| Course | NUR-5290 U.S. Health Policy and Global Health |
|---|---|
| Module | Module 5 |
| Paper type | Policy advocacy paper |
| Length | About 1,001 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Master of Science in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 5290 Module 5
Same Visit, Same Price: An Advocacy Paper for Site-Neutral Payment of Routine Clinic Visits, Tested Against the Safety-Net Objection
Student Name
Master of Science in Nursing (MSN), Thomas Edison State University
NUR-5290: U.S. Health Policy and Global Health
Mentor Name
Month Day, Year
Same Visit, Same Price: An Advocacy Paper for Site-Neutral Payment of Routine Clinic Visits, Tested Against the Safety-Net Objection
Earlier modules traced how a routine follow-up visit at a hospital-owned clinic produces two bills, which patients pay most, which rules allow it and how other countries pay for the same visit. This paper takes a position. It argues that Medicare should pay the same amount for a routine outpatient evaluation and management visit whether it takes place in an independent office or a hospital outpatient department, and that nurses should advocate for that change. It states the position, gives the evidence for it, presents the strongest objection fairly, answers it, and ends with a specific request. The intended audience is the health policy committee of a state nurses association deciding whether to endorse federal site-neutral legislation.
The Position and Why Nurses Should Take One
The position is narrow on purpose: equal Medicare payment for routine clinic visits, the services least likely to depend on hospital resources, with exceptions for emergency departments and hospital-based services that require them. Nurses have a professional reason to engage. The current code of ethics asks nurses to collaborate with others to protect human rights, reduce health disparities and advance health in the community through policy, and to speak for the people they care for (American Nurses Association, 2025). The patients who call our clinic about facility fees are the ones least able to absorb them, and nurses see that cost at the front desk long before it appears in a policy report.
The Evidence for Paying the Same Price
Three pieces of evidence support the position. First, the payment difference is large. Post et al. (2021) estimated from Medicare claims that payments for physicians' services would have been about $114,000 higher per physician per year if the physician were integrated with a hospital, with primary care payments about 78 percent higher. Second, the difference shapes behavior: the same study found that larger payment gaps were associated with physicians moving into hospital employment, which is how our own practice became a hospital department. Third, the current partial remedy has not worked. Post et al. (2025) found that the 2015 site-neutral provision applied to only about 1.5 percent of outpatient department spending and had no significant effect on integration, because its exceptions left most hospital clinics untouched.
Beyond the numbers, the position rests on a simple principle that other wealthy countries already apply: the same service delivered by the same clinician should not cost the patient more because a hospital owns the building. The patient's blood pressure check does not use an operating room, a laboratory on standby or an emergency department.
A fourth consideration is fairness between patients. Two people with the same blood pressure, the same clinician and the same visit currently pay different amounts depending on whether the clinic's sign carries the hospital's name. Patients cannot see that difference when they choose a clinic, and many have no choice at all once a hospital owns most practices in a town. A payment rule that charges them differently for identical care is hard to defend on any principle a nurse would recognize.
What Hospitals Will Say
The strongest objection comes from hospitals, particularly safety-net and rural hospitals, and it deserves a fair statement. Hospitals argue that facility fees do reflect real costs: hospital outpatient departments must meet hospital conditions of participation and accreditation standards, maintain emergency readiness, treat sicker and poorer patients and provide care regardless of ability to pay. Outpatient revenue cross-subsidizes services that lose money, such as obstetric units, behavioral health beds and trauma care. Cutting outpatient payments, the argument runs, will push fragile hospitals toward closing services or closing altogether, and the communities most harmed will be the ones nurses are trying to protect.
This objection is serious. A policy that saved Medicare money while closing rural labor and delivery units would be a poor trade, and nurses would be among the first to see the harm.
Answering the Objection
Three answers keep the position intact. First, the evidence on distribution does not show that site-neutral payment would fall disproportionately on vulnerable hospitals. Lou et al. (2025) compared three site-neutral designs and reported that the cuts would be spread across hospital categories roughly in proportion to their outpatient volume, with no type of hospital singled out, and with similar effects for beneficiaries who also qualify for Medicaid as for everyone else. Second, the narrow scope proposed here, routine visits only, sits at the low end of that range, leaving hospital-dependent services untouched. Third, if specific rural or safety-net hospitals need support for standby capacity, the honest way to provide it is direct, transparent funding for those functions, not higher prices for blood pressure checks paid partly by older patients through uncapped coinsurance.
The answer also includes a concession. The association should support site-neutral payment paired with protections: a transition period, an exemption or offsetting payment for critical access and sole community hospitals, and a requirement that savings to beneficiaries be visible through lower coinsurance. A position that acknowledges real costs and proposes a way to cover them is more persuasive than one that dismisses them.
