Introduction
The United States’ health care system is comprised of many agencies, authorities, and facilities that help to ensure adequate access to care for the entire country’s population, as well as high quality of treatment. Due to the high complexity of the system, there are multiple forces that govern the work of medical institutions and their personnel.
Each agency has a different focus and scope of power, although some are working in collaboration to raise efficiency and the degree of oversight. For nursing students and practitioners, knowing the regulations and guidelines enforced by regulatory agencies is crucial both to provide for better health outcomes and to ensure compliance with legislation to avoid fines and lawsuits. This paper provides a synopsis of the role of five federal agencies that impact the provision of medical care, as well as to outline their importance for nurses and nursing students.
The Centers for Medicare and Medicaid
The Centers for Medicare and Medicaid (CMS) was initially established in 1977 as the Health Care Financing Administration (CMSHHSgov, 2015). The agency governs national health initiatives, including Medicaid, Medicare, Children’s Health Insurance Program, and Health Insurance Marketplace (CMSHHSgov, 2015). The CMS manages the flow of public funds to these programs in order to make quality healthcare affordable for all American citizens (CMSHHSgov, 2015). The agency has ten regional offices and collaborates with all parties involved in providing access to health care, including state and federal governments, care providers, CMS contractors, and community groups, providing oversight and improving collaboration (CMSHHSgov, 2015).
According to the CMS, one in three Americans is involved in one of the funded programs (CMSHHSgov, 2015), meaning that the vast majority of public health care provided needs to work with the agency and comply with its regulations. It is important for DNP graduates and nursing students to be aware of the agency’s functions and authority, as the CMS manages the provision of services under the Medicaid, Medicare, and other affordable care programs.
For example, the CMS’s Conditions for Coverage (CfCs) & Conditions of Participation (CoPs) are important as they provide information on the patients’ eligibility for affordable care, as well as the standards that healthcare organizations must meet to participate in Medicare and Medicaid programs. Another important aspect of the CMS’s work is the Electronic Health Records (EHR) Incentive Program that aims to improve electronic information management. It is essential for all care providers to understand the requirements of the EHR Incentive Program to ensure that the operations at the facility to comply with the regulations.
The Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality (AHRQ, 2016) is a federal agency that works to improve the safety and quality of healthcare throughout the country. The agency “develops the knowledge, tools, and data needed to improve the health care system and help Americans, health care professionals, and policymakers make informed health decisions” (AHRQ, 2016, p. 1).
The work of AHRQ is crucial for DNP graduates, nursing students, and health care providers, as the agency provides recommendations and models for improving care, such as AHRQ’s Re-Engineered Discharge Protocol, Project ECHO (Extension for Community Healthcare Outcomes), and other initiatives. Moreover, AHRQ creates and spreads materials for clinical education and training, such as the Comprehensive Unit-based Safety Program. The application of these training programs in care facilities is crucial as it helps to improve operations’ effectiveness as well as ensure patient safety.
The Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is a federal authority that works in conjunction with other agencies to implement policies for control of diseases, occupational safety, and health, as well as clinical laboratory standards. One of the most important areas of CDC’s work that apply to nurse practice and education is the research and improvement of practices for effective care. For example, CDC “supports state and local preparedness systems to increase molecular diagnostic testing capacity” (CDC, 2016, para. 2).
In the case of disease outbreaks, CDC (2016) works with hospitals and other care providers to ensure case reporting and population surveillance through its National Syndromic Surveillance Program (NSSP). Another important activity of the CDC is the provision of funding to address local and national population health issues. Overall, every DNP student and graduate needs to be aware of CDC’s activities and regulations, as this helps to ensure that the care provided answers to the federal requirements. Furthermore, CDC’s research offers opportunities to apply innovations to patient treatment and care, which contributes to improving the quality of services provided.
The Food and Drug Administration
The Food and Drug Administration (FDA) is a federal authority that ensures the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices (FDA, 2017). Among the functions that are especially relevant to healthcare providers, FDA regulates the certification, distribution, and use of drugs, including prescription and over-the-counter drugs. The agency is also responsible for regulating the production and use of biological materials, such as vaccines, blood, and cellular therapy products.
Moreover, FDA governs the production, certification, and utilization of medical devices, such as x-ray equipment, surgical implants, and prosthetics (FDA, 2017). In general, the agency manages how healthcare facilities all over the country use various medical, technological, and biological products in patient care and treatment, which is why the function of FDA is essential for every medical facility and its personnel. For DNP students and graduates, the awareness of FDA policies and regulations is necessary to ensure the appropriate quality of care and the use of certified equipment, drugs, and materials.
Nurses, as well as other medical practitioners, are required to use only certified and approved products and technologies to treat and care for the patients, whereas the violation of FDA guidelines and regulations may lead to fines, lawsuits, and other issues for the institution and its staff. Working in compliance with FDA provisions, on the other hand, helps to ensure better and more reliable health outcomes for every patient, as the products and equipment approved by the agency are safe and proven to be effective.
The Joint Commission on Accreditation of Health Care Organizations
The Joint Commission on Accreditation of Health Care Organizations (JCAHO) is an independent non-profit organization that regulates the process of accreditation and certification of medical institutions on the national level (The Joint Commission, 2017). While the accreditation and certification are not mandatory, approval of the JCAHO provides institutions with a competitive advantage to gain federal funding and participate in programs such as Medicare and Medicaid (The Joint Commission, 2017). Adhering to the standards set by the JCAHO helps medical institutions and care providers to raise the quality of patient care and improve operations, which is why the knowledge of JCAHO standards and processes is essential for medical personnel, including nurses.
References
CMSHHSgov. (2015, October 1). Getting to know CMS – Short version. [Video file].
The Agency for Healthcare Research and Quality (AHRQ). (2016). The Agency for Healthcare Research and Quality: A profile.
The Centers for Disease Control and Prevention (CDC). (2016). CDC strategic framework. Web.
The Food and Drug Administration (FDA). (2017). About FDA.
The Joint Commission on Accreditation of Health Care Organizations (JCAHO). (2017). About The Joint Commission.