Can you respond to this discussion post…this was the original question —

Select one (1) of the following health care systems and discuss the pros and cons of having the government involved in providing and/or paying for health care through those systems:                   

Medicare

Medicaid

Veterans Health Administration

Indian Health Service

Affordable Care Act 

Be sure and Include in your response:

a) How progressive these health care systems have been / are in granting APRNs full practice authority; may be a pro or a con.

b) What level of government – federal or state – is involved in this type of reimbursement? Is this level of government in the best position to play a role in the provision of health care? (There may be no clear answer here.)

c) Describe any professional experience providing healthcare under this type of reimbursement.

d) Describe any personal – including family or friends – experience receiving healthcare using this type of reimbursement

e) What changes are projected or needed for this type of reimbursement to increase access and/or improve quality and/or reduce costs?

And this is another student respond to it. I need help responding to the student. thank you

Medicaid is dually funded by the state and federal government.  It has several benefits by providing healthcare to low income families who generally would not have access to healthcare and to those who are excluded or cannot afford private insurance.  Medicaid also acts as a safety-net during economic recessions as there are no enrollment caps or wait times, (The Kaiser Family Foundation, 2013).  While Medicaid is meant to provide more access to healthcare, especially in lower income or more marginalized states/communities, the restrictive laws surrounding scope of practice for APNs has caused barriers.  Healthcare professional shortages are more evident in underserved areas, and low provider participation in Medicaid makes this issue worse. In a study where researchers compared access to healthcare in different states, it was found that states with restricted NP scope (Alabama and Mississippi) had poorer health outcomes than states with full scope (Colorado and Utah).  Furthermore, the states with limited NP scope of practice laws had a larger rate of rural and Black populations receiving care through Medicaid/Medicare, (Sonenberg & Knepper, 2017).  This research may suggest some barriers to supply and demand of NPs in states that have restricted scope of practiceespecially in areas where they are needed most. 

While the Medicaid reimbursement policy is different by state, NPs are not definitively authorized to be a primary care provideror if they are, Medicaid has disparate reimbursement policies compared to physicians providing the same services.  This billing poses several problems, like disincentivizing organizations to hire NPs where they are needed and further perpetuating the shortage of healthcare providers especially for minority and low-income patients.  Federal and State actions to improve access to care involves giving full practice authority to NPs in all states.  Immediate executive action was carried out by all governors to change state laws to allow NP full scope of practice during the pandemic to help with increased demands.  Previously only 22 had full scope of practice and certain organizations are asking for these laws to be reversed once the pandemic is over (Stucky et al., 2020).  By lifting the laws in states that prohibit full practice authority to APRNs, more marginalized individuals who utilize Medicaid services may have more access to care, especially in primary care and specialty care settings.  Governing bodies must also elicit increased participation in Medicaid by increasing outreach and streamlining Medicaid processes, and provide incentives to attract NPs and retain them in healthcare centers that care for minority/marginalized patients.

I dont have much personal or professional experience dealing with reimbursement policies as I work inpatient ICU (we have a social worker who deals more with this for patients that eventually discharge) and care isnt coordinated based on what insurance the patient has when they are acutely illWe are most focused on saving their life and do whatever it takes regardless of reimbursements.  There are however certain medications frequently prescribed to patients at discharge that causes problems.  One medication in particular, Brilinta, is a daily medication often not covered or fully covered by most insurance policiesthis medication is extremely necessary for post cranial embolization patients because it prevents their intracranial stents from clotting off or flicking off clots into the brain.  At times, patients are unable to afford Brilinta because it is thousands of dollars each month for them out of pocket.  Sometimes we will readmit patients who are non-compliant with this medication because they cant afford it and they have a stroke as a result.  Whenever we have patients like this I always think how unfair it is that these medications are so expensive and wonder if a social work consult was missed prior to their initial discharge.

References

The Kaiser Family Foundation.  (2013).  Medicaid: A Primer Key Information on the Nations Health Coverage Program for Low-Income People.  https://www.kff.org/wp-content/uploads/2010/06/7334-05.pdf

Sonenberg, A., & Knepper, H. J. (2017). Considering disparities: How do nurse practitioner regulatory policies, access to care, and health outcomes vary across four states? Nursing Outlook, 65(2), 143153. https://doi.org/10.1016/j.outlook.2016.10.005

Stucky, C.H., Brown, W.J., & Stucky, M.G. (2020). Covid 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for Permanent Full Practice Authority. Nursing Forum, 56(1), 222-227. https://doi.org/10.1111/nuf.12515

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