The Request
I ask the committee to recommend that the association endorse federal legislation establishing site-neutral Medicare payment for routine outpatient evaluation and management visits, conditioned on a phased transition, protection for critical access and sole community hospitals, and reporting of beneficiary savings. I also ask the committee to recommend that member nurses in hospital-owned clinics be given simple information about facility fees and financial assistance so they can answer patients accurately while the policy debate continues. The request is modest, specific and grounded in evidence, and it starts from what nurses see every day: patients paying twice for one visit.
The request is also timed. Federal site-neutral proposals have appeared in several recent legislative packages, so an association that adopts a position now can comment when a bill is next considered rather than scrambling after the fact.
References
American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/
Lou, K. K., Linehan, K. E., da Fonte, L. N., Lai, P., & Buntin, M. B. (2025). Medicare site-neutral payment policies: Effects of proposals on hospitals and beneficiary groups. Health Affairs, 44(6), 668-676. https://doi.org/10.1377/hlthaff.2024.01501
Post, B., Norton, E. C., Hollenbeck, B., Buchmueller, T., & Ryan, A. M. (2021). Hospital-physician integration and Medicare's site-based outpatient payments. Health Services Research, 56(1), 7-15. https://doi.org/10.1111/1475-6773.13613
Post, B., Thai, N., Noor-E-Alam, M., & Young, G. J. (2025). Site-neutral payment reform: Little impact on outpatient Medicare spending or hospital-physician integration. Health Affairs, 44(6), 659-667. https://doi.org/10.1377/hlthaff.2024.00972
Reading the NUR 5290 Module 5 assignment instructions
Module 5 of NUR-5290 usually centers on advocacy. The prompt typically wants a stated position on a health policy question, write to a specific audience such as a legislator, agency or professional association, support the position with evidence, address opposing views and make a clear request. Some sections ask for a letter or brief format instead of a paper. The TESU classroom gives the format, length and audience; check whether the request must be a specific bill or regulation, whether a word limit applies to the advocacy piece itself, and whether you must document how you would deliver it. Write for the audience you name, not for the mentor.
How the NUR 5290 Module 5 example is put together
The paper opens by linking to earlier modules, stating the position and naming its audience. A section explains why nurses should take a position, using the ethics code. The evidence section presents three findings, the size of the payment gap, its effect on acquisitions and the weakness of the existing rule, and adds the equal-payment principle. The objection is stated in its strongest form, including cross-subsidy of losing services, and the paper admits it is serious. The answer uses a modeling study on distribution, narrows the proposal, and adds protections as a concession. A closing request asks for a specific endorsement and a practical step for nurses. The request names exactly what the association should endorse and what conditions it should attach.
NUR 5290 Module 5 rubric: what earns full marks
Advocacy papers are commonly graded on a clear position and audience, quality of evidence, fair presentation of the strongest opposing argument, persuasiveness of the response, a specific request, and professional writing. Mentors give heavy weight to the treatment of the opposing view: a weak or straw-man objection costs points even when the position is well supported. The request should be specific enough that the audience knows exactly what to do. Evidence should be current and drawn from credible sources, and claims about effects should match what studies found. Professional tone matters, since advocacy that disparages opponents is less persuasive and reflects poorly on the profession. A professional tone toward opponents also counts in many rubrics.
NUR 5290 Module 5 help from the desk
The most frequent weakness is an advocacy paper that never names its audience or ends without a request. Decide who will read it and what you want them to do. Another common problem is choosing a weak version of the opposing argument; find the objection that the strongest opponent would make and answer it. Students also overstate evidence, such as claiming a policy will save a specific amount without a source. Keep the position narrow enough to defend. A concession that improves the proposal, such as protections for vulnerable providers, often strengthens the case. The desk writes advocacy pieces to a named audience when you send the issue and your evidence.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 5290 Module 5 questions, answered
Where can I find a free NUR 5290 Module 5 sample paper?
The whole advocacy paper is above, with margin notes on every sheet. It argues for site-neutral payment of routine visits; use its structure of position, evidence, objection, answer and request for your own issue.
How do I handle the opposing argument in NUR-5290?
State the strongest version of the opposing view fairly, acknowledge what is true in it, and answer it with evidence or a modified proposal. Mentors reward advocacy that takes the best objection seriously.
Who should the audience be for an advocacy paper?
A real decision maker or group, such as a legislator, an agency, a hospital board or a professional association's policy committee. Name the audience and write for its interests and level of knowledge.
What makes a good request in an advocacy paper?
It is specific, achievable and within the audience's power, such as endorsing a named bill, supporting a regulatory comment or adopting a policy. Vague requests to raise awareness are less persuasive.
Can nurses advocate on payment policy?
Yes. Payment rules shape access, costs and the settings where nurses practice. The ethics code supports nurses' participation in policy, and nurses' direct knowledge of patients' experiences makes their advocacy credible.