1/14/2014 10:40:00 AM Letter to the editor: Healthcare legislation too vague, creates more bureaucracy
To the editor:
I would like to introduce myself to the honorable council members and delegates of the Navajo Nation. I am a registered nurse currently employed at Tuba City Regional Healthcare. I come to Tuba with 32 years' experience. My training was at Indiana University School of Nursing and my practice background is the delivery of critical care and emergency nursing as well as 20 years as a manager of both ED and ICU/CCU. I am currently Lead Application Specialist and Acting Clinical Education manager here at Tuba City Regional Health Care Corporation.
I am writing to express my concern for legislation posted for public review on Wednesday, November 13, 2014.
Overall I find this proposed resolution to be too vague while creating duplication of services and disciplines. Terms are general, broad, and lacking any specific plan. Many terms such as "fragmentation of healthcare systems" and "stated results of loss of coverage and reimbursement" are too general to readily verify for accuracy and fact.
As a nurse working in both inpatient and outpatient settings, I find that medical providers, mid-level providers, and therapists who do bill for service are quite familiar with both surrounding state and federal guidelines based on the current Medicare and Medicaid regulations. Creating another layer of complexity to me does not seem to be a fiscal or rational use of resource or healthcare dollars in a time when those dollars are shrinking.
In the proposed resolution is the implication that current providers do not provide culturally relevant or quality healthcare. I personally and professionally find this quite inflammatory and unfounded. Following this logic then to establish another level of bureaucracy responsible for the broad oversight capacity proposed would seem to worsen this allegation. I do not believe the welfare of the Navajo people is at the core of this resolution.
While I am not Navajo, I am of native descent and have a deep and abiding respect for this nation's first people. I am well educated and somewhat politically savvy which increases my sense of obligation to our customers. Proposing more layered and potentially conflicting oversight to any level of provider does not equate to improving quality or enhancing culturally relevant care.
To reference line 23 on page 2 of 7, I find this so broad that I wonder what is the proposed timeframe to establish a functional oversight group that is educated and with the level of expertise it takes to collect, integrate, analyze, interpret, and disseminate data on health care, behavioral risk factor surveillance (takes at least a doctoral level), morbidity and mortality indicators, and health and human research. This group would also be appointed to "serve at the pleasure of the President of the Navajo Nation." This seems to subject the entire effort to critical potential for accusations of impropriety.
To reference lines 1-17 of page 5 of 7, I would like to ask the very pointed question of how any item let alone all items mentioned at issue would be established within the constraints of current federal meaningful use mandates as well as ICD-10 billing regulations that will affect all healthcare payers and providers whether private or government?
When reviewing the resolution I also find no provision for how the entity would provide knowledgeable oversight of licensure for healthcare providers. Minimally, all professionally licensed providers have licensing boards in all 50 states and in many states those licensing boards have established reciprocity for practice. These boards monitor minimal practice standards and provide direct due process for complaints or legal actions involving licensed personnel. There is established monitoring and reporting that also follows established state laws. How does another entity propose to operationalize efforts that at best duplicate these established licensing agencies? Due process implies that all peoples have a legal way for appeals, burden of proof for allegations or denials, or safeguards from prejudice to be adjudicated. To have an oversight committee or counsel with the all-encompassing power implied in this resolution would be subject to questionable motives when rendering any decisions.
Fundamentally allowing any agency or entity to self proclaim such broad power as is suggested at all phases of this resolution, is to bring the very idea of sovereignty under question.
There is no clear infrastructure to perform any of the proposed actions of a newly created Office of Medicaid or Department of Health specific to the Navajo Nation nor have they made a clear argument based on known fact or research statistic that would support such endeavors.
I would implore those who currently represent the lives they have sworn an oath to protect and serve by serving in any branch of Navajo government to carefully review this proposal with clear vision to purpose and potential. Many laws have some measure of good intention yet all voters must rely on the gravity imposed on elected and appointed officials to maintain their constituents' best interest in governing their decisions and actions. I could not make that argument to our patients if I were asked if this resolution were in any way in their best interests.