Encourage your Members of Congress to co-sponsor the Home Health Care Planning Improvement Act of 2013 Enactment of the Home Health Care Planning Improvement Act of 2013 will make it possible for NPs to provide necessary services for their Medicare patients by allowing them to certify that patients under their care are eligible for home health care services. Passage of this legislation will reduce Medicare spending by eliminating duplicative services while also improving the quality and timeliness of care for the beneficiaries who require home health services. Here is the link to the Bill, H.R. 2504 - To amend title XVIII of the Social Security Act to ensure more timely access to home health services for Medicare beneficiaries under the Medicare program.
As much as some would like you to believe that this is not
about turf protection, make no mistake, it is exactly about protectionism and
nothing in the interest of the patient. The latest buzz words are now
“team-based care” where nurse practitioners, physicians, and other members of
the health care team, are working for the common goal of better health outcomes
while the inefficiencies of today’s healthcare system vanish. The problem with
this presumption is that there is no defined model of team-based care.
So what then is team-based care? If you ask a physician what
team-based care is, they would say it is where they are in charge of the team and
tell what the other members to do. They hold the most hours of in-patient
training and in doing so can care for every patient and every condition without
anyone else telling them how to do it. Plain and simple. Captain of the ship.
If you ask a nurse practitioner about team-based care, they
will refer to a theoretical model where all members of the team are active
participants in the provision of care for that patient. True collaboration
takes place where providers seek solutions collectively and the right provider
is caring for the patient at the right time and place. Precious time is spent
developing the communication strategies of the team, the team composition and
The next talking point is to highlight how NPs order more
tests. There was one small study that observed this (well over 10 years ago), however
the study did not focus on patient outcomes. Therefore, this has very little
applicability to draw any significant conclusions about healthcare costs or
anything else for that matter.
Finally, nurse practitioners do not want to be physicians
nor do we purport to be. NPs are not taking a “shortcut” to medicine or trying
to fool patients into thinking we are something we are not. It is our goal to
be recognized for the unique clinicians that we are – melding nursing and
medicine together to care for the whole patient. Nurse practitioners are among
the majority of providers caring for the health disparate and doing so in an evidence
based, culturally competent, and high quality manner that NPs bring to every
patient encounter. The pillars of health promotion, health education, wellness,
and disease management make nurse practitioners uniquely qualified for the aging
population. And when there is a patient with multiple health issues whose body and/or
mind are not responding to the latest recognized treatment, it’s good to know
that a physician is waiting for the handoff. Or are they?
As the case for nurse practitioners is becoming increasingly obvious across the spectrum, predictably, the turf battles are rearing their ugly heads. Here is a blatant example of the rhetoric and follows a formula that I am going to reveal to spare any future time wasting reading them.
Refer to the physician shortage and mention "Obamacare"
State the obligatory, "nurse practitioners are valued as part of the health care team"
Point out the differences in education and training (for example, physicians have 1 billion hours of training where NPs have nothing even remotely close to that)
Make the inference that quality of care will somehow suffer because of the differences in education/training (though there is not one shred of evidence that proves this)
Make sure NOT to mention anything about patient outcomes being the same or better when NPs are primary care providers
If there is mention of outcome studies, be sure to highlight how they are "old" studies with small numbers of patients
Conclude by saying something with the phrase "physician-led team"
There you have it! I hope with this post, I was able to save the reader time wasted reading the same old argument.
As a bonus, for on-line stories that allow readers to comment, I am going to save you time from reading the barrage of denigrating comments by summarizing here:
Blah blah blah...as a medical student blah blah blah....physicians should stop teaching NPs/PAs etc
Blah blah blah...(make statement about NP education yet have no clue about it)...blah blah
And finally, state that NPs won't see the poor and underserved and prefer to practice in the "better" practices with insured patients
Of course, this is not the sentiment of most and the one's who truly want to improve health care understand that.
My apologies in advance for this post as I'm sure it is a bit all of the place. I wanted to just jot down some of my thoughts on the "nurse practitioner vs. physician debate." There has been many articles recently written about this, so here are my thoughts: (these of course are my own thoughts and not representative of my affiliations)
Above all else, nurse practitioners want to practice at the "top of our licenses." That is, to our full education and training. Imagine having access to the most wonderful car in the world - that can not only take you to wherever you want to go, in great comfort and with with excellent gas mileage, but not having the keys to start it. That is the restriction of the collaborative agreement. NPs have the education and training to care for patients in their specialty. However, without a collaborative agreement with a physician, we can't use any of it. We are stuck in the proverbial parking lot without keys.
Nurse practitioners DON'T want to replace or supplant any profession. Yet inherently, there is the insinuation of NPs "taking over" or "replacing" others. I guess I would be defensive if someone told me that I would be replaced by someone else too.
