How has expansion of nurse practicioners scope of practice (or other mid-level p
ID: 386338 • Letter: H
Question
How has expansion of nurse practicioners scope of practice (or other mid-level providers) addressed the current concerns of: healthcare workforce shortages, health insurance cost-containment, and the provision of prevention and curative services to under served populations in the U.S.
What steps need to be taken to make this proposal a reality?
How could stakeholders (federal and/or state government, institutions of higher education for these professions, the health insurance industry, others?) play a role in supporting the expanded scope of practice?
What barriers can you identify to make this happen?
Explanation / Answer
Nurse practitioners (NPs), often called mid-level providers, are able to provide some aspects of primary care, complementing the work of primary care physicians. They are also categorized as an advanced practice registered nurse (APRN). Nurse practitioners are nurses with advanced clinical training. They need fewer years of training than physicians making them a more immediate support to a stretched primary care workforce. Additionally, NPs reduce cost because their average earnings are half those of primary care physicians.
NPs are important for areas of the country that face severe primary care physician shortages especially rural areas. They are the lifeline for those areas.
The Bureau of Labor Statistics estimates that healthcare will add approximately 2.4 million new jobs by 2026 and a new analysis suggests this growth may fall short of industry demand in six occupations.
The analysis comes from Mercer's Workforce Strategy and Analytics practice. Here are six healthcare jobs projected to experience supply gaps by 2025* (*https://www.beckershospitalreview.com/workforce/analysis-us-projected-to-face-shortages-of-these-6-healthcare-occupations-by-2025.html).
1. Home health aides — 446,300
2. Nursing assistants — 95,000
3. Medical and clinical lab technologists — 58,700
4. Medical and lab technicians — 40,000
5. Nurse practitioners — 29,400
6. Physicians and surgeons, all other — 11,000
However, there is some evidence which shows a healthy improvement in NPs practice in the US. Few examples are:
· The 2014 expansion of the Medicaid program, mandated by the Affordable Care Act (ACA), will enroll approximately 16 million new participants, many needing a primary care provider for the first time.
· Empowering NPs to diagnose and prescribe without physician oversight. It is one of a vital tool in helping to ensure that there is an adequate primary care workforce to serve the population.
· Analysis of Massachusetts' data revealed that patient visits with nurse practitioners or physician assistants were, on average, 35 percent less expensive than physician visits. The authors estimated that expansion of nurse practitioner scope of practice laws in states could save between $4.2 billion and $8.4 billion over ten years for the state. (https://www.communitycatalyst.org/resources/tools/medicaid-report-card/primary-care/primary-care-expanding-the-use-of-nurse-practitioners)
But, to secure better health facilitation for our new aging population require below steps in coming future.
1. In many parts of the country, the old battle lines between physicians and providers are remaining unchanged. It means practitioners can provide services without the supervision of physician supervision in most areas. We need to take a step to remove this condition, especially in remote and urban underserved areas.
2. Salary is not attractive for medical aides and other practitioners. We need to increase per hour as well as per annum minimum salary bar.
3. A partnership between Hospitals, NPs and Physician. Their collaborative work model will definitely cut down cost and time.
Different stakeholders are playing a vital role in supporting the expanded scope of practice.
Recent News
DENVER, CO - Los Angeles' Christian Health Centers' (LACHC) nurse practitioner-led hepatitis C virus (HCV) program is an effective example of improving HCV care in underserved populations, according to research presented at American Association of Nurse Practitioners 2018 National Conference. (https://www.clinicaladvisor.com/aanp-2018-annual-meeting/hepatitis-c-virus-educational-program-encourages-screening-primary-care/article/777436/)
AUSTIN, TX - Today, the American Association of Nurse Practitioners (AANP) released new data showing that more than 248,000 nurse practitioners (NPs) are currently licensed to practice in the United States. This number has seen a substantial increase since 2007 when there were an estimated 120,000 NPs. Patients are benefiting from the high quality, comprehensive, patient-centered health care services provided by NPs now more than ever before. (https://www.aanp.org/press-room/press-releases/173-press-room/2018-press-releases/2190-number-of-nurse-practitioners-hits-new-record-high)
On March 1st, Oklahoma House Bill 1013 passed the state House of Representatives by a wide margin of 72-20. The successful bill will allow nurse practitioners to write prescriptions without the oversight of a physician. (https://nurse.org/articles/nurse-practitioner-scope-of-practice-expands-mar17/)
All the above news is pieces of evidence that stakeholders are doing their best to support NPs in the US.
As decision makers at every level with the urgent need to broaden access to health care, these challenges have become clear. The care provided must be competent, efficient, and readily available at all stages of life; it must come at a cost that both individuals and society at large can afford, and it must allow for appropriate patient choice and accountability.
There are four major barriers to make this happen:
· State Practice and Licensure: State licensure regulates NP practice and is a barrier to NPs practicing to the fullest extent of their education and training. Licensure and practice laws for NPs vary per state, despite the main goal of full practice authority.
· Physician Related Issues: Some physician professional organizations, including the American Medical Association, believe that because physicians have longer and more rigorous training than NPs, nurse practitioners are incapable of providing quality, safe care at the same level as physicians.
· Payer Policies: Many NPs report that payer policies have a significant impact on their ability to practice to the fullest extent of their licensure and training.
· Political opposition: Another key consideration for states as they think about expanding scope-of-practice laws for NPs is potential opposition from the physician community. Many physician groups are opposed to expanding NP scope-of-practice citing concerns about overuse of specialty services and overall quality of patient care.
Related Questions
drjack9650@gmail.com
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.