Health Policy Analysis

Analysis

 Introduction

 A health policy entails judicial solutions, or laws that respond to a particular health issue. The process for developing a health policy is described by Berkowitz (2012). According to Berkowitz a nursing leader should have skills for analyzing a policy in the policy making process to assess its potential impact. The process of analyzing a policy should begin with the identification and detailed description of the problem. In this paper, the nonpayment Medicare policy is analyzed by defining the health care policy problem. Further, the stage sequential method will be used to analyze a healthcare policy in the policy making context from the ethical, legal, economic, and political perspective. The goals and objectives of the policy are then analyzed and compared with two other policies. Finally, the most effective policy is discussed based on its implications for nursing.

 

 Background information

 In the last 20 years, the rate of Healthcare-associated Infections (HAI) in the US has risen significantly. HAIs are infections acquired by patients in a healthcare facility setting after their admission for a different condition. According to the Office of Disease Prevention and Health Promotion, (2015) HAIs normally appear more than 48 hours after a patient's admission to the healthcare facility and affect 5-10% of patients in the US. HAIs affect more people in the developing nations than in the developed nations. Further, HAI is a leading cause of morbidity and fatality among admitted patients. They also cause a significant rise in the cost of healthcare.

 The US government’s Centers for Medicare & Medicaid Services, in acknowledgment of the high cost of treatment for HAI, proposed the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005 and the US Congress passed them into law. The Acts sought to enforce a non-payment policy for HAI by Medicare. The nonpayment policy, on its part, would exclude HAI from other recognized Diagnosis Related Groups, which Medicare usually compensated.

 Policy Problem

 According to Berkowitz (2012), the process of analyzing a policy should begin with the identification and detailed description of the problem. A problem is a set of challenges that require the development of solutions to reduce their negative effects on the society. In this case, the high economic and health effects of preventable HAIs was identified as a major problem that required a policy solution to minimize the economic losses and improve the quality of healthcare offered in the American health institutions. The Office of Disease Prevention and Health Promotion (2015) lists HAIs as one of the leading causes of death in patients admitted in the US and one of the leading causes of preventable deaths.

Consequently, the reduction in the rate of HAI would reduce the fatality and morbidity rates in admitted patients in the US. Medicare would save funds by not paying for preventable health conditions, funds that would ultimately contribute to the improvement of health care services. The US government’s Centers for Medicare & Medicaid Services, the US agency responsible for overseeing the implementation Medicare proposed the adoption of the non-payment policy that would exclude the HAI-related cost of treatment from the Medicare funding. The policy would prevent wastage in publicly funded health programs and ensure better, safer, and more sustainable funding for healthcare through Medicaid. For it to succeed, the policy should be acceptable and supported by all stakeholders in the health sector.

 After the identification of HAI issue, The US government’s Centers for Medicare & Medicaid Services conducted research, the findings of which indicated that 5-10% of the patients admitted to the US hospitals suffers from assorted HAIs. These HAIs were as a result of using contaminated equipment, non-adherence to hospital hygiene, and negligence. Medicaid purchases the largest proportion of health care services in the US. Their research indicated that more than 98000 Americans died from preventable in the US healthcare system. The loss from the HAIs was more than $29 billion. After research, Medicaid identified ten health conditions that health conditions that it attributed to human error (Peasah, McKay, Harman, Al-Amin, & Cook, 2013).

 The ten conditions included retained foreign material after surgery, air embolism, incompatibility of transfusion blood, patient falls and related injuries, health issues arising due to poor glyme tic control. Other conditions are Catheter-Associated UTI, Vascular Catheter-Associated Infection, DVT, and several Surgical Site Infections. The US government’s Centers for Medicare & Medicaid Services, in 2007, issued new requirements for all the hospitals under the Medicare to conduct a Present on Admission (POA) report with every claim of compensation for all inpatient payments.

 Social Factors

 Several social factors can exasperate the risk of HAI developing in admitted patients. Firstly, the conditions are more likely to occur in critical care patients and those admitted to the high dependency unit due to the use of life support devices like catheter and respirators that increase the likelihood of HAI. Also, patients from relatively poor social backgrounds are at a higher risk of acquiring HAIs since they may not afford some high-quality services. In the US, the African American, and the Latino populations are more susceptible to HAIs than the White population. Similarly, the occurrence of HAI is more prevalent in individuals at the extremes of life. These are the young children and the elderly patients. These two categories of a patient have a low immunity when compared to the rest of the population. They are also more likely to undergo procedures that increase their exposure to the risk of HAI such as intubation, catheterization, and ventilation.

