Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.


Date of Graduation


Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing


Erika Metzler Sawin

Maria deValpine

Susan Winslow


The Medicare Inpatient Psychiatric Services (IPS) policy, originally developed in the 1960s and without any significant or meaningful updates since the 1980’s, is physician specific, does not reflect the current model of care for psychiatric inpatients, and is restrictive for psychiatric mental health nurse practitioner (PMHNP) practice. The policy is complex, consists of outdated regulations, and results in millions of dollars in compliance costs for Inpatient Psychiatric Facilities (IPFs) annually (NABH, 2019). Although clearly an important part of the inpatient psychiatric services team, PMHNPs are not identified or defined in the policy (Center for Medicare and Medicaid Services [CMS], 2019). Despite advances in scope of practice for nurse practitioners (NPs), PMHNPs in psychiatric inpatient settings experience practice limitations based on the current policy and its interpretation.

The Medicare IPS policy was analyzed using Bardach’s Eightfold Path to Policy Analysis as implemented by Collins (2005) and the Institute for Healthcare Improvement (IHI) Quadruple Aim framework (IHI, 2020). The policy was interpreted and compared with the de facto policy instituted by a private, non-profit healthcare system in the southeastern United States (U.S). Beginning in early 2019, a policy interpretation change at this facility resulted in the only PMHNP on the adult behavioral health unit being unable to participate in the care of Medicare psychiatric inpatients or bill for their care.

All Medicare IPS admissions on the adult behavioral health unit (BHU) at the subject facility were evaluated during the years 2018-2021. The total number of Medicare admissions for this time frame were compared for PMHNP involved vs non-PMHNP involved care with specific indicators including average length of stay (ALOS), average hospital admission cost, average reimbursement, and average loss for admission. Findings indicated a statistically significant reduction in hospital cost and a medium effect size for hospital loss with PMHNP involved care for Medicare admissions. PMHNPs are billable providers of Medicare services in outpatient and inpatient care settings (CMS, 2022). Revision of the current Medicare IPS policy to explicitly name PMHNPs as providers could lead to improved quality of care, reduce health care costs, and enhance provider access for this vulnerable and high-risk population.

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