Healthcare policies refer to the laws and rules that regulate the management of the healthcare system. These policies are often formulated and enacted by the legislative bodies; the senate and the House of Representatives, which makes up Congress. However, these policies can be influenced by the members of the public as well as health care providers such as nurses. This is because healthcare policies not only affect citizens through the quality of care provided, but they also influence the working conditions of healthcare providers, particularly nurses who are the majority.
Therefore, it is important for nurses to be actively involved in all healthcare policy formulation and implementation processes to enhance the effectiveness of these policies in improving the healthcare system. This presentation provides an assessment of the impact of the healthcare policy on nursing practice and the general delivery of healthcare services with the Protecting People from Surprise Medical Bills Act as a policy of reference.
Bill Summary
The Protecting People from Surprise Medical Bills Act is a bill that has been introduced by a bipartisan group of Representatives that seeks to cushion patients and Americans from chagrin financial implications accompanied by an unexpected visit to out-of-network care providers, especially during medical emergencies. The bill is being supported by key jurisdiction committees which are the Energy and Commerce, Education and Labor, and Ways and Means committees. This bill is similar to that of the Senate Committee on Health, Education, and Labor; S.1895, the Lower Heath Care Costs Act.
This is because the standing orders stipulate that the same bills from both legislative houses have to be in the same form before they are presented to the President. The Protecting People from Surprise Medical Bills Act, if enacted, will put to an end the practice of balance billing. Patients will longer be subjected to payment disputes over received care from out-of-network providers. Upon its enactment, the legislation will provide patients with the most robust protection by ensuring that struggling lower and middle-class families do not go bankrupt due to surprise medical bills.
The bill aims to protect patients from heavy financial implications when they acquire services of the providers who do not have any contract with health insurance providers funded by the federal government using the arbitration approach. This approach will be similar to the one that New York State adopted in 2015. The arbitration approach stipulates that when insurers and providers are unable to agree on a payment rate they will be compelled to go through an independent dispute resolution (IDR) under the moderation of an arbiter.
The arbiter will ensure that the two parties agree on a payment rate that is fair for both. The approach has already proven to be effective in some states that have enacted similar bills such as the New York State. For instance, a study conducted in 2018 indicated that out-of-network bills were reduced to 34 percent in New York within the three years in which the arbitration legislation had been in operation.
Some of the critical reforms that will be made by the Protect People from Surprise Medical Bills Act which will have a profound impact on the nursing practice include; banning the tradition of billing patients for inadvertent out-of-network care, adopting of an arbitration approach for payment rates, and compelling health plans to identify in-network providers and medical deductibles hence promoting transparency within the health care system.
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- The Impact of the Bill on Professional Nursing Practice
The Protect People from Surprise Medical Bills Act, if passed, will have a profound impact on the nursing practice. Practices of professional nursing have summarized the answers to the following questions; who, what, where, when, why, and how.
The “who” constituency is comprised of professional nurses, the “what” constituency represents the promotion, protection, and optimization of provided healthcare services. This bill will remove the financial barrier that deters nurses from promoting, protecting, and optimizing provided healthcare services for accelerated patient recovery. For instance, cost implications will no longer compel nurses to lower standards for the purpose of fitting into what the patient can afford.
Provision of care, wherever there is a need, has been represented by the “where” cluster. This implies that nursing services should be offered without restrictions of any kind. However, in most instances, the services of nurses in out-of-network medical facilities are often limited by the cost barrier. If enacted, the bill will break this barrier and give nurses the freedom that they need as they offer their services.
“When” implies that the services of a professional nurse should be provided whenever they are needed. No one should be denied these services, particularly during emergencies. Nevertheless, the cost implication sometimes compels nurses to turn away patients when they are unable to afford the proposed treatment intervention. Therefore, this bill will ensure that nurses are at liberty to offer their services whether in out-of-network or in-network medical facilities.
Lastly, in answering the “why” question, nursing practice standards represents a social contract between nurses and the community whereby nurses are required to ensure that positive patient outcomes are achieved during sickness or upon an injury. However, nurses, particularly those working in out-of-network facilities are obligated to breach this social contract due to the ineffective billing practice. Hence, if enacted, the bill will ensure that this social contract is not breached by promoting the standards of nursing practice and the accessibility of these treatment practices.
Also, if the bill is not enacted, it implies that the standards of the nursing profession will continue to be compromised by a myriad of challenges perpetuated by the billing practice. These include limitations of nursing services in terms of quality and place. Additionally, nurses will continue to be involved in social and political activism as they advocate for the patient’s rights through reduced healthcare costs instead of focusing on patient recovery which is detrimental to the standards of nursing practices.
