The Home Health Planning and Improvement Act of 2011 would allow advanced practice registered nurses (APRNs), which includes nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants, to order home health services under Medicare in accorance with state law (Conant, 2011). APRNs now provide the majority of care to home health patients. However, Medicare law has kept APRNs from signing home health plan of care and from certifying Medicare patients for home health benefit. This greatly limits the care that these healthcare workers can provide. In rural areas where physicians are often limited, these regulations have led to delays in health care delivery, inconvenience for patients and their families, and increased costs to the Medicare system when patients are required to make otherwise unnecessary visits to more expensive institutional settings. Currently, only physicians can sign home health care plans and authorize Medicare patients for home health care. Seniors and disabled citizens who see APRNs must make extra visits to physician offices because Medicare will not certify payment for the services provided by APRNs until a physician signs the order ("Congressional legislation", 2011). In support of the act, ANA President Karen Daley, RN, PhD, MPH, FAAN, stated, "In order to meet our nation's healthcare needs, an integrated, national healthcare workforce that optimizes utilization of all qualified providers must be put into action." ("ANA endorses home", 2011).
On January 31, 2011, the Home Health Planning and Improvement Act was read twice in Congress. It was then sent to the Senate Finance Committee ("Congressional legislation", 2011).
The original sponsor is Susan Collins (R-ME), who introduced the proposed legislation to the Senate. Collins is a businesswoman and congressional aide with a BA from St. Lawrence University (1975). She currently serves on the Appropriations Committee, Armed Services Committee, and is a member of the Special Committee on Aging. Collins also served six years on the Committee on Health, Education, Labor, and Pensions, where she supported programs to expand access and improvement to healthcare, especially in rural areas. Collins helped restore funding to Medicare for home health so that elderly citizens are able to receive care in their own homes ("Susan Collins", 2011). Co-sponsors in the Senate include: Sen. Daniel Akaka (D-HI), Sen. Kent Conrad (D-ND), Sen. Daniel Inouye (D-HI), Sen. Tim Johnson (D-SD), Sen. Jeff Merkley (D-OR), Sen. John Reed (D-RI), Sen. Ron Wyden (D-OR), and Sen. Chris Coons (D-DE). Representatives Allyson Schwartz (D-PA) and Greg Walden (R-OR) introduced the Home Health Care Planning and Improvement Act of 2011 to the House of Representatives. There are approximately 30 representatives in support of the act.
This bill really shows the expanding role of advanced practice registered nurses in the US healthcare in general. By allowing this development of their role, healthcare users have a more availability to care. As you said, this bill would really benefit the citizens who see APRNs as their primary healthcare provider. There is also growing efforts to increase of the role of APRNs to being able to practice without the supervision of a MD. Is this bill a bridge to some greater things for APRNs in the future? I think it will be very interesting to see what will come over our nursing careers.
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With the number of baby boomers reaching retirement age increases over the next decade, I see this bill becoming more and more of a prevalent health care issue. The role of APRN’s seems to be a highly debated topic within health care legislation, but it seems inevitable that these practitioners will serve a vital role in filling increased healthcare needs across our country. I found it interesting that the bill mentioned the impact rural settings has on the access patients have to local physicians. In the areas surrounding Harrisonburg, home health serves a huge role to patients who have limited access to transportation and financial resources. If APRN’s were able to provide plans for home health care in addition to MD’s, would area hospitals see less acute care patients because of greater access to home care?
ReplyDeleteFrom the MD standpoint, one can see that the expanding role of APRN’s may seem threatening if many MD roles become those of APRN’s as well. It will be interesting in Virginia especially, since it was mentioned during our lecture from the VNA that the physicians in Virginia have continually lobbied against the advancing role of APRN’s.
Christina-- We definitely believe that this bill will be a bridge for the roles of APRNs and the healthcare system as a whole. Their increased role and responsibility in the community will help provide easier access to health care with APRNs as the leading providers of care. APRNs will also enjoy more autonomy within their practice.
ReplyDeleteJoe--We like that you're thinking about good 'ol tertiary prevention! From our standpoint, APRNs managing the health conditions at the community health level will help prevent the need for further care at an "acute care hospital setting." While doctors may be concerned that they would no longer be the only health professionals providing specific care, we feel this concern is more deeply rooted in historical role dynamics placing nurses below physicians in provided care and skill set.