Primary care services are an important focus of improving health outcomes in this country. These essential preventive services save lives and improve the quality of life by detecting health problems early. Visits to a primary care provider can help promote health by allowing patients qualified guidance in their decision making, encouraging family involvement, and putting patients in touch with community resources. Since the inception of the first Nurse Practitioner (NP) programs in the 1970’s, these providers have been providing primary care services to patients across the lifespan, typically with an emphasis on underserved populations. Just as long, there has been considerable resistance to NPs being allowed to practice by physician groups …show more content…
who often cite concerns for patient safety. Today, there is a considerable amount of research that suggests that primary care delivered by NPs is not only safe but is equivalent to and in some ways superior to care delivered by physicians.
Despite this evidence, NPs still face considerable barriers to practice in most states; however, several states currently provide unrestricted independent practice rights to NPs. The purpose of this paper is to examine the available literature about what effect unrestricted NP practice has on accessibility to primary care and health outcomes in the states where independent practice is permitted. Literature Review Kuo, Lorest, Rounds, and James (2013) examined the relationship of the percentage of medicare patients seeing NPs for primary care and the level of restriction placed on NP practice in the state. The authors hypothesized that in states in which there were both fewer primary care physicians per capita and less restrictive NP laws, a higher amount of medicare patients would report NPs as …show more content…
their primary care providers than states that restricted NP practice more heavily. The authors used a non-experimental research design and performed a quantitative analysis of data from a five percent national sample of Medicare beneficiaries between the years 1998-2010. In order to meet the criteria of having a NP as one’s primary care provider, the majority of the evaluation and management services had to be billed by the NP. States were categorized into those that allow NPs independent practice and prescriptive authority, those that allow them independent practice but requiring physician oversight for prescriptions, and those that required physician supervision for both practice and prescribing. Data was assessed using hierarchical generalized linear mixed models. It was determined that there was a strong correlation between the number of NPs utilized as primary care providers for medicare patients and the level of restriction placed on NP practice. States with less restrictive environments had a 2.5-fold greater likelihood of their medicare patients having a NP for a primary care provider when compared to the most restrictive states. The authors go on to conclude that relaxing regulations that limit NP practice will increase the number of NPs being utilized for primary care services and increase access to care by helping to eliminate the shortage of primary care providers in many areas. Oliver, Pennington, Revelle, and Rantz (2014) conducted a study exploring the impact NPs have on health outcomes of medicare and medicaid patients.
Through a non-experimental design, the authors analyzed data to determine whether full, reduced, or restricted practice rights for NPs affected the health outcomes of medicare and medicaid patients in those states. The type of NP practice allowed was compared to state rankings for avoidable hospitalizations, readmission rates after inpatient rehabilitation, and hospitalizations of residents of long term care facilities, as well as state health outcome rankings provided by the United Health Foundation. The authors performed a quantitative statistical analysis of previous studies done pertaining to outcomes of medicare and medicaid patients. To be included in the analysis, previous studies had to have a national scope but also provide a state ranking system and an explanation of how the ranking was performed. The authors performed two-sampled t tests on all data to determine if there was a correlation between autonomous NP practice and patient outcomes. The results of comparing potentially avoidable hospitalizations, readmission rates of rehabilitation patients, annual hospitalizations of long term care patients and overall state health outcomes between states with full practice and those without, showed that full practice produces more desirable outcomes. Potentially avoidable hospitalizations per 1,000 person-years in
states with full practice were 100, in states without they were 146. Hospital readmissions within thirty days of discharge from rehabilitation were 10.46 in full practice states, and 11.68 in the restricted and reduced practice group. Annual hospitalization of nursing home patients was 18.1 in full practice states and 25.9 in states without full practice. In assessing overall health outcomes, lower numbers are associated with better outcomes. States with full practice scored 17 and those without scored 30. The authors point out that these correlations do not demonstrate causation, but that they do suggest that relaxing restrictions on NP practice could have a favorable impact on health outcomes in states without full practice. Traczynski and Udalova (2014) performed a non-experimental statistical analysis on the Medical Expenditure Panel Survey Full Year Consolidated Data files for the years 1996-2011 in order to analyze the relationship between health care utilization and NP independence. They determined which states had independent practice by analyzing state practice statutes. According to the authors one of the most important indicators of disease prevention is whether an individual has had a routine checkup in the last year. The study analyzes the relationship between a change in state statute to allow independent NP practice and the percentage of the population that receives annual exams. The authors determined that the probability of an adult having an annual exam goes up 3.1 percentage points within two years of this regulatory change, and by the eleventh year after this regulatory change the percentage increase rises to 7.4 percentage points. The authors projected a long run treatment effect of 11.2 percent increase in adults receiving yearly checkups. Conclusion With so much evidence that NPs provide safe and effective care independent of physician supervision, it seems that restrictions on their ability to practice independently inhibit access to care and quality of care. The purpose of this paper was not to analyze whether NPs are quality primary care providers, but to see if there is evidence in the literature that suggests that states that have adopted independent practice for NPs have superior health outcomes and better access to primary care providers. The three studies reviewed in this paper are among the few that have examined the evidence to compare states with independent practice, and all of the research overwhelming supports loosening of restrictions on NP practice. The positive impacts of independent NP practice on Medicare and Medicaid patients explored here are compelling as these populations typically struggle with access to care. With all the evidence that demonstrates that NPs provide safe and effective care, having additional information that also shows that loosening restrictions on NPs improves patient outcomes requires that as a country we work toward this end.