Yes, we all get that physicians have more hours of training.
I laugh at the pilot and flight attendant analogies.
We are not the enemy.
Collaboration is not a dirty word. I refer back to my post written nearly five years ago, Collaboratus. Working together in the interest of the patient. Novel concept? It shouldn't be.
I really laugh at the "if you want to be called doctor, then go to medical school." I haven't heard that one before.
When NPs practice, physicians aren't in the room watching over them waiting for them to make a mistake or miss something.
Who "owns" quality of care? Every single licensed provider has a vested interest in the quality of care they deliver. With more and more available data points, patients will judge and decide who provides their care.
Decreased costs. There is an assumption that since NPs are paid less than physicians, then costs should go down. My counter for pay parity: patients are receiving treatments (with similar or higher quality) and THAT will decrease costs.
NPs can only take care of "simple" things. Not true. No condition is simple. We treat patients, not conditions. Nothing is simple and we recognize and understand that as we partner with our patients.
Please no more "us vs them." Stakeholders far and wide agree, that the way we provide healthcare in this country must change. It will be much better for all involved if we go at it together. Ok, I feel a little bit better now.
Hello Everyone and thanks for reading my blog. It has been a while since my last post - not for a lack of topics to post about - but due to an insane schedule that I have been keeping. Here in New York, we have been through he effects of SuperStorm/Hurricane Sandy, another presidential election, and the tragedy of the unfathomable nearby Newtown Connecticut shootings.
There is so much also going on in healthcare and the aforementioned happenings are also intertwined in the landscape - from emergency preparedness, state health insurance exchanges as part of the Affordable Care Act, and mental health respectively.
Specific to nurse practitioners, there have been numerous articles written about us (and the interesting negative commentary that always follows and isn't worth commenting on anymore). We have also seen the merger of two national nurse practitioner organizations into one large one. CMS announced that there will be increased Medicaid reimbursement for certain physician providers but seemingly omitted nurse practitioners from the higher rates.
I will try my best to offer my commentary on the latest news, issues, and trends as I have been doing since 2008, the inception of A Nurse Practitioner's View. There has been many changes since then (I am so glad to see more NP Bloggers out there) and some things have stayed the same (i.e. an article published about NP guided care, then cue the demeaning and disparaging remarks). NPs are among those front and center and I look forward to sharing my view and perspective in this new age of healthcare. As always, there will be no advertisements on this blog and I am no longer accepting any guest posts (thanks to everyone who submitted over the last few months).
One of the biggest areas of frustration for students, stakeholders, and nurse practitioners are the seemingly lack of consistency among state regulations regarding NP practice. The rules in one state may not necessarily apply in the next (and even neighboring state). I have known NPs that lived near state borders, licensed in both states, yet had completely different sets of rules regarding what they can/can't do, requirements for collaboration versus autonomy and prescribing ability.
Barton Associates created this free interactive tool that lets you visually compare all 50 states' (plus DC) NP scope of practice. It is ultra handy and can help one decide whether to practice in one state that is very prohibitive compared to one that offers autonomy.
There is also a push for the APRN Consensus Model whose aim is to have consistency among the states when it comes to regulations.
If moving out of the state isn't feasible, well, the alternative is to become involved, active, and supportive of a national and local nurse practitioner organization (it is helpful to be supportive whether your state is autonomous or not since there are constant threats to your practice!)
An example of the advocacy that membership affords was evidenced this past week. The American Academy of Family Physicians (AAFP) put out their white paper, "Primary Care for the 21st Century." I looked forward to reading this report based on the title and hoped that I would find innovation and new ways of enhancing care for our patients based on the primary care model. To my surprise (and dismay), I found myself reading the executive summary and seeing terms like "nurse practitioners are not doctors" and "the ideal practice ratio of nurse practitioners to physicians is 4:1" and on. Huh? "How is this a report about primary care?" I thought.
Then I realized that it wasn't, it was an attack on a profession by another wrapped in a pretty looking monograph with old data. It might as well have been called "Lets Denigrate the NPs Under the Auspices of Solving the Ills of the Health Care System Report." At least I would have known what to expect.
To be completely honest, I really couldn't read it beyond the executive summary (I looked at the Table of Comments and further became ill).
Luckily, one of our national NP organizations (the AANP) did read the whole thing (I am unsure if they became ill or not) and responded. Here is one of the benefits of advocacy for nurse practitioners that benefits all nurse practitioners.
All areas of the health care sector must better work together to achieve outcomes that are truly patient-centric. Do reports like the one referenced above help? I am highly doubtful. We have real issues to deal with and turf wars will continue to distract from them.