Will Nurse Practitioners Help Meet Primary Care Demand?
By David Martin, President and CEO of VeinInnovations
Imagine going to the doctor’s office. You need care and a prescription. Now imagine that you don’t need to see a doctor for the healthcare you need. Instead of a physician, a nurse attends to all your needs and you walk out the door prescription in hand. In some states concerned about the predicted doctor shortage, that scenario is already a reality. For years, experts have worried about a potential doctor shortage, citing an aging population, aging (and retiring) doctors, and, in the advent of the Affordable Care Act, a strain on the system as the ranks of the insured grow. To fill the gaps and meet the growing demand for healthcare, some states are changing their laws to provide nurses with the authority to treat patients independent of physician supervision.
In California, a patient can get one-on-one primary care and the prescription medication they need from a nurse. Although patients don’t see a doctor, a physician is still involved behind the scenes. At the Glide Health Services clinic in San Francisco, nurses treat patients all week but a doctor comes to consult on difficult cases and sign off on various forms. 30 million Americans are expected to gain insurance over the next decade and we need providers to care for them. Nurses have been, and will continue to be, a vital part of our healthcare infrastructure. Expanding the role nurses play could be especially helpful as their training time is shorter than that of physicians. Though the training period is shorter, it is rigorous. To become a nurse practitioner, candidates must first become a registered nurse, then complete a masters degree followed by up to 700 hours of supervised clinical experience. In 2012, the National Association of Governors found that nurse practitioner care is similar to physician-provided care on several process and outcome measures.
As the American healthcare system expands, we must meet demand with caring and competent providers. In 17 states and the District of Columbia, nurses are allowed to practice indepently. How independently varies widely from state to state. Advocates for expanded nurse practitioner care, like the American Nurses Association, contend that insurance companies can hamper the ability of nurses to practice by writing policies that make reimbursement difficult. Nurses are often unable to bill insurers directly for services provided to patients, making independent practice difficult or unfeasible. Physician’s groups impose their own roadblocks by opposing nurse practitioner pushes to operate independently. Many physicians argue that without the team approach of nurse care with physician oversight, patients will be put at risk. Further, the physician groups question if expanded independence will actually lead to greater access to healthcare.
Nurse practitioner groups have appealed to the White House for help, asking the Obama administration to require insurers to include their practices and services in the new plans offered to consumers through the ACA insurance marketplaces. In 2013, the administration declined to do so, but did agree to “continue assessing” the situation. In Massachusetts, the flagship state of healthcare reform, lawmakers required insurers to reimburse nurse practitioners as primary care providers. The result was not as effective as nurses hoped because insurers are still able to write restrictive reimbursement policies. Although there are now more than 6,000 nurse practitioners in Massachusetts, very few are credentialed by major insurers. As other states follow suit and expand the authority of nurses, the industry (and the administration) will follow the effects on patients and overall access to care closely.
Readers who need insurance (or know someone that does) should be advised: the Affordable Care Act marketplaces will close at the end of March. If you don’t get insurance through the marketplace before March 31, you’ll be unable to get coverage until the marketplace opens again on November 15. Remember – if you don’t have coverage, but do get sick in the intervening months, you will not qualify for coverage. You’ll be on your own for all health care costs in the interim period. (Certain milestones, such as marriage, divorce, the birth or adoption of a child or the loss of a job will qualify you for a special enrollment period while the market is closed.) Remember, too, that the tax penalty for going uninsured begins this year. You will pay either 1% of your yearly household income or a $95 fee – whichever amount is higher. Visit HealthCare.gov to get a more in-depth explanation.
Finally, a brief update on Haleigh Cox, the eponymous inspiration behind Haleigh’s Hope Act. She and her mother are settled in Colorado Springs. Her parents hope she will soon have access to CBD treatment. If you’d like to follow her story, you can do so on her Facebook page.