Maria Hernandez

Main Post:

H.R. 977- Patient Access to Higher Quality Health Care Act of 2023.

Description: When a patient has health insurance, depending on which premium, they are made to use providers or hospitals that are “in-network” to avoid higher costs of services. This can often be an issue for patients because some providers are not in network with their health insurance, specifically Medicare recipients. The Patient Access to Higher Quality Health Care Act would “repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals” (Congress.gov, 2023).

Background: According to the American Hospital Association, “For decades, the Ethics in Patient Referrals Act (“Stark Law”) has protected the Medicare program from the inherent conflict of interest created when physicians self-refer their patients to facilities and services in which they have a financial stake” (AHA, n.d.). At one point, physicians were allowed to make referrals to hospitals with ownership within the entire facility; this gap was closed in 2010 when the Affordable Care Act was passed.  

Social Determinant: One social determinant is access to health care and quality care. Patients, regardless of their socioeconomic status, should receive high-quality care. The American Hospital Association states, “The Government Accountability Office (GAO), the Centers for Medicare & Medicaid Services and MedPAC all found that physician-owned hospitals’ patients tend to be healthier than patients with the same diagnoses at general hospitals” (AHA, n.d.). This would lead those with serious illnesses to rely on general hospitals for healthcare services.

Evidence: The growth of Physician-owned hospitals was prohibited in 2010 after the passing of the Affordable Care Act. According to Ehrenfeld, “a systematic review of 30 years of research demonstrating that physician-owned specialty hospitals or so-called “focused factories” offer higher-quality care at comparable or lower cost, while physician-owned community hospitals are no worse than their counterparts” (Ehrenfeld, 2023). If H.R. 977 is passed into law, it would allow physicians of physician-owned hospitals to extend their services to the community by opening new hospitals that would provide high-quality, efficient care and be affordable to patients. This would place competition against general hospitals at risk of losing market share, leading them to reform their services to stay in competition. This would benefit patients in being able to seek assistance in a variety of hospital or hospital-owned facilities. 

References:

American Hospital Association. (n.d.). Fact sheet: Physician self-referral to physician-owned hospitals. https://www.aha.org/fact-sheets/2023-02-27-fact-sheet-physician-self-referral-physician-owned-hospitals

Congress.gov. (n.d.). H.R.977 – 118th Congress (2023-2024): Patient Access to Higher Quality Health Care Act of 2023. https://www.congress.gov/bill/118th-congress/house-bill/977?q=%7B%22search%22%3A%5B%22HR+977%22%5D%7D&s=1&r=1

Ehrenfeld, J. M. (2023, August 10). End restrictions on physician-owned hospitals to expand Quality Care. American Medical Association. https://www.ama-assn.org/about/leadership/end-restrictions-physician-owned-hospitals-expand-quality-care

• Reflect on connective leadership styles. Which style most closely aligns with your personal leadership characteristics?
• How might you use power to influence change in your NP role?

 Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:

Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment. She has never been in therapy before, and has no history of depression or anxiety. However, her alcohol use has recently been getting in the way of her marriage, and interfering with her newly-retired life. She describes drinking increasing amounts over the last year, currently consuming approximately a six-pack of beer per day. She notes that this amount “doesn’t give me the same buzz as it used to.” She denies ever experiencing “the shakes” or any other withdrawal symptoms if she skips a day of drinking.

Jax comments that her wife is her biggest motivation to decrease her alcohol use. She tells Jax that she gets argumentative and irritable when she drinks, though she does not always remember these incidents. She has also fallen while intoxicated twice, causing bruises both times and hitting her head on one of the occasions.

Questions:

Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers. 

1. Describe the presenting problems/issues. Is there any information that was not provided that you would need to formulate a diagnosis?
2. Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
3. What physiological and psychological processes lead to substance dependence?

