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Case Study: You are the health care administrator for a busy free rural medical clinic in the mountains of Western North Carolina

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Case Study:

You are the health care administrator for a busy free rural medical clinic in the mountains of Western North Carolina. This clinic serves a large number of indigent clients. One particular client that comes to the clinic is Myrtle. Myrtle has a number of health care issues and she routinely sees the nurse practitioner. Myrtle is a smoker and has been told by the nurse practitioner and physician that she needs to stop smoking because it is making her condition worse. Given the limited funding of the clinic, staff come to you and asks to discontinue providing free care to Myrtle due to her lack of compliance to care. The staff is concerned that Myrtle is using resources other clients need and due to her non-compliance, they believe these resources should be directed to other more needy and compliant clients.

For this discussion, imagine that you are the health care administrator for this clinic

1. In your first post:

• Describe your role (I am a Physical Therapist Assistant). Your description should be based on researching credible sources for information. Post the complete URL of any site where you find information (e.g. http://www.bls.gov/ooh/Healthcare/Physical-therapists.htm)
• As the health care administrator, what is your decision regarding the staff’s recommendations and why?
• In your opinion, does everyone have a right to health care? Explain your position.
• Is there a more creative and reasonable solution to this issue with Myrtle? If so, describe your ideal resolution.

2. After posting your initial response, select posts by two classmates to respond to and offer your argument in opposition to their positions. Remember, it is important to support your position with sources that are credible.

