DiversityNursing Blog

Kelly Kennedy, USA TODAY

The Health Insurance Marketplace open enrollment launch on October 1, 2013 spurred discussion about the influx of newly insured patients and the shortage of primary care professionals. Nursing@Simmons, an online Master of Science in Nursing program for aspiring Family Nurse Practitioners, created an infographic to illustrate the state of primary and preventive health care in the U.S. and the role nursing professionals hold. This infographic provides a snapshot of what has happened in the years since the Affordable Care Act was conceptualized and enacted, in addition to showing how nurse practitioners are contributing to primary care.

Share the infographic below to raise awareness about the role that Family Nurse Practitioners play in health care reform under the Affordable Care Act.

Source: Simmons Nursing

by Molly Mattison

As more Americans gain access to healthcare, and fewer physicians are available, family nurse
practitioners (FNPs) can play a valuable role in providing families with access to primary care. 

What is an FNP? 

FNPs work autonomously and as part of a primary-care health team to:

• Manage patients’ overall care
• Diagnose/treat acute and chronic conditions
• Prescribe medications
• Educate patients on disease prevention/health management

What is the salary of a family nurse practitioner?

Nurse practitioners enjoy an average, full-time, total salary of $98,760, according to the American Association of Nurse Practitioners.

Named one of the best jobs in America by CNNMoney/Payscale.com in 2012, FNPs also enjoy increased autonomy, expanded responsibilities and time to spend with patients. Check out the infographic below for more reasons why family nurse practitioners are today’s healthcare superheroes:

Infographic by Chamberlain College of Nursing

Source: NY Times

Source: Maryville University Nursing 

The U.S. is currently seeing a physician shortage that will only continue to rise and affect medical practices all over the country. By 2020, the American Association of Medical Colleges (AAMC) estimates there will be a shortage of more than 90,000 physicians, and that number will grow to 130,000 by 2025.

To solve this problem, many healthcare providers are turning to Nurse Practitioners (NPs) and Physician Assistants (PAs). While many people believe NPs and PAs are unable care for patients as well as physicians, studies have found that to be untrue.  Victoria Garment, editor at SoftwareAdvice.com--a website that presents reviews and ratings of healthcare technology-- explains:

“Decades of studies have demonstrated that, when permitted to practice to the full extent of their training, NPs and PAs can perform a majority of the tasks that physicians do while providing the same quality of care.”

These tasks can include performing physical exams, diagnosing and treating conditions such as diabetes or high blood pressure, writing prescriptions, order diagnostic tests and more. Additionally, “while PAs cannot practice independently of physicians, there are approximately 250 practices across the U.S. that are run solely by NPs,” Garment said.

Another benefit of hiring NPs and PAs is the significant cost savings:

• Reduced salary expenses - The average base salary of a physician is more than double that of NPs and PAs.
• Lower overhead costs - Studies show PAs require lower overhead costs than physicians by department, patient demographics and medical care resource use, resulting in a $30,000 boost to the bottom line.
• Lower costs of care - The costs of NP-managed practices have been found to be 23 percent below physician-managed practices. This can lead to statewide savings of $4.2-$8.4 billion.
• Higher patient volumes - Another study found that adding an NP to a practice can double patient numbers and boost yearly revenue by $1.65 million per 100,000 enrollees.
• Reduced insurance and liability costs - Not only is a PA’s liability risk cost one-third of a physician’s, but NPs also have much lower rates of malpractice claims and lower costs per claim.

What’s more, patients often report having an equal or even better experience with an NP or PA compared to a physician. A survey by Medscape found that 80 percent of patients felt NPs “always” listened while carefully compared to 50 percent of physician patients. Similarly, the Kaiser Permanente Center for Health Research released a report that said PA patients ranked their satisfaction levels between 89 to 96 percent for the quality of care they received in the areas of interpersonal care, confidence in the provider and understanding of patient problems.

With all the benefits that NPs and PAs bring, they can be a great addition or alternative to any medical practice, especially those experiencing physician shortages.

To read the full report on The Profitable Practice blog, visit: “Nurse Practitioners and Physician Assistants: Why You Should Hire One (or the Other).”

By Anna Reisman

By Alvin Tran

More than 27 million Americans will soon gain health coverage under the health law. But who will treat them all?

With such a large coverage expansion, and with an anticipated shortage of primary care physicians available to serve them, some states have or are considering allowing so-called advanced practice nurses -- those with advanced degrees -- to treat more patients. David Hebert is at the issue’s center. Hebert, a veteran health care lobbyist and former CEO of the American College of Nurse Practitioners, is the first CEO of the American Association of Nurse Practitioners (AANP) -- a new group with 42,000 members recently formed from the merger of the American College of Nurse Practitioners and the American Academy of Nurse Practitioners.

Hebert says that despite doubts from some doctor groups, nurse practitioners are honing their craft in patient care and research to position themselves to help care for this new influx of patients, and they’re doing so without sacrificing the quality of care.

KHN's Alvin Tran sat down recently with Hebert to discuss the changing role nurse practitioners may soon have, as well as some physicians' efforts to stop them.

Here are edited excerpts of that discussion:

Q. As of 2012, 18 states and the District of Columbia allow nurse practitioners to diagnose, treat patients and prescribe medications without a doctor’s involvement. What is the biggest impediment to expanding to other states? How are you planning to expand that to the other states?

