Policy-Bill on Protecting Access to Primary Care Act Objective and anticipated outcome of the proposed legislation or regulation

On August 2, 2013, Congresswoman Suzanne Bonamici (D-OR) introduced the Protecting Access to Primary Care Act (H.R. 2986). The primary objective of the proposed legislation was to improve access to primary care for individuals enrolled in Medicaid. The anticipated outcome is that the bill will improve reimbursement rates for nurse practitioners, physician assistants, and other primary health care providers. The proposed legislation will make a small but significant change to the Affordable Care Act (ACA), which will motivate primary care providers to serve Medicaid patients (Brooks et al., 2015). With the current nursing shortage, it is anticipated that the Act will attract at least one million extra nursing professionals in the field. It is obvious that the country needs more primary care providers to meet the needs of the increasing population (Ricketts, 2013).

Background contributing to the legislation/regulation formation

Presently, the ACA offers increased remuneration rates for physicians. Unfortunately, it has failed to increase reimbursement for other primary care professionals such as physician assistants and nurse practitioners (Ricketts, 2013). For example, if a Medicare/Medicaid patient goes to the physician's office, Medicare will reimburse that physician 100%. However, if that the same patient goes to the Nurse Practitioner's Office, Medicare will reimburse the nurse practitioner less than 100% even though they are both providing the same service to the same patient. This is not fair. This congressional representative introduced this bill so that if it is passed, it will put a stop to this reimbursement gap.

Worse still, the drastically increasing healthcare costs are making access to care difficult in the United States. From the recent unstable economy, the number of uninsured has increased following reduced employee benefits and job loss. This pattern is projected to continue unless there is intervention. The adverse impacts of reduced access to healthcare are having alarming consequences on the nation's economic health. All these led to the introduction of the Act that marks the beginning of a pronounced transformation in America's healthcare framework. After several attempts to reform the healthcare system, the U.S. leadership is pushing for the success of this landmark regulation. This will ensure most citizens have access to healthcare insurance by the end of 2015 (Brooks et al., 2015).

Impact of the legislation/regulation on existing health care policies

The Protecting Access to Primary Care Act will substantially reshape the healthcare policy landscape within which public health is practiced. Nurse practitioners, physician assistants, and other primary health care providers will receive improved reimbursement rates. If the bill is passed, it will put a stop to the current reimbursement gap between physicians and nurse practitioners. The proposed legislation will address this vital omission. Medicaid members currently depend on clinical nurse professionals and other primary care specialists to serve their healthcare needs. By giving these providers improved reimbursement rates, the bill will motivate more to care for Medicaid clients. This is especially vital in underserved and rural regions that record shortages of primary care providers.

Implications of the legislation for advanced practice nursing

The Protecting Access to Primary Care Act will have some implications for the advanced practice nursing (APN). First, it will oversee that advance practice providers get similar rewards for primary care services granted to Medicaid beneficiaries as is given to physicians. The Act sets the floor for physician incentives for primary care services within Medicaid, demanding that these incentives equal those applied within Medicare. Another implication is increased funding for Advanced Practice Nursing (APRNs) education, precisely for advanced specialties and degrees. Today, estimates indicate that the U.S. is experiencing a shortage of roughly 10,000 primary care physicians (Ricketts, 2013). After the implementation of the Protecting Access to Primary Care Act, the demand for primary care providers will increase. A huge volume of patients will seek care services from APRNs for wellness and preventive care. With the acknowledgment of the countrywide deficit of primary care providers, approximately $50 million has been allocated through the Protecting Access to Primary Care Act to boost the advanced practice nursing.

Identify position of employees. Presently, with the Act under way, employers are forced to retool reimbursement policies, which are crucial resources for worker recruitment, retention, and loyalty. Reports indicate that the proposed Act's tax credit for small hospitals will entice health facilities to increase reimbursement for primary care providers. As a result, health facilities have sought consultants' perspective to help them understand the law, adhere to the new standards and communicate changes to nurses and physicians.
The position of private-practice physicians is that policymakers neglected them during the discussions about the bill. This illustrates a possible disconnect between the grassroots stakeholders and the American Medical Association (AMA) that advocated for the law. From their perspective, they were cheated by the scope and rate of the proposed reform. An estimated 60% cite that they stop dealing with patients and pursue administrative jobs.

Obstacles and barriers influencing passage or implementation of the legislation/regulation

Money is the one factor expected to hinder the passage or implementation of the Act. It includes the need for creative strategies to eliminate the current nurse-physician reimbursement. The new law will warrant additional federal funding. Kaiser Family Foundation conducted a study, which reveals nurses have "been 'revenue invisible. This implies that nursing services are not separated from the institutional room fee or other professional fees on the billing statements. In turn, it promotes the belief that nurses are not 'revenue generators (Davis et al., 2011). According to experts, money is the greatest motivator in any job. Therefore, implementation of the law will motivate those nurse practitioners, physician assistants, and other primary health care providers (Schoen et al., 2014). In turn, these professionals will provide quality, safe healthcare, which improves outcomes. They should not be regarded as physician substitutes. Research indicates that DNP APRNs have been trained to provide a holistic approach to medical care. This approach tends to recognize a client as a unique creature under an encompassing physical, social and energy setting.

Factors favoring passage or implementation of the legislation/regulation

In the United States, over 80,000 clinical nurse professionals have the expertise and skills to enhance care quality and reduce healthcare costs. Most of them are managing the primary care needs of patients with chronic diseases. The country needs to ensure those nurse practitioners, physician assistants, and other primary health care providers are granted appropriate incentives to ensure all Americans receive the health care they need. For this reason, The National Association of Clinical Nurse Specialists endorses this important bill, and there are high chances that the Act will be passed and implemented. With its implementation, roughly eighty million (Schoen et al. 2014) Americans will enjoy new access to preventive services.

Discuss position of opposing groups, against the legislation/regulation

Critics hold that the Act a possession of the healthcare system by the government accounts for approximately sixth of the economy. In fact, the biggest threat to its implementation comes from the coercive nature of its architect. Opponents are concerned that nurses and other primary care providers do not have similar credentials as physicians. Therefore, they cannot be reimbursed same as physicians. Previously, nurse specialists were regarded as non-income generators. Today, this is illegal as it is one of the Act's central focuses. Already, many of these advanced-practice nurses work as their patients' principal provider. They make diagnoses, prescribe medications, order, and perform diagnostic tests. Moreover, since they are reimbursed less than physicians are, proponents of the legislation are quick to point out, increasing reimbursement of nurse practitioners could lower health care costs (Schoen et al. 2014). However, physicians disagree. Many of the them say that physicians are offering higher-quality care than the cursing counterparts and increasing reimbursement for nurses will not necessarily improve effectiveness, quality, equity or safety.

Discuss the economic impact of the legislation

In looking at the totality of the Act, the good news promised to American nurse specialists and primary care providers are noticeable. The most notable factor is that financial incentives will shape healthcare. For the past 30 years, these professional have been viewed as non-income generators (Davis et al., 2011). This justifies why the reduced healthcare quality is linked to lower compensation, reduced competitiveness, and human resource problems within the nursing field. With the passage of the legislation, we will see a reduced nurse turnover rate since they will be financially motivated to stay in their jobs. From an economic angle, this demonstrates that more Americans will provide quality, safe healthcare, which improves outcomes, thus household incomes. Additionally, by safeguarding nurses' financial status and enhancing their lifestyles, the legislation will help minimize the severity of future recessions while enhancing the protection of the nurse specialists.