Monday, July 21, 2008

More on the Medical Home

Today's New York Times has an article about the Medical Home concept. These projects are becoming more popular as insurers are deciding to cover the costs. The article refers to a patient who visited his very busy physician that missed a stroke diagnosis because of a hurried exam. While mostly inexcusable, it provides a real life example of the issues occurring every single day due to the system's lack of access, communication, reimbursement, and high-quality. While the article doesn't make specific reference to NPs, Senators from New Mexico, Iowa, Alaska and Maine recently discussed expansion of Medical Home projects to include NPs, and other non-physician providers of primary care to lead medical home demonstrations. Senator Bingamin of New Mexico sums it by saying:

Furthermore, nurse practitioners epitomize the delivery of high quality, cost-effective primary care that is crucial to the medical homes model.

Senator Murkowski of Alaska adds:

Nurse practitioners function as partners in the healthcare of their patients, so that, in addition to clinical services, nurse practitioners focus on health promotion, disease prevention
and health education and counseling, guiding patients to make smarter health and lifestyle choices.

The timing of this NY Times article coincides with a recent report by The Commonwealth Fund, a non profit entity. The report found that the U.S. fails on most measures of health care quality, waiting times, and lack of preventative care. This is just more evidence that we must dramatically change the way healthcare is delivered today.

Monday, July 14, 2008

The Solution!

Medgadget recently had the opportunity to interview the president-elect of the AMA, a cardiologist. Someone obviously with the finger on the pulse of primary care. One of the hot topics that he was asked about was the bleak outlook on primary care. This is from the interview:

Q: Here's a question from one of our editors, Nick Genes. He's a resident of emergency medicine at Mount Sinai in New York. Many pundits and experts believe that the US government will improve access to primary care (one way or another) in the next 2-5 years. The Massachusetts experiment suggests there will not be enough primary care doctors to cover the increased demand. Already, primary care doctors are overworked and under compensated, with many leaving the field or choosing specialty training instead. How is the AMA planning to respond to this challenge?

A: ... We continue to mention the importance of trained primary care, and I should also mention the AMA created the scope of practice partnership, because our concern is, that there are those who would rather have the nurse practitioner become the primary care physician. And we don't believe that's fundamentally fair for patients to try and say that a nurse practitioner is the same as a well trained physician who's undergone post graduate training in the practice of medicine.

For those of you unfamiliar with the "scope of practice partnership(SOPP):" is a collaborative effort within the House of Medicine to focus on the resources of organized medicine to oppose scope of practice expansions by non-MDs/DOs that threaten the health and safety of patients.

So the AMA's solution to respond to the challenge of physicians leaving primary care is to denigrate NP practice. I think most NPs acknowledge the fact that we aren't the same as physicians and use that difference as our distinction - we synthesize nursing and medical care. We NPs aren't the only targets here - optometrists, podiatrists, nurse midwives and chiropractors are among other professions that also make the list. In fact, 35 professional organizations formed a joint statement and launched the website, Coalition for Patient's Rights to offer a counterpoint to any inaccurate or misleading information.

The SOPP organizations are also prepared to put their money where their mouth is. It is estimated that at the onset of this movement in 2006, they had a minimum of $470k at their disposal and no less than $300k each additional year. That is a lot of money that doesn't do much to help the single mother without health insurance. Again, this is all under the guise of "protecting the health and safety of the public."

To put those dollars in perspective, my recent post on Remote Area Medical (RAM) operates on a budget of $250k/year and treats about 17,000 patients. Unfortunately, they must turn away thousands of patients since they simply cannot meet the demand.

Sadly, this is another example of creating further barriers to access healthcare. Precious resources are being wasted in this campaign that tries to portray NPs (and other health providers) as being part of the problem in healthcare.

This is the solution? Really?!?

Sunday, July 13, 2008

What's Wrong with this Picture?

Picture this: hundreds of patients braving the elements, lining up for access to a free healthcare clinic, dozens of healthcare professional volunteers offering their time to provide medical, dental and vision services and thousands of dollars in donated medical supplies. Sound like a medical corps serving a third world country? Guess again. Its happening in Tennessee, Virginia and Kentucky.

Tonight, 60 Minutes ran an updated story about Remote Area Medical (RAM). This is an amazing volunteer organization started by Stan Brock. His original intention was to help injured and sick people in desolate parts of the world. Now, a large part of the people being helped are right in our own backyard. What does that say about the state of healthcare today?

The news piece also highlights NP volunteer Teresa Gardner providing women's health services to those in need. She counsels and treats a patient that hasn't followed up in 3 years status post cervical cancer surgery. Sadly, these stories are all too common today. Check out RAM's website in the link above to find out more about the organization and ways to help.

Saturday, July 5, 2008

On Vacation

Hi All,

I will be on vacation for the next week! So, I won't be posting. I know I know for all of the few readers out there you'll just have to find another way to spend your time! :-)

In the meantime, here is a nice press release from the AANP regarding their recent conference that was attended by more than 3000 NPs.

(Image via flickr)