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.
• Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
• Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
• You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Discussion 1

Every day, people make choices that affect their physical health and wellness. Some choices are influenced by the environment and social factors, which in turn contribute to people’s health outcomes. Healthcare professionals (i.e., physicians, nurses, dietitians, sports medicine, etc.) are responsible for their own health by making decisions and practicing behaviors that enhance their wellbeing. Healthcare professionals also have a responsibility to their clients. While responsibilities may vary among healthcare professionals, it is important the healthcare team is alert to clients’ nutrition problems and needs.

After studying 

Module 1: Lecture Materials & Resources
, answer the following:

1. In one paragraph, give at least 2 examples of how culture, society, politics, or religion influences your nutrition. Discuss the role that food plays in your family or personal life.

2. Navigate to 
Your Digestive System and How it Works: 

https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-worksLinks to an external site.
 View the webpage and share in 1 paragraph at least 1 example of something your learned about the digestive system.

3. Search the internet for 1 example of an over-the-counter medication designed to treat common digestive problems such as heartburn, constipation, diarrhea, and hemorrhoids. Write 1 paragraph describing a) appropriate and inappropriate uses for this medication, and b) adverse health implications associated with misuse and/or overuse of this product.

Discussion 2

Carbohydrates have received a bad reputation, especially when it comes to their role in weight gain. All carbohydrates are not bad and the primary role of carbohydrates in the body is to supply the cells with glucose for energy. One type of carbohydrate is sugar. Some people are unaware that instead of avoiding all sugars, they can choose to include natural sugars found in vegetables, whole grains, legumes, and fruit. On the other hand, most people know that too much fat poses health risks, but may be surprised to learn that too little does, too.

After studying 

Module 2: Lecture Materials & Resources
, answer the following:

1. Navigate to My Plate: 

https://www.myplate.gov/Links to an external site.
 and to the Diabetes Plate: 

What is the Diabetes Plate Method?Links to an external site.
 (diabetesfoodhub.org) then, submit at least 1 paragraph comparing both for

A. similarities

B. differences

C. share who should follow MyPlate and who should follow the Diabetes Plate method?

2. Navigate to the American Heart Association: 

http://www.heart.org/HEARTORG/Links to an external site.
 and to the National Cancer Institute: 

http://www.cancer.govLinks to an external site.
, submit a 1 paragraph analysis on the relationships between dietary fats and the risk of heart disease, cancer, or type 2 diabetes (choose one).

3. Choose a food label from your favorite snack, and take a picture of the Nutrition Facts on the food label. Navigate to the U.S. Food & Drug Administration, “Interactive Nutrition Facts Label: 

https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/#introLinks to an external site.
 Choose one ingredient from your label. Share with the class one (1) health fact and (1) action step you learned about that ingredient in the interactive site.

4. Explain the differences between high-quality and low-quality proteins, and well-balanced vegetarian diets.

Discussion 3

The body manages its energy supply with amazing precision. Consider that many people maintain their weight within about a 10- to 20-pound range throughout their lives. How do they do this? How does the body manage excess energy? How do bones, muscle, fat, fluid, and other tissue influence our body composition? However, overweight, and underweight both result in energy imbalance. Almost 42% of adults aged 20 and above are overweight placing them at risk of developing chronic diseases that affect quality of life.

After studying 

Module 3: Lecture Materials & Resources
, answer the following:

1. Conduct a nutrition/survey interview with 2 athletes and ask them a) what protein or amino acid supplements they use in their diet? and b) why do they use those supplements? Then, navigate to: 

www.quackwatch.orgLinks to an external site.
 and enter the name of the supplement. Provide 1 paragraph with your analysis of the products and what you found out about the products’ nutritional characteristics (see Chapter 5, page 132 of your textbook).

2. Search the internet for a popular weight-loss program (i.e., Jenny Craig, Weight Watchers, etc.), and submit 1 paragraph with the following:

A. describe the diet plan

B. evaluate whether the plan offers a nutritionally reliable way to lose weight or is it a Fad Diet (see Chapter 7, Table NP7-1, page 193 of your textbook)

3. In 1 paragraph, describe type 1 diabetes, type 2 diabetes, and gestational diabetes by providing:

A. characteristics

B. definition

C. causes & symptoms (see Chapter 20, Table 20.2, page 564 of your textbook).