NPs and Health Reform

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The patients I see are very concerned about health care reform and what it means for them. I'm sure you see these patients in your own practices and share their concerns about the unknown. None of these patients are really interested in whether health care reform is incremental or represents a radical change. They all just want to know if they will be better off with a new option.

Health care reform legislation has passed and change is going to happen. The details of how the new legislation will impact nurse practitioners are still unclear. As legislative imperatives come into focus and regulations begin to emerge, there are some changes NPs hope will be established: NPs don't want to find themselves in a status quo position. We don't want a system in which NPs are not directly addressed. We don't want our practice or our reimbursement tied to physicians. We don't want management systems that fail to record, recognize, and report the care we provide and the prescriptions we write. We don't want to be invisible providers anymore.

Some changes can be made that would benefit both patients and NPs. A summary of a January 2010 invitational conference convened by the Josiah Macy Jr. Foundation to address how to strengthen the primary care system in the United States reported: “…in response to shortages of primary care allopathic physicians, the numbers of osteopathic physicians, primary care advanced practice nurses (nurse midwives and NPs), and physician assistants grew. …Physician assistants tend to practice where physicians practice. For the most part, therefore, the number of physician assistants in primary care has diminished in accordance with physician practice patterns. NPs proved effective in primary care roles, but regulatory and reimbursement policy barriers often prevented efficient and effective use of their services.”

One of the conclusions on which the conference participants reached consensus was, “In order to meet societal needs for primary care and train the right primary care professionals in the right numbers with the right competencies for the most appropriate roles, health care systems need incentives to dramatically change the way primary care is valued, delivered, and integrated in evolving healthcare systems.”

One of the recommendations to achieve that conclusion was, “Coupled with efforts to increase the number of [primary care providers], state and national legal, regulatory, and reimbursement policies should be changed to remove barriers that make it difficult for NPs and physician assistants to serve as primary care providers and leaders of patient-centered medical homes or other models of primary care delivery. All primary care providers should be held accountable for the quality and efficiency of care as measured by patient outcomes.”

I believe these are good road maps to change toward which NPs should lend their energy and efforts.

To view a copy of the Executive Summary, go to www.macyfoundation.org/documents/jmf_ChairSumConf_Jan2010.pdf.