The Impact Of Policy Changes On Healthcare Delivery And Advo

The Impact of Policy Changes on Healthcare Delivery and Advocacy

The Patient Protection and Affordable Care Act of 2010 introduced numerous positive healthcare policies, including expanding access to affordable health insurance, removing pre-existing condition exclusions, increasing transparency in healthcare charges, and compelling healthcare providers to actively improve quality and health outcomes. These reforms aimed to address the intertwined drivers of healthcare costs, quality, and access. According to a White House briefing in 2014, the ACA was effectively giving millions of middle-class Americans greater health security, slowing healthcare cost growth, and increasing marketplace transparency. However, alongside these benefits, the legislation also imposed financial burdens on providers, driving some out of business, and generating unintended consequences for healthcare delivery, especially within vulnerable populations and in rural areas.

One significant challenge resulting from the ACA’s implementation concerns the transition in home health payment systems. Section 3131(a) of the law required Medicare to rebase payments over four years, beginning in 2014, leading to cumulative reductions of 11.6% for home health services. These cuts, coupled with increased administrative requirements, added financial and operational stress on healthcare providers, exacerbating access issues, especially for rural populations with limited primary care providers. In particular, Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs) are restricted from signing orders for home health services; only physicians, osteopaths, or podiatrists can do so. This policy limits the capacity of healthcare professionals to efficiently coordinate care, especially in underserved areas where physicians are scarce.

From a policy advocacy perspective, employing the Kingdon Model provides a structured approach to change. The model posits that successful policy change hinges on the alignment of three streams: problem, policy, and politics. Analyzing these streams reveals that the problem is the administrative burden and limited access to care stemming from restrictive signing regulations and provider shortages. The policy stream involves proposing legislation that authorizes APRNs and PAs to sign for home health services, thereby reducing administrative barriers and extending care access. Politically, advocacy efforts must align with supportive lobbying groups and identify opportune moments when policymakers are receptive, such as during budget debates or health reform discussions, especially amid efforts to curb healthcare costs.

Advocates, including nurses and other frontline providers, can engage in legislative lobbying, heighten public awareness of access issues, and leverage data demonstrating improved outcomes with expanded scope of practice. The timing of these efforts is crucial; current healthcare reform debates and budget considerations create opportunities to push for policy changes. By framing the issue around reducing administrative burdens and improving access, advocates can appeal to bipartisan interests, emphasizing cost-effective care delivery and resource optimization. Ultimately, policy change that broadens the signing authority to include APRNs and PAs could significantly enhance healthcare access, especially in rural and underserved communities, while also containing costs in a value-based care environment.

In conclusion, reforming policies governing the scope of practice for healthcare professionals in home health services exemplifies how strategic advocacy can facilitate systemic change. Applying models like Kingdon’s effectively highlights pathways for policy entrepreneurs to advance reforms that improve access, reduce administrative hurdles, and promote cost-effective, high-quality care. As healthcare continues to evolve amidst fiscal pressures and workforce shortages, proactive advocacy for legislation supporting broader provider signing authority is vital for ensuring equitable healthcare delivery across diverse populations.

References

• Centers for Medicare & Medicaid Services. (2013). MLN Matters: Home health prospective payment system (HH PPS) rate update for CY 2014. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Downloads/MM8515.pdf
• Government Publishing Office. (2014). Code of Federal Regulations, Part 424.22. Retrieved from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-424/subpart-B/section-424.22
• 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 & Bartlett Learning.
• Centers for Medicare & Medicaid Services. (2013). Home health prospective payment system (HH PPS) rate update for CY 2014. MLN Matters Article MM8515. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Downloads/MM8515.pdf
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