An aspect of the troika known as health care access, cost, and quality that does not often receive the attention it warrants is scope of practice laws in the states. Substantial amounts of time and money are spent throughout the U.S. by members of certain professions to enhance their scope of practice. Their efforts are opposed by members of other professions who devote similar amounts of energy to preventing these groups from succeeding. The main rationale for this staunch resistance is to protect the safety of patients. Nonetheless, once additional states loosen restrictions and allow other professions to expand their scope of practice, eventually hundred of thousands of patients will have been treated by the newcomers. If the outcome is that none or a neglible amount of them were endangered in any way, then an argument that the public is at a serious risk of injury as a result of changing practice laws begins to lose some of its power to persuade legislators.
For example, Colorado Governor Jared Polis on June 7, 2022 signed into law HB 22-1233, making that state the 10th one to allow optometrists to perform laser procedures. The legislation, which goes into effect on August 10 of this year, also will allow the practice of optometry to include several interventions that include eyelid injections and use of local anesthetic. Despite opposition from the American Academy of Pediatrics, Colorado Medical Society, Colorado Society of Eye Physicians & Surgeons, and the American Society of Plastic Surgeons, the optometrists were successful in convincing legislators that experience in nine other states has shown that patient safety concerns should not be a factor in preventing optometrists from enhancing their scope of practice. Moreover, since care by ophthalmologists is not readily available throughout the state, access by patients to vision care will be improved. Similarly, other professions that engage in efforts to enhance their scope of practice on the basis of being able to provide safe care and address the problem of underserved areas include: nurse practitioners v. physicians; dental hygienists/therapists v. dentists; psychologists v. psychiatrists; and nurse anesthetists v. anesthesiologists.
Medicare Prospective Payment Systems And Proposed Policy Changes
Medicare is a highly important federal health program that is instrumental in meeting the needs of millions of beneficiaries. As it continues to increase in size over the decades, it also undergoes constant change. A recent example of how modifications tend to occur can be found in the May 10, 2022 issue of the Federal Register, the official journal of the federal government of the U.S. This particular edition contains a proposed rule that would affect several different functions, including the Hospital Inpatient Quality Reporting (IQR) Program and Hospital-Acquired Condition (HAC) Reduction Program. Detailed in small print at three columns per page, the proposed rule covers 639 pages and is drenched in a torrent of acronyms, e.g., Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Interested parties were invited to comment on the proposed rule and the deadline for doing so was no later than 5 p.m. EDT on June 17, 2022. Hundreds of respondents have expressed their views.
Examples of some concerns are that if the rule is implemented, the Centers for Medicare & Medicaid Services (CMS) will be able to suppress hospital data and measures of preventable hospital-cause harm, such as falls resulting in serious injuries. A related issue is that the 10-measure Patient Safety and Adverse Events Composite (PSI 90) would be hidden from public data files and would not appear on the CMS Hospital Compare website. Also, worst-performing hospitals no longer would be subject to a reduction in Medicare reimbursement. An overall concern is that the ability to identify providers with patient safety problems will be compromised seriously.
Public’s Confidence In Federal Government Employees
As exemplified by a recent proposed Medicare rule on May 10, 2022 that required 639 pages of triple-columned pages to describe, at some juncture program staff will have to synthesize all the public comments that arrive and decide the extent to which these views will affect the contents of that rule. Clearly, federal agencies have a significant impact on the lives of U.S. inhabitants. Meanwhile, according to a report on June 6 of this year from the Pew Research Center, the share of Americans who have a great deal or fair amount of confidence in career employees at federal agencies has declined among Democrats and Republicans since 2018. A decline in appreciation for the work these employees do probably will not act as a major disincentive to finding some joy in carrying out their daily tasks.