Nurse Practitioners and Primary Care: Introduction FocusFederal laws, state laws, and other policies limit howadvanced practice nurses can help meet the escalatingneeds for primary careAssociated State Current LegislationMaryland Senate Bill 0760… StakeholdersHealthcare providersCurrent and future patients requiring primary careState and federal governments (resources and budgetaryimpacts).
Nurse Practitioners and Primary Care: Overview Relevance of ProblemShortage of primary care as direct result of population growthand increased of insured populations after 2013 Policy ProposalsExpand Nurse Practitioners practice to wider rangeof preventative and acute health care services Identified IssuesResistance from various physician groupsState legislators determining non-physician scope of practiceFederal legislation impacting advanced practice nursereimbursement
Nurse Practitioners and Primary Care: Context Current Problem StatisticsOnly 18 states and D.C. allow Nurse Practitioners to diagnose, treat, and prescribe medications without physician’s involvement5,700 regions involving 55 million residents dealing with shortage of primarycare accessMore than 15,000 additional practitioners needed todayShortage expected to grow as individuals age and attain increased insurancecoverageLargest portion of primary care can easily be provided by advanced practicenursesCurrent belief and upcoming legislation outlines future restructuring ofprimary care delivery models involving advanced practice nurses
"Health Policy Brief: Nurse Practitioners and Primary Care," Health Affairs, October 25, 2012.http://www.healthaffairs.org/healthpolicybriefs/
Nurse Practitioners and Primary Care: ImplicationsSignificance of Expanding Scope of PracticeReceiving primary care is more important than who provides those servicesSimilarity among clinical outcomes between physicians and advancedpractice nurses in Health status Prescribing patterns Treatment practicesPatient satisfaction with services higher when received from advancedpractice nurses in areas of care coordination and cultural sensitivityAdvanced practices nurses can fill growing shortages in less time thanphysiciansAlthough paid 85% rate of physician services, advanced practice nursesprovide services at less costs
Nurse Practitioners and Primary Care: Policy Implications Support for Needed ChangeNeed for uniform payment for Nurse PractitionersRecognition that all state should allow a wider scope of practice for advanced practice nursesMedicare Payment Advisory Commission found no reason for difference in Medicare payment rates for Nurse PractitionersMore than half of states pay small Medicaid percentages to Nurse PractitionersInstitute of Medicine (IOM) recommends Congress apply enhanced Medicaid payment for primary care services to Nurse PractitionersMajor managed care organizations need to credential Nurse PractitionersFee-for-service plans in states being encouraged to cover services provided by Nurse Practitioners
Nurse Practitioners and Primary Care: Policy Implications Support for Needed Change (cont’d)Numerous awards and Affordable Care Act support efforts of projects designed to increase production and utilization of advanced practice nursesIOM recommends states allow nurse practitioners to practice to their full potential through reformed scope-of-practice laws and regulationsIOM recommends Federal Trade Commission identify state regulations related to advanced practice nursing that have anticompetitive effect that does not contribute to health and safety of the publicMaryland Senate Bill 0760 proposes legislation to prohibit the State Board of Nursing from requiring certified nurse-midwives to have written documentation of consultation, collaboration, or referral with another health care practitioner as a condition of licensure
Nurse Practitioners and Primary Care: ReferencesCassidy, A. (2012). Health policy brief: nurse practitioners and primary care, Health Affairs, retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79Maryland 2013 Regular Session, Senate Bill 0760, retrieved from http://mgaleg.maryland.gov/webmga/frmMain.aspx?id=SB0760&stab=01&pid=billpage&t...Now, let’s look at a Federal Health Policy Brief…
Reducing Waste in Healthcare: Introduction FocusIdentification of ways to eliminate healthcare waste (aside from fraud orabuse) without affecting quality healthcare Associated Federal Current LegislationFederal Senate Bill 214… StakeholdersHealthcare providersAncillary healthcare disciplinesAll healthcare programsCurrent and future patients requiring primary care
Reducing Waste in Healthcare: Overview Relevance of ProblemHealthcare waste in excess of 765 billion dollars exists due to unnecessary and inefficient spending in public programs, private insurance, and out-of- pocket expenses by consumers Policy Proposals Aggressive federal government and legislative initiatives to reduce current estimated waste to one-third of current costs spent on U.S. healthcare Identified IssuesCurrent healthcare organization, delivery, and economic incentives favor volume over valueSpending driven by technological advances, demand of services, and redundant health administration practices
Reducing Waste in Healthcare: Context Current Problem StatisticsFive broad categories of waste identified including Failures of Care Delivery Excess 102 billion Failures of Care Coordination Excess 25 billion Overtreatment * Excess 200 billion Administrative Complexity Excess 240 billion Pricing Failures Excess 100 billionIOM (2012) estimates greater than 690 billion is wasted in U.S. (not includingfraud and abuse)Waste affects costs of services and amount of taxes paid by individualsSuch magnitudes of waste decrease available dollars for services truly needed
""Health Policy Brief: Reducing Waste in Health Care," Health Affairs, December 13, 2012.http://www.healthaffairs.org/healthpolicybriefs/
Reducing Waste in Healthcare: Policy Implications Support for Needed ChangeNeed for legislatures to identify and implement ways to reduce healthcare spending…or at least slow its growthUse of evidence-based guidelines will help reduce healthcare spendingMany specialty group initiatives are being implementedConsumer report initiatives being implemented regarding routinely used procedures and tests that may not be the best to useStandardized forms and procedures for administrative functionsIOM recommends creation of system with focus on provider-patient partnershipsIOM recommends focus on provider incentives focusing on quality, not volume
Reducing Waste in Healthcare: Policy Implications Support for Needed Change (cont’d)IOM recommends emphasis placed on using data from evidenced-based outcomesRecommendation for use of digital data to improve care, increase comparative effectiveness for informed decisions, facilitate use of clinical guidelines, support coordination between providers and communitiesRecommendation for financial incentives to reward low-cost, high-quality careRecommendation to move from fee-for-service to value and outcome use of accountable care organizationsImprove transparency of provider outcomes, cost, and quality informationFederal Senate Bill 214 proposes legislation to preserve access to affordable generics. Prohibits brand name drug companies from compensating generic drug companies to delay entry of a generic drug into the market.
Reducing Waste in Healthcare: ReferencesBerwick, D.M. and Hackbarth, A.D. (2012). Eliminating waste in US health care, JAMA, 307 (14), 1513-1516.Institute of Medicine, Best care at lower cost: the path to continuously learning healthcare in America, September 6, 20120 Report.Lallemand, N.C. (2012). Health policy brief: reducing waste in healthcare, Health Affairs, retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79S. 214-113th Congress: Preserve Access to Affordable Generics Act. (2013). Retrieved from http://www.govtrack.us/congress/bills/113/s214