 HAIs are also more prevalent in patients with chronic illnesses that compromise their immunity. These include diabetes, leukemia, AIDS, kidney disease, and tumors. Also, patients affected by opportunistic illnesses suffer from low immunity to infections. Patients who are taking immunosuppressive drugs also have lower immunity and are prone to HAIs. Other factors that increase the susceptibility to HAI include exposure to skin-breaking injuries, impairment of the mucous membranes, and malnutrition. Essentially, there are factors that affect people from lower social classes than middle-class citizens (Provincial Infectious Diseases Advisory Committee (PIDAC), 2008).

 Economic Factors

 Healthcare service provision has a high cost in the US although it is greatly supplemented by Medicare, Medicaid, and health insurance schemes. HAIs affect 7% of the patients admitted to hospital and about 19% of patients after discharge. These infections thus represent a considerable proportion of the overall cost of treatment. Patients who acquire HAI while in the hospital cost about 2.9 times more to treat than those patients who do not develop HAI. According to Stone, (2010) these patients on average also spend 11 more days in the hospital. Considering the various costs of treatment of HAI, nursing services contribute the highest cost followed by hospital overheads. The highest cost is, therefore, incurred by the hospital.

 The patients also incur more personal costs especially in cases of post-discharge HAIs where they have to employ informal carers. It also took longer for these patients to recover fully and resume their working schedule leading to a potential loss of income. It is also estimated that death rate in admitted patients is relatively higher in patients who have infections. Patients with HAI have to take more drugs to manage the secondary infections increasing their pharmaceutical expenses especially when the infection occur post discharge. The economic productivity of the patients who develop infection is hampered, the number of hospital days increases unnecessarily, and more nursing staff are dedicated to attending the cases. Essentially, if all the HAIs were controlled, the US healthcare cost would reduce by more than $19 billion and more than 500,000 bed days.

 Ethical Factors

 There are various professional codes of ethics that guide healthcare professionals in the US. The nursing professionals are guided by the American Nursing Association code of ethics which designate a nurse as the leading patient advocate. Nurses should, therefore, endeavor to ensure that patients are offered the best services in a well-protected environment. A nurse should, therefore, be accountable and professional in the discharge of their duties. The nurses should also seek to improve their competence to improve their services to their patients.

 In a hospital setting, a nurse should ensure that patient gets proper attention, good hygiene and that there are preventive measures for HAIs in the hospital or after discharge. Nurses should also serve the role of educating a patient on the appropriate measure for disease prevention to prevent cases of post-discharge HAIs. Poper preventive and hygiene measures include training the patients on how to clean and maintain their surgical wounds, proper administration of prescribed medicine, care of hospital issued devices, and first aid measures. Nurses should also participate in research and share the acquired knowledge for better management of diseases and prevention of infections (American Nurses Association (ANA), 2010)).

 Political Factors

 The nonpayment policy for HAI came into force after President Bush signed into law the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005. The Deficit Reduction Act of 2003 specified the various preventable health conditions. When he joined office, President Obama promised to overhaul the Medicare program and replace it with The Patient Protection and Affordable Care Act (PPACA) which came into operation in 2010. The new health care Act would guide the government investment in health. However, the Deficit Reduction Act was not repealed and continued to be in operation. Consequently, the number of preventable conditions being excluded from Medicare payment has continued to rise with an exception of several hospitals (Provincial Infectious Diseases Advisory Committee (PIDAC), 2008).

 Legal Factors

 There have been several legislations aimed at reducing the cost of preventable infections in the US. The nonpayment policy is supported by several Congress bills that were ultimately ratified into law. The Patient Protection and Affordable Care Act (PPACA) acknowledges the need to emphasize prevention and reduce the number of patients affected by preventable infections. The nonpayment policy is thus supported by legislation to give it legal backing (Aiken, 2008).

 The Patient Protection and Affordable Care Act (PPACA) which came into operation in 2010. The new health care Act would guide the government investment in health. However, the Deficit Reduction Act was not repealed and continued to be in operation. Consequently, the number of preventable conditions excluded from Medicare payment has continued to rise with an exception of several hospitals (Provincial Infectious Diseases Advisory Committee (PIDAC), 2008).

 Policy Goals & Objectives

 The policy as two main goals; to improve patient safety through a reduction in the number of HAIs in the US hospitals, and, to minimize or eliminate the amount of money used to fund HAIs. The policy categories several HAIs as never events, requiring the hospital to issue a POA declaration together with the claim for compensation. All HAIs are then excluded from other DRGs, and their cost subsequently removed from the disbursed amounts.

