We Made it to the 4th Quarter of 2019 – Let’s Keep on Pushing
By MaryAnne Sapio, VP, Federal Government Affairs
Although three months remain until the end of the year, there are less than 40 legislative days on the congressional calendar. As the first session of the 116th Congress draws to a close, we want to reflect on the progress made so far and work in concert with you to advance legislative priorities set by the American Association of Nurse Practitioners® (AANP) in the remainder of this calendar year and beyond.
Legislation has been reintroduced and is gaining bipartisan support in this Congress, including the Promoting Access to Diabetic Shoes Act (S.237/H.R.808), the Home Health Care Planning Improvement Act (S. 296/H.R. 2150), the ACO Assignment Improvement Act of 2019 (H.R. 900) and the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2019 (H.R. 3911). These legislative initiatives would reduce barriers to practice for NPs and create greater access to timely high-quality care for patients. Each of these initiatives have attracted widespread support, particularly notable in today’s political climate, from members on both sides of the aisle.
The growing support for our legislative priorities is a direct result of the advocacy of AANP members. We applaud our members for their efforts and urge you to keep pushing elected officials to cosponsor these bills. Please feel free to contact our office at [email protected] for information on your members of Congress and where they stand on the legislation we support.
The progress made this year demonstrates the power of advocacy and the NP voice. We thank you for your incredible outreach and urge you to build on this momentum.
AANP’s website and the AANP Advocacy Center provides further details about these issues and is designed to serve as a resource for you as you conduct your outreach and advocate on these important issues. The AANP Advocacy Center may be accessed at: https://www.aanp.org/legislation-regulation/advocacy-center. We look forward to continuing to work together on issues of importance to NPs and your patients.
Nurse Practitioners: Improving Patient Outcomes for Opioid Use Disorder
By Julia Dieperink, MA, AANP State Policy Coordinator & Chantel DePaepe, MPH, AANP Research Specialist
Background
By the end of today, an estimated 130 Americans will have died from overdosing on opioids. Between 1997 and 2017, deaths from both prescription and illegal opioids increased over 600 percent.
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The loss of life will continue to rise unless the U.S. health care community intervenes. To address the urgent need to prevent these deaths and care for patients with opioid use disorder, the American Association of Nurse Practitioners® (AANP) supports increasing patient access to critical medication assisted treatments (MATs).MATs are vital to improving outcomes for individuals suffering from opioid use disorder; however, until a few years ago NPs were restricted from prescribing them. In 2016, the Comprehensive Addiction and Recovery Act (CARA) implemented a pilot program granting nurse practitioners (NPs) the authorization to prescribe buprenorphine to treat opioid use disorder. In October 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act was signed into law permanently authorizing NPs to prescribe MATs once they have obtained a buprenorphine waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA).
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In the last three years, SAMHSA has reported tremendous growth in the number of NPs with waivers, little information is known about the distribution of waivers by location and what may influence an NP’s likelihood of obtaining a waiver.Methodology
To better understand the current population and geographic distribution of NPs with waivers and the impact of a state’s practice environment on NPs obtaining those waivers, AANP examined current data from the National Nurse Practitioner Database (NNPD) and SAMHSA. The first step involved collecting the number of licensed NPs from each state board of nursing in 2018 and importing that data into the NNPD. Next, SAMHSA data on NPs who held waivers were obtained and used to calculate the percentage of NPs in each state with waivers. In the last step, each state was coded according to state practice environment, i.e., full, reduced or restricted practice, and the results were ranked in ascending order.
Full Practice Authority (FPA) refers to states where practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly the Institute of Medicine, and by the National Council of State Boards of Nursing.
Results
As of May 2019, over 11,000 NPs have obtained waivers. Additionally, results suggest that NPs in FPA states are more likely to have a waiver than those in reduced or restricted practice states.
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When examining the number of NP waivers in each state, the 12 states with the highest percentage of NPs with waivers are FPA states. Conversely, 11 out of the 12 states with the lowest percentage are non-FPA states. Several studies suggest that improvements in patient access, care delivery and quality outcomes are more advanced in FPA states than non-FPA states.5
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Patients in states without FPA may face reduced access to treatments for opioid use disorder, as the analysis of waivers supports. See Figure 1 below for a map of full, reduced and restricted practice states.- Perry J.J.
State-granted practice authority: do nurse practitioners vote with their feet?.
Nursing research and practice. 2012; 2012482178https://doi.org/10.1155/2012/482178
Call to Action
If you are interested in advocating for increasing patient access to MATs through the adoption of FPA for NPs, please share the AANP Nurse Practitioners: Improving Patient Outcomes for Opioid Use Disorder infographic with your colleagues and policy makers. The infographic, which can be previewed in Figure 2 is a useful resource for communicating the impact of NP practice environments with key stakeholders.
