Healthcare Policy Impact on APNs – Reimbursement and Leadership

Healthcare Policy Impact on APNs – Reimbursement and Leadership

Responding to Thandi

Hello,

Great work with your post. It provides a well-rounded discussion on the impact of healthcare policies on advanced practice nurses (APNs), particularly in terms of reimbursement rates and the importance of transformational leadership in the profession. Also, the provided example about Maryland’s reimbursement rates highlights a critical issue that has far-reaching implications for the sustainability of APN practices, especially in underserved areas.

To add on, it is worth noting that the disparities in reimbursement rates not only affect the financial viability of APN practices but also have broader implications for healthcare accessibility. For instance, when APNs are unable to generate adequate revenues because of low reimbursement rates from insurance providers, they limit the number of patients they can attend to or shut down their business—this not only contributes to healthcare deficits in regions with a scarcity of professionals but also in rural and hard-to-staff areas (Bales et al., 2023). They also argue that raising the reimbursement rate for APNs could enhance access to care in these deprived regions and ultimately eliminate disparities in healthcare.

Additionally, the emphasis on the role of transformational leadership in APN practice is particularly timely. Transformational leaders not only encourage and energize people to overcome challenges but also proactively participate in policy change that has extended positive impacts on the healthcare system. For instance, APNs who display transformational leadership can promote policy changes that advance practice authority and patient health. Notably, the use of the transformational leadership model in nursing is linked to improved patient outcomes, increased satisfaction levels of the nursing staff, and a higher degree of integration of the workforce (Khan et al., 2020).

In addition, it would be valuable to explore how APNs can leverage their leadership skills to advocate for policy changes that address social determinants of health. By focusing on these broader issues, Poghosyan et al. (2022) note that APNs can help create a more equitable healthcare system that better serves all populations, especially those who are most vulnerable.

References

Bales, G., Hasemann, W., Kressig, R. W., & Mayer, H. (2023). Impact, scope of practice and competencies of advanced practice nurses within APN-led models of care for young and middle-aged adult patients with multimorbidity and/or complex chronic conditions in hospital settings: A scoping review protocol. BMJ Open, 13(10), e077335. https://doi.org/10.1136/bmjopen-2023-077335

Khan, H., Rehmat, M., Butt, T. H., Farooqi, S., & Asim, J. (2020). Impact of transformational leadership on work performance, burnout and social loafing: A mediation model. Future Business Journal, 6(1), 1–13. Springeropen. https://doi.org/10.1186/s43093-020-00043-8

Poghosyan, L., Stein, J. H., Liu, J., Spetz, J., Osakwe, Z. T., & Martsolf, G. (2022). State‐level scope of practice regulations for nurse practitioners impact work environments: Six state investigation. Research in Nursing & Health, 45(5). https://doi.org/10.1002/nur.22253

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Healthcare policies significantly impact the advanced practice nurse (APN) profession in many ways. One important aspect is the impact of policy decisions on the reimbursement rates for services provided by APNs, which can affect the sustainability of their practice. For example, in Maryland, NPs are typically reimbursed at lower rates than physicians by Medicaid. Their compensation is often based on the Medicare model, where NPs might receive around 85% of the physician fee schedule for similar services (Centers for Medicare and Medicaid., 2021). The state of Maryland determines Medicaid reimbursement rates for NPs. In addition, NP-provided services cost 18% less than their physician counterparts (Razavi et al., 2020). Inadequate reimbursement can lead to financial challenges for practices that rely on APN services.

Healthcare Policy Impact on APNs – Reimbursement and Leadership

Advanced Practice Nurses (APNs) are involved in advocacy efforts to influence healthcare policies to address social determinants of health and reduce disparities. The Healthy People 2020 Leading Health Indicators assessment revealed that threats to all Americans’ health differ based on their identity, living conditions, and the community they belong to (Hoyer & Dee, 2022). APNs develop and lead programs that cater to specific health needs within the community, such as screenings and preventive care initiatives. They also collaborate with policymakers to create and promote legislation that improves healthcare access, affordability, and quality for underserved populations. Advocacy is a crucial aspect of the Advanced Practice Nurse (APN) role, ensuring that care remains patient-centered and that patients’ preferences and values are considered in treatment decisions. Influencing policy enables nurse practitioners (NPs) to play an active role in shaping healthcare policies affecting their practice and patients, focusing on improving care access, enhancing quality, and addressing systemic barriers (Phillips, 2022).

Transformational leadership is based on four characteristics: professionalism, Inspirational motivation, interpersonal relationships, and business skills. The leadership builds a mission-oriented culture within an organization through a social influence process among organizational members (Rojak et al., 2024).

Professionalism is essential for transformational leadership. APNs act as role models and earn trust through ethical behavior and strong values. They demonstrate professionalism by maintaining a high ethical standard, acting with integrity, and respecting patients and colleagues. Fostering a culture of trust enhances teamwork and patient satisfaction.
Inspirational motivation is one of the core pillars of transformational leadership. It involves motivating and inspiring others. APNs inspire team members to pursue further education and certifications, fostering a culture of lifelong learning and professional growth.
Business competency is vital to transformational leadership, particularly for Nurse Practitioners (NPs) who are involved in leadership roles, practice management, or healthcare policy. It encompasses skills and knowledge related to managing and improving the business aspects of healthcare practice, including financial management, strategic planning, and operational efficiency. Here are examples of how NPs use business competency by leading a quality improvement project to enhance patient care processes, such as reducing wait times or improving patient satisfaction scores.
Interpersonal relationships involve building strong, trusting connections with team members, colleagues, and patients. Nurse Practitioners offer guidance and support to new nurses with less experience, helping them navigate complex clinical situations and advance their careers.
Transformational leadership is one of the most effective leadership styles and approaches. It empowers the team to work together towards a common purpose. Transformational leadership is important in influencing policy change.

Reference

Hoyer, D., & Dee, E. (2022). Using healthy people as a tool to identify health disparities and advance health equity. Journal of Public Health Management and Practice, 28(5), 562–569. https://doi.org/10.1097/phh.0000000000001601Links to an external site.

Phillips, J. (2022). Policy Advocacy and Health Equity. The Nurse Practitioner, 47(9), 38–43. https://doi.org/10.1097/01.npr.0000855316.18930.08Links to an external site.

Razavi, M., O’Reilly-Jacob, M., Perloff, J., & Buerhaus, P. (2020). Drivers of cost differences between nurse practitioner and physician attributed Medicare beneficiaries. Medical Care, 59(2), 177–184. https://doi.org/10.1097/mlr.0000000000001477Links to an external site.

Rojak, J. A., Sanaji, S., Witjaksono, A. D., & Kistyanto, A. (2024). The influence of transformational leadership and organizational culture on employee performance. EDUKASIA: Jurnal Pendidikan Dan Pembelajaran, 5(1), 977–990. https://doi.org/10.62775/edukasia.v5i1.926Links to an external site.

Strategic priorities for the Centers for Medicare and Medicaid Services to advance Medicaid Reform. (2021). Forefront Group. https://doi.org/10.1377/forefront.20210129.937900Links to an external site.