running head: HEALTH CARE POLICY DEVELOPMENT

Health Care Policy Development

Brandi Sullivan
Bon Secours Memorial College
On my honor, I have neither given nor received aid on this assignment or test, and I
pledge that I am in compliance with the BSMCON Honor System.

Health Care Policy Development

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May we hope that when we are all dead and gone, leaders will arise who have been
personally experienced in the hard, practical work, the difficulties and the joys of organizing
nursing reforms, and who will lead far beyond anything we have done (Nightingale, 1893, p.
288). Health care policy impacts patients, health care providers, and our community in multiple
ways every day, from who can receive services, who will provide services, the standards for
quality care, requirement standards for practitioners and facilities, and how these providers will
be reimbursed (Blackboard, 2016). This paper will discuss how the current proposed bill, H.R.
1571: Improving access to Medicare Coverage Act to the House of Representatives would
impact nursing and improve health policy.
Bill H.R. 1571: Improving access to Medicare Coverage Act, the importance of this bill
being passed would be to ensure a safer transition from the hospital level of care to the next level
of care for patients. Bill H.R.1571 would Amend title XVIII (Medicare) of the Social Security
Act to deem an individual receiving outpatient observation services in a hospital to be an
inpatient with respect to satisfying the three-day inpatient hospital requirement in order to entitle
the individual to Medicare coverage of any post-hospital extended care services in a skilled
nursing facility(Congress, 2015, para. 1). This bill was introduced to the House and as of
03/27/2015, has only been referred to the Subcommittee on Health for review. The significance
of this bill is that it addresses older Americans and people with disabilities who are hospitalized
but do not meet the 3-day inpatient hospital stay requirement simply because they were placed in
outpatient observation status for some or all of their hospital stay (even when their total actual
stay exceeds three days in the hospital) can face a significant and unexpected financial burden,
which can amount to thousands of dollars, for skilled nursing facility care (Congress, 2015, para
8). Patients under observation and their families are currently responsible for the financial

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burden of an observation stay and if skilled nursing care is needed after their hospital stay
(Congress, 2015). This bill would allow for observation days to be counted towards patients
overall hospital stay days which would open the possibility for placement should a patient have
the need and be unable to return home with a safe discharge plan.
The importance of this proposed bill is to provide better care for patients when they are
ready to discharge a hospital facility. This law affects the profession of nursing since they are the
frontline in providing care to these ineligible patients who deserve to have a safer discharging
plan from the hospital. Observation patients fall into a crack in our system where it is difficult to
sometimes implement the most appropriate solution simply because their status does not meet
Medicares criteria for placement. Patients in observation status remain in the hospital
environment greater than 72 hours at times simply because they are immobile and it is unsafe to
send them home. So nurses continue to provide care to patients who would be more appropriate
in a lower level of care such as a skilled nursing facility (SNF) versus the acute level of care the
hospital provides. The affect this law would have on observation patients would be crucial.
Patients who do not qualify for an inpatient stay could use their observation days towards the
three midnight rule and be qualified for skilled nursing facility placement. The patients who are
most affected tend to be our elderly and with the changes in the family support system, most
have no relatives they can count on to assist with twenty four hour care and or paying upwards of
$8,000 a month for private paying individuals in a SNF (per verbal communication with a local
facility the Gardens of Warwick Forest). When patients and family cannot afford to send a
patient to a facility for the needed recovery, these patients go home with insufficient support
leaving them susceptible for delayed healing and further complicating their illness. This leaves

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ill and frail patients by themselves which negates the safe discharge plan the hospital is required
by law to provide.
In researching, the American Nurses Association (ANA) excels at being a leader in
nursing, creating guides to help create a safe environment for patients and medical professionals
alike. Reports include principles and guidelines on various issues, designed to inform and
instruct (ANA, 2016). Sadly, I could find no evidence that the ANA has taken a stance on this
bill at this time.
There are some financial implications to consider related to this law. If patients are
admitted under observation status in the hospital environment, the government saves money on
their overall care. According to the Centers for Medicare and Medicaid Services (CMS),
observation patients are not covered under Medicate part A when admitted into a bed (2016).
Medicare Part B benefits only cover for the doctor services and outpatient services such as
surgery, lab tests, and Intravenous medications (CMS, 2016). Patients under observation will
have a greater out of pocket financial responsibility making them responsible for the remaining
costs of their stay such as oral medications, food, and some nursing practices. Per CMS, The
copayment for a single outpatient hospital service cant be more than the inpatient hospital
deductible. However, your total copayment for all outpatient services may be more than the
inpatient hospital deductible (2016). As an organization, we are also reimbursed less if a patient
is sent to a SNF since the reimbursement must now be shared amongst both facilities. An
observation patient would be reimbursed by CMS at a lower rate deducting money from the
hospital organization and their bottom line. But when one considers that we are reimbursed at a
lower dollar amount for patients in this status and we end up having to keep them for up to a
week in order to medically prepare a safe discharge the overall would still likely be a saving.

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The Office of the Inspector General of the Department of Health and Human Services is
supportive of counting hospital observation days towards the 3-day inpatient stay requirement. In
addition, in September 2013, the Congressionally established Commission on Long-Term Care
recommended that CMS count time spent in observation status toward meeting Medicares 3-day
stay requirement (Congress.2016, Para 11). With local government agency support at this time,
it is hopeful that the House will review and pass this bill forward. Other opportunities would be
for the nursing community to unite and demand that their local representatives take action and
support this local bill. The largest challenge facing this current bill is lack of representative and
nursing support. AnotherchallengeistoensurethattheSecretaryofHealthandHuman
Serviceshasanunderstandingthattheywillneedtomonitorpatternsofbehaviorsandensure
thatprovidersaredeliveringappropriateandneededlevelsofcare(Congress,2016,para10).
The opportunities and challenges that the passing of this bill present to the
nursing/healthcare profession far outweigh the concerns regarding reimbursement. Patients and
their health care needs should be the top priority of doctors, nursing staff, and government
representatives. Humanity is living longer. Older Americans have worked and paid into our
healthcare system and now they should be given the assistance needed when it is required. We
must implement Bill H.R. 1571: Improving access to Medicare Coverage Act, the importance of
this bill being passed would be to ensure safer transitions from the hospital level of care while
improving patient outcomes.

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References
American Nurses Association. (2016). ANA principles. Retrieved from
http://nursingworld.org/principles
Center for Medicare & Medicaid Services. Find out if youre an inpatient or an outpatient-it
affects what you pay. Retrieved from https://www.medicare.gov/what-medicarecovers/part-a/inpatient-or-outpatient.html
Congress.Gov. (2015-2016). H.R. 1571/S.843: Improving access to Medicare Coverage Act.
Retrieved from
https://www.congress.gov/search?q=%7B%22congress%22%3A
%22114%22%2C%22so
urce%22%3A%22legislation%22%2C%22search%22%3A
%22H.R.%201571%2FS.843%3A%20Improving%20Access%20to%20Medicare
%20Coverage%20Act%22%7D

Mikelaites, C. (2016). Health policy Development Paper Rubric. Retrieved from

https://bsmcon.blackboard.com/bbcswebdav/pid-112240-dt-content-rid638930_1/courses/NUR4240-201516-SP-O1/Health%20Care%20Policy
%20Development.pdf

Nightingale F. (1893). Sick Nursing and Health Nursing. In: Billings JS, Hurd HM, eds.
Hospitals, Dispensaries and Nursing: Papers and Discussions in the International
Congress of Charities, Correction and Philanthropy. Section, Chicago.

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