The two major policy issues that affect the current state of health care delivery and population health equity are:
Doctors and patient’s confidentiality- Confidentiality means that when the patient discloses their information to the doctors, patients are confident and comfortable that no one will know about the patient’s condition. The purpose of doctor-patient confidentiality is to make sure patients are at ease in talking to the doctors and they feel safe and can tell the truth about anything. Truth assists physicians diagnose and treat their patient’s conditions appropriately. Physicians took an oath regarding confidentiality that all information disclosed by the patients is sacred.
Confidentiality is protected by both state and federal laws. If the confidentiality has been broken, patients are given the right to file a lawsuit and complaint if they feel violated of their rights. And file with the Office for Civil Rights. Confidentiality is a vital component of the doctor-patient relationship.
Price Transparency in Healthcare- It is all about making consumers feel more prepared, involved, and informed. It also assists all patients to improve their understanding of costs when they go and see the doctors and get treatments. The CMS has issued two rules: one addresses hospital price transparency and pairing solutions with a high-touch approach for the healthcare providers to be involved and comply with the new rules.
Achieving meaningful price transparency will help lower healthcare costs and empower patients to make informed care decisions. The lack of completion, accounts, and timely information about the health care costs prevents health care from operating effectively and accurately. These two major policies impact the population as patients need to be more involved in their care and once they get their bill to know the details and prior to that, they have the opportunity to shop around for pricing and costs of healthcare services since the cost-sharing information is being available for public information.
Reference: Hospital Price Transparency. CMS. (n.d.). http://www.cms.gov/hospital-price-transparency. (n.d.). a
Doctor-Patient Confidentiality: Here’s What You Need to Know. Medical Records Information. https://medrecordsinfo.com/doctor-patient-confidentiality/.
Lisa:
The Patient Protection and Affordable Care Act (ACA) is changing many of the aspects of our healthcare system. There is now more of a focus on value-based care, coordination of care with a big focus on prevention. The patient-centered medical home is an initiative within the policy that includes population health management. Advanced Practice Nurses are in the forefront of changes that have evolved in this policy development (Encyclopedia of Nursing Research, 2021).
Nurse researchers in collaboration have proven over time the benefits of prevention and health promotion. Nurse researchers have proven the need for nurse practitioners as primary providers and deliverers of coordination of care services (Encyclopedia of Nursing Research, 2021). Within the confines of the ACA is health system reform and creation of our 1st National Prevention Strategy, with its own directions and priorities, with recommended policy, programs, and systems.
One such direction as noted within the strategy is Empowering People and the Plain Writing Act to improve communication health and health literacy (Jordan & Duckett, 2021). Also, other efforts for prevention include America’s Great Outdoor Initiative, and the Neighborhood Revitalization Initiative (Jordan & Duckett).
Jordan, N. & Duckett, P. (2021, May 13). The nurse’s guide to the ACA. Nurse Journal. https://sites.northwestern.edu/nphr/the-affordable-care-act-and-public-health/#:~:text=The%20ACA%20also%20direct%20public%20health%20throughbehavior%20choices%20and%20the%20social%20determinates%20health
Encyclopedia of Nursing Research (4th ed.). (2021). Health policy & health service delivery. https://search-credoreference-com.lopes.idm.oclc.org/content/entry/spennurres/health_policy_and_health_services_delivery10?Institutional=5865
Nicole:
I live in the state of New Jersey. NJ has seen major changes since 2014 such as 500,000 newly insured residents due to the Affordable Care Act and the implementation of the Medicaid managed long-term services (Kitchenman, 2015). Other major issues that NJ has faced are rising healthcare costs, changes to state employees health benefits, how bills outside a patient’s insurance network are handled, curbing opioid drug addiction and deaths which are on the rise, in addition to utilizing Accountable Care Organizations (ACO’s).
It is clear the changes set forth to promote health equity will have a positive effect on the population of NJ residents. Delivering effective and efficient care will be a challenge for healthcare. This will have a direct effect on advanced nursing practice. The more insured seeking healthcare and the ACO’s alone will surely create a shortage of providers. The competent advanced nurses will be needed to practice and provide the additional care for the NJ residents. As it stands now there are too few primary care doctors and nurses. There is a true need to expand the medical workforce. The shortage could result in escalating health issues and completely unnecessary hospitalizations (Stainton, 2019). The areas in NJ with severe shortages are referred to as “Healthcare Desserts”. In fact a report by Rutgers University NJ Collaborating Center for Nursing released a report in 2019 which found that the ratio of for primary care doctor to patient far exceeds the national median in 13 of our 21 counties with many counties having half the number of primary care physicians needed which is 90 per 100,000 residents (Stainton, 2019).
The Advance Practice Nurse (APN) under current law must sign a collaborative agreement with a physician and pay that doctor a monthly fee in order to write prescriptions and in turn the MD must review at least one patient chart per year for each nurse they oversee; collaborating physicians are not legally liable for the APN in which they are contracted and the APN must have her own malpractice insurance. Many APN feel the contracts are an unnecessary, take time, and are expensive and with that being said they have pushed for the legislation to end the use of this agreement, however doctors have largely opposed eliminating this change citing possible patient harm and would eliminate an incentive for team based treatments (Stainton, 2019). Ending the “Joint Protocol” is a goal of the APN in NJ.
On January 8, 2020, NJ denied the passage of Bill A854, also known as the “Consumer Access to Health Care Act” and it’s companion bills S1961 and NJ A669. This bill if passed would have allowed Nurse Practitioners to prescribe medication independently without a physician, the bill did propose limitations for APRN with fewer than 24months or 2,400 hrs of licensed, active, advanced nursing practice to have a formal collaborating agreement with the provided in place; the bill did adhere to the IOM recommendations to eliminate barriers for APRN care in the best interest of patients and the future of nursing (Brusie, 2021). The debate continues in NJ to expand the scope of practice of the APN.
The opposition argues that nurses are not doctors and doctors are not nurses, they are distinctive of each other with separate training. The Doctors have convinced lawmakers to vote against the proposal citing patients deserve care led by physicians and should not allow less, prescribing medication should be a collaborative team decision, medical physicians should only be ordering medications simply because a nurse is not a doctor, the curriculum of medical doctors is not the same as nurses (Brusie, 2020).
Reference
Kitchenman, A. (2015). Healthcare Policy in NJ: The Biggest Issues to Watch in the Year Ahead. Retrieved from: https://www.google.com/amp/s/www.njspotlight.com/2015/01/15-01-04-healthcare-policy-in-new-jersey-issues-to-watch-in-2015/amp/
Stainton, L. (2019). Manu NJ Counties Are “HealthCare Desserts” with Too Few Primary Care Doctors and Nurses. Retrieved from: https://www.google.com/amp/s/www.njspotlight.com/2019/12/many-nj-counties-are-health-care-deserts-with-too-few-primary-care-doctors-and-
nurses/amp/Bruise, C. (2020). NJ Strikes Down Bill to Allow Nurse Practitioners to Prescribe Medication. Retrieved from: https://nurse.org/articles/new-jersey-nurse-practitioners-aprn-prescriptions/
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