In recognition of National Substance Abuse Prevention Month, consider completing a free 24-hour Buprenorphine Waiver Training developed by AANP in collaboration with the American Society of Addiction Medicine and the American Academy of Physician Assistants This training provides valuable information for assessing, screening, referring and treating patients with substance use disorder. You can help your patients by increasing their access to critical MAT treatment. If you are interested in additional resources on opioid use disorder, please visit the AANP CE Center and the U.S. Department of Health and Human Services.
The World of Specialty Practice: How Should We Prepare?
By Amanda Chaney, DNP, APRN, FNP-BC, FAANP; GI SPG Co-Chair
Currently our Gastroenterology (GI) Specialty Practice Group (SPG) forum has been flooded with questions from how to find the best gastroenterology job to what to expect as a new hire - including salary, benefits and training. I have been in a specialty practice for the past 15 years. Here are some tips I’d like to share to help make your journey easier.
Salary and Benefits
The American Association of Nurse Practitioners® (AANP) has a wealth of information on salary and benefits available at aanp.org. It is important during the hiring practice to discuss how you will be compensated for on-call hours, weekends, inpatient management, and whether you’ll be compensated flat-rate/hourly/salaried or paid by productivity measures, such as RVUs (relative value units). Typical benefits to expect include coverage for both health and malpractice insurance, leave/paid time off (sick/vacation), travel allowances for continuing education, certification costs and coverage of your licensure renewals, as well as memberships to professional organizations.
General NP Orientation Model
I believe that a general NP orientation model should at least cover the following within the first week of start date:
- •Revenue / Billing Practices
- •Documentation / Coding Practices
- •Credentialing
- •Human Resources – time card practices, benefits package
- •APP Organization Structure (if exists)
- •Academic Appointment (or other ways to contribute academically to practice)
- •Patient Experience
- •Practice Expectations
- •EHR (Electronic Health Record) training
- •Evaluation and Performance Improvement Strategies
In general, a new NP hire is onboarded/trained by a senior NP/PA in collaboration with the physicians in the practice, i.e., gastroenterologists/hepatologists. In order to fully understand the downstream impacts of the NP’s role, it is also important to discuss the role of others in the practice, i.e., nursing staff and administrators. Clear expectations of the NP’s role are essential in order to ensure the NP is practicing to the top of their license. The new NP should expect to be in training a minimum of several weeks to months.
Practice Expectations
The new NP can expect that an Ongoing Professional Performance Evaluation will be performed on an annual basis. This evaluation is usually completed by the physician chair/leader in the practice and may include a review of patient charts or involve checking off additional competencies (including competencies/criteria to perform procedures, if applicable). This review should include information on clinical competencies and productivity (gross revenue and RVUs) that you have contributed to the practice. NPs should expect to bill independently for seeing patients.
Sources
- Annual Surveillance Report of Drug-Related Risks and Outcomes, United States 2017.U.S. Department of Health and Human Services, Atlanta, GA2018
- S. 524 — 114th Congress: Comprehensive Addiction and Recovery Act of 2016. Retrieved from.
- H.R. 6 — 115th Congress: SUPPORT for Patients and Communities Act. Retrieved from.
AANP Analysis of National NP Database and SAMHSA Waiver Data, July 2019
- Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients.Nursing Outlook. 2014; 62: 440-447
- Rural and nonrural primary care physician practices increasingly rely on nurse practitioners.Health Affairs. 2018; 37: 908-914https://doi.org/10.1377/hlthaff.2017.1158
- Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.Nursing Outlook. 2016; 64: 71-85
- State-granted practice authority: do nurse practitioners vote with their feet?.Nursing research and practice. 2012; 2012482178https://doi.org/10.1155/2012/482178
References
- The promise and problems of non-physician practitioners in general surgery education: Results of a multi-center, mixed-methods study of faculty.Am J Surg. 2018; 215: 222-226
- The advanced practice nurse in gastroenterology. Identifying and comparing care interactions of nurse practitioners and clinical nurse specialists.Gastroenterol Nurs. 2001; 24: 239-245
- Effectiveness of NPs and PAs in managing diabetes and cardiovascular disease.JAAPA. 2018; 31: 39-45
- Physician extenders on surgical services: a systematic review.Can J Surg. 2017; 60: 172-178
- Role of advanced nurse practitioners and physician assistants in Washington state.J Oncol Pract. 2010; 6: 37-38
- Delivery of gynecologic oncology care: Optimizing scope of advanced practice providers to enhance patient care: A Society of Gynecologic Oncology Position Paper.Gynecol Oncol. 2018; 151: 494-500
- Developing nurse practitioner associated metrics for outcomes assessment.J Am Assoc Nurse Pract. 2013; 25: 289-296
- Ongoing Professional Practice Evaluation (OPPE) - Intent: What is the intent of the requirement for Ongoing Professional Practice Evaluation?.(Accessed January 15, 2019.)
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