- How the Bill Might Impact Personal Practice
Apart from the general impact on the nursing practice, the Protect People from Surprise Medical Bills Act will also have an impact on individual nursing practice in various ways. First, often individual nurses are confronted with dilemmas during service delivery due to financial constraints faced by a majority of patients. For example, sometimes a nurse might be caught in a situation whereby he/she needs to decide whether to compromise the quality of the practice or go on with service provision which might leave a patient or a family bankrupt. However, the enactment of this bill will cushion individual nurses from an unnecessary financial dilemma.
Secondly, some of the out-of-network providers have been found to provide health care services at exorbitant rates with the motive of making profits at the expense of the patient. In this instance, a nurse might be tempted to question decisions that are likely to saddle a patient with unnecessary financial implications which might not auger well with the administration hence leading to a strained relationship between an individual and the administration. But, this bill will ensure that the nurse-administration relationship is not jeopardized by such motives.
Lastly, due to cost implications, an individual nurse might decide that it is prudent to lower the standards of the practice to fit within the patient’s budget. This might lead to undesirable outcomes that will predispose the patient to more harm and the nurse will be required to shoulder the blame. Nonetheless, the enactment of this bill will ensure that individual nurses do not have to comprise the quality of the practice over cost implications.
- How to Communicate Any Concerns Concerning the Bill
The nursing profession is one of the largest professions in the world. The U.S. alone is estimated to be having over four million nurses. Therefore, this indicates that they can greatly influence healthcare policies. One way of participating actively in policy formulation processes by nurses is by communicating their concerns over a proposed healthcare policy using various channels such as letters and being as precise and specific as possible.
As for the Protecting People from Surprise Medical Bills Act, some of the concerns in support of the bill will be based on the standards of the nursing practice. The bill proposes a critical approach whereby providers and insurers will have to negotiate for a fair pay rate. This implies that nurses will not have to compromise the standards of the practice due to cost limitations as this challenge will be addressed by IDR. A nurse can communicate this concern using a letter addressing his/her Congress Representative.
- The Impact of the Bill on the Community
The proposed Protecting People from Surprise Medical Bills Act will have a significant impact on local communities in numerous ways. First, the bill will contribute towards securing household livelihoods hence enhancing the well-being of community members. This is because it has been found that exorbitant medical bills are driving households to bankruptcy. Financially constrained households due to surprise medical bills may no longer be able to meet household basic needs hence leading to increased poverty levels in the community. Therefore, the bill will be of great essence as it will cushion communities from sinking deeper into poverty.
Secondly, the bill will promote the relationship between the community and care providers; out-of-network healthcare facilities and professional nurses. Upon its implementation, the Protecting People from Surprise Medical Bills Act will contribute towards the prevention or reduction of patient debt lawsuits that are negatively affecting the relationship between health care providers and community members. Whenever disputes perpetuated by health care costs are incurred disputes arises, IDR under this bill will ensure that the disputes are amicably solved hence avoiding straining neighborhood relationships. Similarly, the bill will ensure that nurses do not breach the social contract between them and the community members. Nurses will provide community members with the care they deserved wherever there is a need.
Lastly, the bill will enhance the community’s access to quality healthcare services. For instance, whenever there is a medical emergency community members can be able to access the needed medical services from the nearest healthcare facility whether it is an in-network or out-of-network healthcare facility. Increased access to medical services will contribute enormously to the well-being of the community members. Therefore, it is evident that the proposed Protecting People from Surprise Medical Bills Act will not only impact the nursing practice standards but it will also have positive implications for the larger community.
Conclusion
The healthcare system in the U.S. is regulated by policies enacted by Congress. The goal of these policies is to ensure that Americans are able to access healthcare services at an affordable rate. However, study shows that the cost of health care services is escalating at an alarming rate with a majority of Americans not able or no longer willing to pay for care services. To curb this menace the House of Representatives has proposed the Protecting People from Surprise Medical Bills Act to ensure that healthcare services are affordable to all.
The Protecting People from Surprise Medical Bills Act will have a profound impact on nursing practice standards and the well-being of the community through its reforms; banning the traditional billing practice, adopting the arbitration approach towards pay rates, and improving transparency within the healthcare system. These reforms are critical and should be supported by all medical personnel to ensure that nurses working in out-of-network healthcare facilities are able to offer their services without being limited by the cost implication.
