Nurses: the cure for what ails us

A new Health Affairs/RWJF policy brief highlights federal and state laws which limit the extent to which providers. A predicted clinician shortage will worsen as millions of people become insured as a result of the Affordable Care Act (ACA).

In 2012, only 18 states and the District of Columbia allowed NPs to diagnose, treat, and prescribe without physician involvement. The remaining 32 states required physician involvement in one or all of these activities.

NPs were almost always paid less than physicians for providing the same services. Medicare paid NPs practicing independently 85% of the physician rate, even though MedPAC has found no analytical foundation for this difference. Medicaid fee-for-service programs paid NPs directly. These rates varied by state and more than half of the states paid NPs a smaller percentage of physician rates. Health insurance plans varied widely in the types of services and providers that they chose to cover, with some plans excluding NP services. Additionally, some plans would not recognize NPs as primary care providers.

While reimbursement for NPs lags behind that of physicians, programs and funding authorized by the ACA support a number of nurse-centric models, including nurse-led clinics. The ACA recognizes the respectable body of literature which has demonstrated that the care which NPs provide to their patients is equal to or surpassing that of physicians in various categories (e.g. health status, prescribing practices, patient satisfaction). Nurse advocates note that NPs are better situated to fill the primary care gap quickly, as their training takes significantly less time than physicians.

Despite the evidence supporting care provided by NPs,. The AMA emphasizes care delivery through a physician-led team.

Commentary

The recommends that barriers which inhibit nurse practitioners (NPs) from practicing to the full extent of their training be removed in order to enhance patient access to timely and efficient care. The IOM also recommends that the nation double the amount of doctoral-prepared nurses by the year 2020.

Interestingly, this brief did not address the movement among the nursing profession to step-up the minimum training required to obtain advanced practice licensure from a master’s to a doctorate level degree.

NPs are critical to the future of our health care system. Millions more people will qualify for health benefits through enhanced eligibility for Medicaid and private coverage now mandated by the ACA. The medical profession, despite opening several new medical schools in recent years, has been unable to keep pace with patient demand. With the ACA endorsing a more nurse-centered approach, this nurse would agree with policies to provide financial incentives to states that loosen restrictions on NP practice. Some suggestions might include increased funding for NP education especially for those practitioners willing to practice in underserved areas.

“Health Policy Brief: Nurse Practitioners and Primary Care,” Health Affairs, Updated May 15, 2013.

by

Megan Doede, RN, BSN, CEN