of accessibility to health services for America’s sickest and oldest seniors who desires to receive care at home. The legislation will improve home health services to homebound senior who qualifies for Medicare.
The broadening range of NPs threatens physicians. Therefore, the act can increase the nurse–physician conflict in the healthcare system.
All stakeholders of the S.296 bill commit to ensuring that all Medicare beneficiaries access the quality of care they require and deserve. The legislation receives support from varying groups of national stakeholders including health professional provider associations and societies, advocacy organizations, and patient groups. Policymakers are direct stakeholders who promote the reform of the healthcare delivery system. Locally, non-physicians and physicians are likely to conflict from the contradictory roles. The physicians may oppose the bill and become uncomfortable with it whereas the non-physicians may embrace the change. The patients are the major stakeholders and should be the center in any decision-making process. Thus, any actions followed should be for the benefit and satisfaction of the patients. The federal government plays a vital role in decision making. For example, Senator Cardin (D-MD) and Senator Collins (R-ME) introduced the bill, which was discussed by other appropriate health professionals. All officials and representatives of the professionals are directly involved in the process. The management of health facilities at local levels is indirectly involved in the process.
Essentials of Masters of Education
A master of science in nursing opens a nurse to excellence and innovation in academic nursing. The program provides the learner with Essential Series, which acts as a framework that provides them with competencies and advanced knowledge in the nursing discipline and leadership skills essential in improving health outcomes. According to Essential VI: Health Policy and Advocacy, nurses’ primary role is to “promote health, help shape the health delivery system, and advance values like social justice through policy processes and advocacy” (AACN, 2011: P20). Nurses with master’s degree should apply their competency and political efficacy to improve the quality of healthcare delivery and patients’ health outcomes.
Nurses should analyze the influences of a specific policy on the financing and structure of a healthcare system, health outcomes, and practice. By doing this, nurses’ role is enhanced by becoming part of the development and implementation of federal, state, local, and institutional policies. After the implementation of the specific policy, its impact on regulatory and legal processes in the delivery of care needs to be carefully examined. The last critical aspect is an advocate for policies that improves population health and the nursing profession.
AACN. (2011). The Essentials of Master’s Education in Nursing March 21, 2011. American Association of Colleges of Nursing.
Actnow.io. (2019). Ask Congress To Support the Home Health Care Planning Improvement Act S.296/ H.R. 2150. Https://Actnow.Io/4Vqc3hu.
Murphy, C. (2019). Home Health Care Planning Improvement Act of 2019 Introduced in the Senate. Retrieved from https://www.votervoice.net/mobile/NLN/BlogPosts/1201
National Association for Home Care and Hospice. (2019). Home Health Care Planning Improvement Act (S. 445/H.R. 1825). National Association For Home Care And Hospice.
Partnership for Quality Home Healthcare (2019). Partnership Applauds Introduction of Home Health Care Planning Improvement Act of 2019 in the U.S. House. Partnership for Quality Home Healthcare. [online] Available at: http://pqhh.org/article/partnership-applauds-introduction-of-home-health-care-planning-improvement-act-of-2019-in-the-u-s-house/ [Accessed 15 Jul. 2019].
ProPublica Inc. (2017). S.296: Home Health Care Planning Improvement Act of 2019. Retrieved from https://projects.propublica.org/represent/bills/116/s29
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