Well, the problem is that there are certain states that require physicians' supervision of nurse practitioners or there may well be some kind of restrictive collaborative agreement that is imposed upon the nurse practitioner. Often times, that makes it very difficult for nurse practitioners to practice. Sometimes there may be a physician who is unwilling to supervise. Other times you may have an issue where the physician chooses to not form a collaborative agreement with nurse practitioners. So, part of the issue is that we have anticompetitive regulations in place.

There are a number of things that we want to do at the federal level. We are hopeful that legislation is going to be reintroduced this Congress that will allow nurse practitioners in Medicare to admit patients for home health care. Right now, the admission can only be done by a physician. Given the fact that we've had research indicating that it would be cost effective, we can get people out of nursing homes and hospitals quicker. It really makes good public policy sense. Particularly, if you got a situation in a rural area where the nurse practitioner and the patient is waiting for the physician to sign the order to admit into home health.

Same thing is true on hospice. We've not been able to get legislation passed that allows nurse practitioners to admit to hospice. We’re not currently permitted by statute to formaccountable care organizations on our own. That opens up a lot of possibilities for safe and effective, cost effective health care.

Q. Physicians groups, including the American Medical Association, have opposed efforts to expand the scope of practice of nurse practitioners and raised concerns of patient safety, contending that physicians' extended training makes them more qualified to handle such issues. How do you make sure that patients are protected?

There have been studies over the years that shows that our outcomes are the same or better than primary care physicians. The fact is that it’s a total red herring. Nurse practitioners have been practicing safely and providing great outcomes for decades.

Q. Medicare’s reimbursement rate for NPs is 85 percent of the physician rate for the same services. Should these rates be the same for both providers?

One hopes that, when all is said and done, whether they're working with a physician or billing on their own, it should be 100 percent of what a doctor is paid because the fact is, they're providing the same services that a physician is providing. Quite frankly, it doesn't make any sense.

Q. What role do you think NPs will have once the federal health law takes effect in 2014?

I think that once you have a full implementation of the expanded Medicaid provisions of the ACA, you’re going to see increased demand for primary care. Unless there’s someone there to provide that care, the intent of the ACA will not be fulfilled. You’re going to see a lot of patients who may be insured or have coverage under Medicare and Medicaid, but may not be able to get services.

I think the major challenges will be to look at regulations that artificially restrict a nurse practitioner’s ability to practice within their scope. If patients want to choose a nurse practitioner, they should be free to do so.

Q. Your tenure as CEO began last month, what’s at the very top of your 'to-do list'?

We are looking at rebranding and a more enhanced public relations campaign. We're looking at increasing membership. Right now we’re about 42,000 members and there are 155,000 nurse practitioners in this country. So, we have room for growth. We’re going to be spending some time ramping up our association activities.

Source: Kaiser Health News

For years, nurse practitioners in Minnesota have been able to see patients only in association with a licensed doctor. But a governor's task force says it's time to let those nurses work independently -- in part, because of a coming shortage of primary care physicians.

The proposal, which has been opposed by physician groups, was endorsed Thursday in the final report of the state Task Force on Health Reform, headed by Human Services Commissioner Lucinda Jesson. The report is expected to set the stage for a debate in the Legislature, which must approve any changes.

The plan would lift restrictions on the state's more than 5,000 "advanced practice nurses," who get extra training to diagnose and treat many routine conditions, from strep throat to chronic illnesses.

Under current law, they must have a working agreement with a physician, although 17 other states have no such restrictions.

"The reality is that we've got a primary care shortage and you can't turn out doctors fast enough," said Dr. Therese Zink, a University of Minnesota physician who served on the task force. "We can't afford to wait. We need creative solutions."

Many advanced practice nurses already operate semi-independently, running clinics in drug stores, schools, rural areas and other locations, under "collaborative agreements" with physicians. The problem, said Zink, is that if the physician retires and no replacement is found, the nurse practitioner would have to close up shop. "It's probably, more than anything, a rural access issue," she said.

But the Minnesota Medical Association (MMA) says the physician oversight is necessary. "This is a patient safety issue," said Dr. Dave Thorson, a St. Paul physician and chairman of the MMA's board of trustees. "I think nurse practitioners ... do a wonderful job. They're a valuable member of the health care team. But they're not the same as a physician, so they shouldn't be given the same scope of practice as a physician."

The American Academy of Family Physicians also objects to the idea. "Substituting nurse practitioners for doctors cannot be the answer," it said in a report in September. It noted that doctors are required to go through twice as many years of training (11 years) as advanced-practice nurses (five to seven years).

But the trend has been spreading. Today, 17 states, including Iowa and North Dakota, permit advanced-practice nurses to diagnose and treat patients, as well as prescribe drugs and devices, without physician supervision, according to the task force.

One of the driving forces is the anticipated physician shortage, as large numbers of doctors retire and aging baby boomers need more care. National experts predict a shortage of 45,000 primary care doctors by 2020.

"We're trying to stay ahead of the curve," Zink said. "We've got to have solutions that are above and beyond and push the envelope."

The task force report, which includes a broad range of recommendations on quality and access to care, will be posted Friday on the Minnesota Health Reform website, mn.gov/health-reform.