Why Current Advanced Practice Nursing Policies Matter to Healthcare’s Future
Current Advanced Practice Nursing Policy Issues
Advanced practice nursing (APN) is rapidly evolving, and with it comes a slew of policy changes and challenges that are critical to the profession’s future. As healthcare continues to reform, these policies impact the roles of Advanced Practice Registered Nurses (APRNs) and their ability to deliver care, as well as the systems in which they work. Understanding these issues is crucial for APRNs to navigate the evolving landscape of healthcare.
The Affordable Care Act (ACA) remains one of the most significant policy initiatives shaping the future of healthcare, especially for APRNs. Passed in 2010, the ACA and the Health Care and Education Reconciliation Act expanded healthcare access and coverage, but its implementation has seen various challenges. The ACA has reshaped the way healthcare is delivered, moving from traditional fee-for-service models to value-based care systems like Accountable Care Organizations (ACOs). Despite this, APRNs have faced hurdles, such as limited roles within ACO governance structures.
Policy Initiatives in Health Reform
The ACA and the Health Care and Education Reconciliation Act of 2010 are landmark legislative efforts that continue to influence healthcare policies. These laws, initially designed to address issues of cost, quality, and access, have substantially increased insurance coverage. By 2016, more than 20 million previously uninsured individuals gained coverage. However, the promises of comprehensive, affordable healthcare have been slow in coming. In states where Medicaid expansion was accepted, coverage grew, but millions remain uninsured, reflecting ongoing policy issues related to affordability.
Table: Key Data and Facts About Advanced Practice Nursing Policy Issues
| Policy Issue | Impact on APRNs | Resolution Needed |
|---|---|---|
| Affordable Care Act (ACA) | Expanded access to care but limited APRN roles in ACOs | Inclusion of APRNs in leadership and decision-making processes |
| Medicaid Expansion | Improved coverage for low-income individuals | Continued expansion and increased APRN participation |
| Value-Based Care Models (e.g., ACOs) | Promotes patient-centered care but excludes APRNs from cost-sharing | Remove physician-first policies in ACO structures |
| Bundled Payment Programs | Encourages efficient care but challenges APRN reimbursement models | Recognition of APRN roles in cost-saving measures |
| Medicare Shared Savings Program | Allows APRNs to serve Medicare patients, but with limitations | Full inclusion of APRNs in patient assignment and savings |
For more information, visit the Medicare Hospital Compare website at: https://www.medicare.gov/hospitalcompare/search.html
The Value Agenda: Moving Toward Value-Based Care
A significant shift from fee-for-service to value-based healthcare models has reshaped how healthcare is delivered. Value-based models like Accountable Care Organizations (ACOs) incentivize care providers to focus on patient outcomes rather than the quantity of visits or procedures. For APRNs, however, participation in these models has been restricted by policies that favor primary care physicians, limiting the role APRNs play in managing care under ACOs.
The American Association of Nurse Practitioners (AANP) continues to push for policy changes that allow APRNs to lead and manage care under ACOs. The 2019 final rule by the Centers for Medicare & Medicaid Services (CMS) removed the requirement for a physician visit in the Medicare Shared Savings Program, which was a significant step toward empowering APRNs within these structures. However, challenges remain, as the language of the ACA continues to restrict APRNs from full participation.
Bundled Payments and the Role of APRNs
Another key policy issue is the implementation of bundled payment models, in which a lump sum payment is provided for an entire episode of care, such as hip or knee replacements. This model rewards hospitals that provide high-quality care at lower costs but penalizes those that do not meet cost and quality targets. For APRNs, this represents an opportunity to contribute to significant savings and improved patient outcomes by reducing hospital readmission rates. However, many bundled payment programs are structured in ways that overlook the value of APRN care.
Challenges Facing APRNs in Policy Leadership
Although APRNs are increasingly recognized as essential healthcare providers, their participation in policy-making and leadership positions remains limited. The establishment of the Patient-Centered Outcomes Research Institute (PCORI) in 2010 aimed to prioritize patient-centered care through research, but APRNs are underrepresented in decision-making roles within this organization. With only one nurse on its board, the lack of APRN voices in such influential policy arenas continues to be a pressing issue.
FAQ on Current Advanced Practice Nursing Policy Issues
Q1: How has the Affordable Care Act impacted APRNs?
The ACA has expanded healthcare access, allowing APRNs to take on more significant roles in patient care. However, APRNs face restrictions within models like ACOs, limiting their leadership roles and participation in shared savings programs.
Q2: What are the key policy challenges facing APRNs in 2024?
The main challenges include limited participation in value-based care models, underrepresentation in policy leadership roles, and barriers to full recognition of their contributions to cost-saving healthcare initiatives.
Q3: How do bundled payment models affect APRNs?
Bundled payment models provide opportunities for APRNs to contribute to efficient, cost-effective care. However, many programs do not adequately recognize APRNs’ roles, which limits their ability to participate fully in these savings initiatives.
Q4: What progress has been made in APRN participation in ACOs?
CMS’s 2019 rule change, which removed the “physician visit” requirement, has allowed APRNs to serve as primary care providers for Medicare patients. However, further policy changes are needed to ensure APRNs can participate equally in ACO leadership and shared savings programs.
Q5: How can APRNs influence future healthcare policies?
APRNs can advocate for changes in policy by engaging with professional organizations like the AANP, participating in legislative discussions, and taking on leadership roles in healthcare organizations to shape policy decisions that affect their practice.
Addressing the Future of APRN Policy
As healthcare systems continue to evolve, APRNs will need to stay engaged in ongoing policy discussions. Ensuring that APRNs have a seat at the table in policy-making bodies like PCORI and CMS will be critical in shaping the future of healthcare. Removing barriers that limit APRN roles in value-based care models will also allow for more equitable participation in cost-saving initiatives, ultimately improving patient outcomes across the healthcare continuum.
In conclusion, while significant progress has been made in healthcare reform, current advanced practice nursing policy issues continue to present challenges. Through sustained advocacy, leadership, and policy engagement, APRNs can help reshape the future of healthcare, ensuring that their vital contributions are fully recognized.