Health care reform a golden opportunity for nurse practitioners
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Health care reform is great news for those who have been unable to find affordable insurance. But an unfortunately corollary is that the jump in new patients will exacerbate our shortage of primary care doctors.
A paltry 10 percent of medical students chose to concentrate on primary care medicine in 2008, so it’s uncertain where will we get the vast numbers of front-line professionals we need to improve prevention and reduce ER usage, two vital tasks in reining in runaway health care costs.
Federal efforts to increase the supply of primary care doctors include increased resources for training, new care incentives and greater support for primary care doctors in underserved areas. Here in North Carolina, a joint project between the N.C. Academy of Family Physicians and Blue Cross and Blue Shield of North Carolina aims to pair medical students with experienced primary care doctors to “strengthen skills and … health care leadership training.”
Despite such efforts, it seems likely that primary care demand will almost certainly outstrip supply when reform becomes fully effective in 2014. This represents a significant opportunity for nurse practitioners.
The profession was originally created in 1965 in response to similar concerns about the adequacy of primary care capacity in the wake of Medicare’s creation. This time around, nurse practitioners’ lower costs (a RAND Corporation analysis found the average cost of a nurse practitioner or physician assistant visit to be 20-35 percent lower than the average cost of a physician visit), patient focus and emphasis on preventive medicine makes them “darlings to health reformers,” as TIME Magazine puts it.
A Project Hope study published in Health Affairs found that care delivered by nurse practitioners got even better results than MDs when it came to measures of patient follow-up, consultation time, patient satisfaction, and screening, assessment, and counseling. This study only adds to the considerable evidence supporting the value of nurse practitioners.
A key player in North Carolina’s public hospital system, UNC Healthcare CEO Bill Roper, has suggested nurse practitioners could be important in managing North Carolina soaring primary care demands.
So what’s the hold up? The biggest barriers to broader utilization of nurse practitioners seem to be resistance among MDs and state laws that limit what services they can provide. The proper role for any particular health care provider is always a tough question for state legislators. In my experience, most legislators hate having to referee scope-of-practice disputes.
Perhaps it’s time to let go of such turf disputes in favor of a team approach in which MDs and NPs work together to create a “medical home” offering patients greater attention and continuity of care. While there are political barriers to this vision – physicians aren’t always the best team players, after all – I see change as a real possibility given big shifts coming in how health care is financed in the U.S.
It inevitable that we will move away from traditional fee-for-service fees toward global fees or capped arrangements, creating strong incentives for teamwork among health professionals. If doctors are paid on a capitated basis (either per patient/per month or via bundled fees independent of services provided), efficiency is critical. In that environment, nurse practitioners, physician assistants and other non-MDs could be extremely useful in providing good care on very tight budgets.
Though reform doesn’t require greater use of nurse practitioners, I’m betting that changes in the business side of insurance will create a strong push in their direction.
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