Home Health Care Planning Improvement Act: A Case Study

Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.

Many nursing homes assume in error that if a patient has stopped making progress towards recovery then Medicare coverage should end. In fact, if the patient needs continued skilled care simply to maintain his or her status then the care should be provided and is covered by Medicare.In fact, patients often receive an array of treatments that don 't need to be carried out by a skilled nurse but that may, in combination, require skilled supervision.Even in cases where the SNF initially treats the patient as a Medicare recipient, after two or more weeks, often, the SNF will determine that the patient no longer needs a skilled level of care and will

The health care industry is experiencing a surge in the number of baby-boomers needing health care and increased demands on the physicians providing the care. This trend has made the role of Advanced practice providers more important (cite). It is imperative to understand the differences and similarities in the advanced practice provider roles as it pertains to healthcare. This paper will identify specialty nursing roles including advanced practice registered nurses (APRN). It will further compare and contrast the advanced practice nurse (APN) and physician assistant (PA) roles in practice.

This paper explores the perception of clinical practitioners to the change in policy related to the advanced practice registered nurse (APRN) full practice authority. The author conducts a one-on-one, open-ended interview of 5 nurse practitioners and 5 physicians licensed to practice in Maryland on their perceptions of the recent passage of the Advanced Practice Registered Nurse Full Practice Authority. A literature review was conducted in a policy report by the professional nursing organization, and discussion within the peer-reviewed article supported an overview, regulatory differences among 50 states, including the District of Columbia. Their policy implication for enhancing APRNs role nationally. The author discusses a critical component

Given our rural veterans' and other non-veterans need for access to high quality healthcare, allowing nurse practitioners to practice with full authority in the rural and underserved areas will increase access to care, decrease lengthening delays in healthcare delivery, decrease healthcare costs, and promote patient safety. This is why I urge you to move forward with the proposal to recognize nurse practitioners to practice within their full scope in the rural and underserved urban

In 2010, the President of the United States signed the Patient Protection and Affordable Care Act (PPACA) into law (Luther & Hart, 2014). As written, the PPACA will be the most extensive change in the financing and provision of healthcare in 50 years (Luther & Hart, 2014). The stated purposes of the legislation are to decrease the number of medically uninsured people as well as decrease the cost of insurance and healthcare for those already insured (Shi & Singh, 2015). Medicaid expansion is significant element of the PPACA and is designed to provide health insurance to the lower income population (Vincent & Reed, 2014). The purpose of this paper

With the passing of the Affordable Care Act in 2010 approximately 32 million more people will be insured throughout the United States. The need for healthcare workers and providers will be in drastic demand to provide care to these insured Americans. The 2010 IOM report details out how the advanced practice nurse can be a valuable asset in primary, chronic and transitional care and their skill set should be used to promote better healthcare across the nation (IOM, 2010). This impact of this report should help progress advanced practice nurse’s ability to practice without individual state regulation and be governed under one body to server in and outside of the hospital setting

Many Americans use Advance Practice Nurse Practitioners (APRN) for a number of their health care needs. For more than fifty years, APRN’s have provided a great amount of services in primary care and acute settings, making their presence in the health care system important. Likewise, expectations are that APRN’s will become even more crucial to the delivery of healthcare as more Americans gain access to providers through the new tax reform. With this being said, it is imperative that the APRN be able to practice to his or her full practice authority. “Full practice authority is comprised of state practice and licensure laws that allow advanced practice registered nurses to practice fully in the four domains of practice, under the exclusive licensure

One of the suggestions is for licensed practical nurses and registered nurses to incorporate health care education and counseling, using evidenced based clinical guidelines, to patients with chronic conditions through continued care offered via home visits and telephone follow-up calls (Institute of Medicine, 2010). It is also recommended to utilize APRNs as primary care providers in both outpatient and inpatient settings as this decreases the provider to patio ratio thus potentially enhancing the quality of care, and it allows the APRNs to practice to their fullest abilities (Institute of Medicine, 2010). APRNs participating as primary care providers widen the opportunity for health promotion, disease prevention, and limiting disabilities via early diagnosis and treatment. Transformation to a health care system driven by primary care practice as suggested by the IOM report will create a more qualified, accessible, and value driven health care system (Tri-Council for Nursing, 2010).

As stated previously, it will encourage nurses to pursue advanced degrees to make up for shortages in primary care and the pay-for-performance system will stress the overworked nurses. Nurses will also see more opportunities to work in new settings as there are needs in the new community-based programs prescribed in the policy. Nurses will also be inundated with much sicker patients, as this segment receives more benefits to seek care and the previously uninsured or underinsured can now pursue the care they need. The system has pluses and minuses, but it is undeniable that this healthcare policy could lead to many opportunities for all

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

As the young and rapidly-aging population continues to increase, the demands of primary, acute and chronic disease management will also increase. As a result, more health care professionals who provide primary care will be needed to meet these demands. Thus, the emergence of Advanced Practice Registered Nurse (APRN) evolve. APRN is a nurse who has completed a graduate degree and has acquired advanced knowledge and skills. APRNs are grounded with theory, concepts and principles that enable them to assess, diagnose, treat and manage their patients. APRNs can work in conjunction with other health care professionals or independently. APRNs improve access to health care by providing care in the rural and underserved areas. APRNs also reduce the cost to health care (Joel, 2013).

Primary care practice will be greatly impacted by health care reform. To provide better health care, the country will see a trend away from specialty to primary care and the avoidance of acute issues by delivering this care in the community setting. As a result, primary care physicians will be overwhelmed with the patient load as the number of the insured increases exponentially. The committee recognizes the scope of nursing practice that remains untapped and therefore the profession

This policy helps the primary care facility to enhance the overall health of the patients. By doing preventive and screening check up this will enable early detection of diseases such cancer. Primary care facilities are cheaper than hospitals, that’s why low-income families are more likely to visit primary care facilities. Primary care facilities are greater in number, so it’s more accessible than hospitals. Also, they provide high quality of care because they provide patient-centered services where the needs of patients are part of their resolutions and decisions. Primary care clinics focus on the overall wellness of patients rather than just the treatment of diseases. It also focuses on public health and the education of patients. By doing all these it prevents diseases and decreases future hospitalizations. Primary clinics are located in various communities including low-income communities or communities with diversity, which narrowed the gap of health care disparity. Minority groups are more comfortable with primary care providers because they are usually their local community health providers. They usually have a more diverse health workforce and also, have a healthy communication with their patients sometimes through interpretation services. Their healthcare workers also provide a culturally appropriate

These impose severe constrictions on the ability of the nurse to move forward or advance into the areas of practice where traditional nursing practices were not allowed {Institute of Medicine, 2010}. However with the increase in the number of nurses graduating with advance degrees in nursing; the situation is changing. These well educated nurses are leading the charge to confront the complex issues that the rapidly changing health care situation presents. Regulatory barriers must be lifted so that nurses can practice within their scope in order to be reimbursed by private insurance for the services they provide. These changes can be done through the federal and state legislators as well as supervisory agencies and bodies such as congress and licensing regulatory boards. The IOM also recommends that nurses will expand their scope of practice and increase their responsibility through teaching and counseling of patients. {Institute of Medicine,2010}. The use of Advance Practice Registered Nurses and Physician Assistant in providing primary care services will decrease wait time and increase patient satisfaction. The high turnover of nurses transitioning from school to practice also affects the quality of care. These nurses do not have enough experience to make decisions in patient care.{Institute of Medicine,2010}.The IOM and JCAHO{2012} report supports the recommendations for the introduction of nursing residency