Communication with a Public Official As a health care administrator, you will be in a position to advocate for Search for Bills or Laws reforms and changes to health Find your Senator care policy based on your expert Find your House knowledge. This Representative knowledge can be used to leverage Sample Letter to Senator or government officials House Representative that might otherwise not fully understand health care in general. In your role, you will have the ability to be a resource and guide to your Senator or House Representative. In order to develop skill in this process, it is important to understand how to contact a public official and establish dialog that might be helpful to him or her and to communicate an important message regarding your position on certain issues relating to health care policy formation. The first step in contacting a public official rests with the idea that you have something of value to say. Perhaps your local public official is considering a new law regarding the provision of funding for birth control to help reduce the incidence of teen pregnancy. As a health care administrator or even simply as an interested citizen, you can search for the bill under consideration and read the bill to become informed. Maybe you think the idea is wonderful but you are concerned that funding will be an issue for your small community. Perhaps you are opposed to using State of Federal funds to combat this issue and are opposed to it. Consider your position carefully. Write notes to yourself that describe your position and the pros and cons of your position. Consider how the new law (if passed) might impact your business or employer. As you consider your position, draft a first letter that articulates your thoughts. Have a colleague review the letter to ensure that its tone and message are respectful and objective. Be sure that you speak from a position of knowledge rather than one of ignorance. This is demonstrated in your knowledge of the proposed legislation. Revise your letter to a final draft. Once you are confident your letter properly and respectfully speaks to the issue, send it to your public official. You will get a response. In some cases, your public official may recognize your status in health care and call you to solicit additional information from you regarding your position. Perhaps the public official has not made a decision on his or her position yet and seeking additional clarification. Whatever the case may be – be prepared to have a legitimate and informed conversation. In some cases, you may receive nothing more than a standard thank you letter. However, understanding how to communicate with a public official provides skill that will help you establish and ongoing dialog for the future. Defining Health Care Policy Are you sitting at your desk reading this and wondering exactly how health policy will impact your life as a health care administrator? Consider the following facts: Affordable Care Act Summary • National health policy impacts every citizen in the United States • Health policy is generally not a policy at all – it is a law! Medicare Timeline • Health care administrators frequently must comply with national health policy through regulations that govern health care operations. Health Policy Historical Perspective When you look at health policy, it is important to understand the true definition. Porche (2012, pg. 2) defines policy as “decisions or principles that Search for Bills or Laws serve as guidelines for actions.” As you explore the idea of health care policy, you can reasonably come to the conclusion that health care policy means Find your Senator policy (guidelines or laws) that serve to govern matters of health. From an initial look – this concept seems pretty simple – right? Not so fast …there are Find your House many different forms of policy to consider – health policy, public health policy, Representative public policy, social policy, organizational policy, legal policy, and institutional policy. The focus for this course will be health care policy and the importance of policy initiatives that involve matters of health for individuals, families, communities, and populations. However, it is important to understand that health policy often cuts across all political boundaries and does impact social policy, organizational and institutional policy, legal policy, and public health. Understanding the place that health care policy has in the larger picture will provide you with a broader view. As you explore the definition of health care policy, consider for a moment how a policy focused on health comes to reality. It all starts with an identified problem. Health care problems are plentiful. If you were to look at the problems plaguing health care today, it is easy to arrive at a problem statement that impacts the health of individuals, families, communities, and populations. Consider the issue of access to care for populations that do not have health insurance. As you consider this idea, think about who pays for the care of a person that does not have health insurance. People that have limited access to care often do not seek out care until there is a serious or life threatening issue. Oftentimes, when an uninsured individual presents to the hospital, the health issue is significant such as cancer, heart disease, or uncontrolled diabetes to name a few. Should these individuals have the same right to care that the insured individual has? Who has a right to health care? These are serious questions, ones that need to be answered by our collective society. This is how health care policy is often born. Consider the new Affordable Care Act (ACA). This act provides health care protections for all Americans. The impetus for the development and proposal of this new law was to provide coverage for those that do not have coverage and to make this coverage comprehensive and affordable for all citizens of the U.S.. While there are many opinions about the ACA, and many political problems with the implementation of the law, the very premise of this health care policy is to insure the population and reduce the costs of health care. Policy formation begins with the understanding and desire to resolve a problem. These problems may be community based or could be part of the national health care agenda. You should understand the importance of policy as a general term and how it applies specifically to health care. Health care policy can serve as a guideline at an organizational level or a law at the national level. You can leverage our knowledge as health care administrators through effective communication and dialog with our political and governmental representatives. Historical Perspective - Medicare In order to fully understand how policy like the Affordable Care Act came into law, it is vitally important to understand the historical perspective of how health policy developed as a part of our overall national agenda. While health policy has been around for a long time, the most notable health policy development in the last century and certainly the most significant reform was the passage of Medicare into law. Problem – Policy Identification Affordable Care Act Summary Medicare Timeline Health Policy Historical Perspective Prior to 1965, senior citizens, those over the age of 65 were often under insured or lacked any form of health insurance. Disease among this population grew out of control and the elderly would often present in the emergency room with chronic illness issues that required treatment. Much like the indigent populations we have today, the elderly would receive enormous amounts of care and lacked health insurance to pay. Hospitals would extend care to the elderly as a loss. Policy Agenda – Seeking a Resolution As the older population began to grow, government officials and elderly advocates began to petition the government for a national health insurance plan that would extend coverage to the elderly. A Bill is Born - Medicare Recognizing the future impact of this growing population and the over whelming need to provide care to the elderly population that were indigent, the federal government drafted legislation entitled the Medicare Bill. This was not a popular idea for many American citizens and there was a great deal of political maneuvering to prevent the passage of the bill into law. As you might imaginge, like today with the ACA, political forces near and far come out to fight for and against the new Medicare bill. Political Power – Medicare Becomes the Law of the Land However, in 1964, President Johnson signed Medicare into law. In order to better understand how national health policy impacts the collective society, you need to take a larger look at the historical perspective of policies. The historical perspective of how Medicare has changed over the last fifty years provides an excellent illustration of the evolution of health care policy. Medicare was enacted into law by President Johnson in 1965. However, the original bill was introduced to Congress in 1945 by President Truman. The bill provided health insurance coverage for the elderly to decrease the numbers of elderly living in poverty and to meet disparate health care needs. The average life expectancy in the 1940’s was 61 years old for white Americans and 48 years old for African Americans. Yet, despite the need and overwhelming statistics on mortality in those days, the bill was so controversial, Congress voted the bill down. If you compare the Affordable Care Act to Medicare, you can see many similarities. The Affordable Care Act was originally introduced during the Clinton administration as a national health coverage plan. Much like Medicare, Congress failed to approve the legislation until many years later. The question often asked is why do health care reforms fail? What are the reasons and who is responsible to ensure that the nation’s health is top priority? These are excellent questions that can be addressed through reason and understanding of the national health care system. First and foremost, the United States offers the best health care in the world. However, first class health care can cost a great deal of money and in fact, national spending on Medicare takes a great deal of the national health care budget. The reason significant health policy initiatives fail is often due to conflicting interests and a lack of consensus among key stakeholders; which includes political maneuvering that is precipitated by special interest groups, lobbying efforts, and mood/climate of the country at the time the health care policy is being considered. In many cases, national health reform fails due to the cost! If we revisit Medicare, each of the issues and concerns just discussed are applicable. Medicare was seen as a national entitlement program. Special interest groups represented major stakeholders in the process and put enormous pressure on members of congress not to pass the Medicare bill. However, as time went on, the issues of significant health disparities and poverty impacting elderly citizens could no longer be ignored because the nation was providing care for free. Indigent care payments to hospitals continued to grow over this period as well as increases in elderly mortality. By the 1960’s, the need for a national insurance for those over the age of 65 was a top priority on the national agenda. The political climate and culture within society demanded a better solution for the care of the elderly. This is the reason Medicare finally passed. Growth of Medicare After Medicare legislation passed in 1965, the program remained generally unchanged until 1972 when Medicare was expanded to include those with disabilities as well as the coverage for end stage renal disease. A national study conducted in 1975 demonstrated the results of Medicare by documenting that well over half of elderly citizens were no longer living in poverty as they were in the 1940’s. While the data suggested many different reasons for this, the one compelling fact was that elderly Americans were receiving health care that was increasing life expectancy. Disease prevention became the important part of Medicare benefits during this period of time. In 1982 Medicare was once again expanded to include hospice benefits to those with terminal illness and disease. In 1988, President Reagan signed into law the Medicare Catastrophic Care Act which defined out-of-pocket costs and provided poor drug benefits. National advocacy groups for senior citizens as well as lobbyists fought to have the law repealed, citing that the costs for American seniors was far too excessive. In 1989, the law was repealed by congress. In 2003, the Medicare Modernization Act better defined Medicare coverage and expanded coverage to include a prescription drug benefit. It also decreased the “donut” hole by decreasing deductable requirements for out of pocket expenses. In response to requests from the American Association of Retired People (AARP), Medicare introduced part D drug benefits that allowed seniors to select a private plan for drug coverage with shared costs. In order to understand the importance of national health policy, one only needs to look back in history to see the turbulent and often challenging road laws like Medicare and the Affordable Care Act have faced to become reality. If history has taught us anything, we must learn that national health care policy is driven by the culture and climate of the time, and society’s willingness to move forward with significant health policy legislation. Introduction to Health Policy This lesson provides an introduction to health policy; policy and political theory; different forms of policy; and a historical perspective on how policy has impacted individuals, families, communities, and society as a whole. The objective of this lesson is to help provide a road map for you to become politically aware and engaged in the process of health care policy development.