 Evaluations of Options & Alternatives

 There are several options available under the policy. The first option would be to exclude all the payments of HAI-related illnesses from the compensation in Medicare. This option has the advantage of reducing the cost of Medicaid due to HAI. However, the option would also cause hospitals to deny treatment to patients with HAI especially when the condition develops after the patient has been discharged.

 The second option is to eliminate te only specific HAIs from the payment by Medicaid. This option requires the accurate reporting of all conditions treated for by the physicians and the nursing professionals. It enhances the cooperation between policy implementer and the health institutions. However, the policy might be unsuccessful if the healthcare organizations do not accurately report their patient data.

 Cost

 The policy reduces the overall cost of Medicare used to fund preventable infections by identifying the various categories of HAIs and requiring POA declaration from the hospital. The patients are not required to pay any additional cost for procedures that were done wrongly by the medical staff. Essentially, the policy is not an additional cost to the consumer. The policy also bars the hospital from balancing the bill for the amount not reimbursed by Medicare. Some hospitals would earlier bill the excess on their patients under the co-pay arrangement.

 However, the hospitals are supposed to cater for the excess cost of treatment due to HAIs. Many hospitals recover the funds by reducing the per diems for the healthcare staff. Essentially, hospitals have to recover the additional costs to remain operational. However, some hospitals have been exempted from the strict procedure of requesting payments. The policy also, despite shielding the patient from additional cost, neglects to issue guidelines for apologies due to Additional suffering by the patients. The hospitals are also allowed to appeal wrong or erroneous nonpayment.

 Quality of Care

 The quality of care is expected to improve tremendously as a direct result of the implementation of the nonpayment policy. Hospitals have implemented measures to improve the quality of healthcare offered I their facilities to avoid financial losses due to HAIs. Similarly, the improved reporting regime for HAIs has led to more research on strategies to minimize their occurrence and ensure that they are ultimately eliminated from the healthcare system. The American Society for Healthcare Risk Management (ASHRM), (2011) notes that since the implementation of the legislations for non-payment policy, the number of HAIs has reduced by more than 36%. However, the rate of HAIs is still high in the US, and better management policies should be implemented (WHO Regional Office for the Western Pacific, ‎2005; Stone, 2010)

 Protection of patient & provider autonomy

 The patient is protected by the policy since it prohibits that health vendor from revising patient fees due to the occurrence of an HAI. The patients are only required to pay the normal fees charged under the co-pay. The healthcare providers have, however, lost their autonomy in the policy because they are not allowed to make health funding decisions independently. All the treatment regimes are monitored under the policy. The physicians have to submit the reports on their identified MDGs when submitting compensation results. Essentially, medical practitioners should be allowed to make independent decisions when diagnosing or treating patients. The requirement to report all diagnoses and the related POA undermines their independence (Chase, 2010). The nursing staff who also should offer independent care for all patients might also be prevented from offering care for HAIs since the per diems will not ultimately be paid for them. Finally, the hospitals might be forced to deny treatments to patients who report back with HAIs.

 Political Feasibility on Nursing Implications

 The nonpayment policy might encourage the nurse leaders to be more strict in ensuring that the nursing staff follow the right procedures and thus prevent the occurrence of HAIs. Nurses would also benefit from training to improve their compliance with the nonpayment policy and ensure that their patients are not exposed to HAIs.

 Conclusion

 The nonpayment health policy in the US is a valid deterrent measure to reduce the incidences of HAI. Medicaid purchases the largest proportion of health care services in the US. Their research indicated that more than 98000 Americans died from preventable in the US healthcare system. The loss from the HAIs was more than $29 billion. After research, Medicaid identified ten health conditions that health conditions that it attributed to human error. The ten conditions included retained foreign material after surgery, air embolism, incompatibility of transfusion blood, patient falls and related injuries, health issues arising due to poor glyme tic control.

 Other conditions are Catheter-Associated UTI, Vascular Catheter-Associated Infection, DVT, and several Surgical Site Infections. The US government’s Centers for Medicare & Medicaid Services, in 2007, issued new requirements for all the hospitals under the Medicare to conduct a Present on Admission (POA) report with every claim of compensation for all inpatient payments. The policy will ultimately reduce the cost of treating HAIs and improve healthcare in the US.

 Essentially, the nonpayment policy might encourage the nurse leaders to be more strict in ensuring that the nursing staff follow the right procedures and thus prevent the occurrence of HAIs. The US government’s Centers for Medicare & Medicaid Services, in acknowledgment of the high cost of treatment for HAI, proposed the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005 in the US Congress. The Acts sought to enforce a non-payment policy for HAI by Medicare. The nonpayment policy, on its part, would exclude HAI from other recognized Diagnosis Related Groups compensated under Medicare.