power point presentation of two healthcare policy briefs for NURS 525

2. Nurse Practitioners and
Primary Care: Introduction
Focus
Federal laws, state laws, and other policies limit how
advanced practice nurses can help meet the escalating
needs for primary care
Associated State Current Legislation
Maryland Senate Bill 0760…
Stakeholders
Healthcare providers
Current and future patients requiring primary care
State and federal governments (resources and budgetary
impacts).

3. Nurse Practitioners and
Primary Care: Overview
Relevance of Problem
Shortage of primary care as direct result of population growth
and increased of insured populations after 2013
Policy Proposals
Expand Nurse Practitioners practice to wider range
of preventative and acute health care services
Identified Issues
Resistance from various physician groups
State legislators determining non-physician scope of practice
Federal legislation impacting advanced practice nurse
reimbursement

4. Nurse Practitioners and
Primary Care: Context
Current Problem Statistics
Only 18 states and D.C. allow Nurse Practitioners to diagnose, treat, and
prescribe medications without physician’s involvement
5,700 regions involving 55 million residents dealing with shortage of primary
care access
More than 15,000 additional practitioners needed today
Shortage expected to grow as individuals age and attain increased insurance
coverage
Largest portion of primary care can easily be provided by advanced practice
nurses
Current belief and upcoming legislation outlines future restructuring of
primary care delivery models involving advanced practice nurses

5. "Health Policy Brief: Nurse Practitioners and Primary Care," Health Affairs, October 25, 2012.
http://www.healthaffairs.org/healthpolicybriefs/

6. Nurse Practitioners and
Primary Care: Implications
Significance of Expanding Scope of Practice
Receiving primary care is more important than who provides those services
Similarity among clinical outcomes between physicians and advanced
practice nurses in
Health status
Prescribing patterns
Treatment practices
Patient satisfaction with services higher when received from advanced
practice nurses in areas of care coordination and cultural sensitivity
Advanced practices nurses can fill growing shortages in less time than
physicians
Although paid 85% rate of physician services, advanced practice nurses
provide services at less costs

7. Nurse Practitioners and Primary
Care: Policy Implications
Support for Needed Change
Need for uniform payment for Nurse Practitioners
Recognition that all state should allow a wider scope of practice for advanced
practice nurses
Medicare Payment Advisory Commission found no reason for difference in
Medicare payment rates for Nurse Practitioners
More than half of states pay small Medicaid percentages to Nurse Practitioners
Institute of Medicine (IOM) recommends Congress apply enhanced Medicaid
payment for primary care services to Nurse Practitioners
Major managed care organizations need to credential Nurse Practitioners
Fee-for-service plans in states being encouraged to cover services provided by
Nurse Practitioners

8. 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 nurses
IOM recommends states allow nurse practitioners to practice to their full potential
through reformed scope-of-practice laws and regulations
IOM 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 public
Maryland 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

9. Nurse Practitioners and Primary
Care: References
Cassidy, A. (2012). Health policy brief: nurse practitioners and primary care, Health Affairs,
retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79
Maryland 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…

10. Reducing Waste in Healthcare:
Introduction
Focus
Identification of ways to eliminate healthcare waste (aside from fraud or
abuse) without affecting quality healthcare
Associated Federal Current Legislation
Federal Senate Bill 214…
Stakeholders
Healthcare providers
Ancillary healthcare disciplines
All healthcare programs
Current and future patients requiring primary care

11. Reducing Waste in Healthcare:
Overview
Relevance of Problem
Healthcare 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 Issues
Current healthcare organization, delivery, and economic incentives favor
volume over value
Spending driven by technological advances, demand of services, and
redundant health administration practices

12. Reducing Waste in Healthcare:
Context
Current Problem Statistics
Five 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 billion
IOM (2012) estimates greater than 690 billion is wasted in U.S. (not including
fraud and abuse)
Waste affects costs of services and amount of taxes paid by individuals
Such magnitudes of waste decrease available dollars for services truly needed

13. ""Health Policy Brief: Reducing Waste in Health Care," Health Affairs, December 13, 2012.
http://www.healthaffairs.org/healthpolicybriefs/

14. Reducing Waste in Healthcare:
Policy Implications
Support for Needed Change
Need for legislatures to identify and implement ways to reduce healthcare
spending…or at least slow its growth
Use of evidence-based guidelines will help reduce healthcare spending
Many specialty group initiatives are being implemented
Consumer report initiatives being implemented regarding routinely used
procedures and tests that may not be the best to use
Standardized forms and procedures for administrative functions
IOM recommends creation of system with focus on provider-patient partnerships
IOM recommends focus on provider incentives focusing on quality, not volume

15. Reducing Waste in Healthcare:
Policy Implications
Support for Needed Change (cont’d)
IOM recommends emphasis placed on using data from evidenced-based outcomes
Recommendation for use of digital data to improve care, increase comparative
effectiveness for informed decisions, facilitate use of clinical guidelines, support
coordination between providers and communities
Recommendation for financial incentives to reward low-cost, high-quality care
Recommendation to move from fee-for-service to value and outcome use of
accountable care organizations
Improve transparency of provider outcomes, cost, and quality information
Federal 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.

16. Reducing Waste in Healthcare:
References
Berwick, 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=79
S. 214-113th Congress: Preserve Access to Affordable Generics Act. (2013). Retrieved from
http://www.govtrack.us/congress/bills/113/s214