I will discuss how LTC contributes to the U.S. Healthcare System, the targeted clients, employees that work within the long-term setting, the benefits and services offered within LTC, and the expected outcomes for individuals in a long-term facility. I will discuss the legalities and regulatory issues faced within the LTC setting along with ethical issues that may impede successful facilitation of a long-term facility.
In the United States, depending upon the state in which they work, nurse practitioners may or may not be required to practice under the supervision of a physician, frequently referred to as a “collaborative practice agreement”. However, in consideration of the shortage of primary care/internal medicine physicians, many states are eliminating or lessening the restrictive authority which allows and nurse practitioners the ability to function more autonomously (AANP 2015).
During one of my undergraduate courses, “Community and Population Health”, I completed a paper on my community and access to healthcare. During the research and community outreach performed to meet the goals of the paper, my eyes were opened to the plight of small communities in regards to access to quality healthcare. This plight has become my passion, and has formed the basis for my vision of the Family Nurse Practitioner role.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
The Centers for Medicare and Medicaid Services (CMS) have recently begun requiring hospitals to report to the public how they are doing on patient care. Brown, Donaldson and Storer Brown (2008) introduce and explain how facilities can use quartile dashboards to transform large amounts of data into easy to read and understandable tool to be used for reporting as well as to determine areas in need of improvement. By looking at a sample dashboard for an inpatient rehab unit a greater understanding of dashboards and their benefits can be seen. The sample dashboard includes four general areas, including nurse sensitive service line/unit specific indicators, general indicators, patient satisfaction survey indicators and NDNQI data. The overall performance was found to improve over time. There were areas with greater improvement such as length of stay, than others including RN care hours and pressure ulcers. The areas of pressure ulcers and falls did worse the final quarter and can be grouped under the general heading of patient centered nursing care. The area of patient satisfaction saw a steady improvement over the first three quarters only to report the worst numbers the final quarter. A facility then takes the data gathered and uses it to form nursing plan...
Much like how US healthcare operates today, there is no Gatekeeper system in place in France where citizen are required to be evaluated by a General Practitioner prior to seeing a specialist(). There is however, an incentive for citizen to first see a GP. If the citizen see a GP and then is refereed to ta specialist insurance will cover seventy percent of the bill where if not only sixty percent is covered (Reid 54). Yet, a key issue with the current US system is the fact that it does not possess a gatekeeper system and thus care is often uncoordinated. According to Thomas Bodenheimer in his textbook, Understanding Health Policy, the key task of primary care (thus GPs) is: one, be the first point of contact, two, to be longitudinal, three, to be comprehensive, and fouth, to coordinate the care of the patient. Therefore, if the United States wished to adopt a system similar to the French then it would be intelligent to alter it by adding a gatekeeper like system to properly coordinate the care of patients and thus reduce the total cost of care in the long
It is no secret that the current healthcare reformation is a contentious matter that promises to transform the way Americans view an already complex healthcare system. The newly insured population is expected to increase by an estimated 32 million while facing an expected shortage of up to 44,000 primary care physicians within the next 12 years (Doherty, 2010). Amidst these already overwhelming challenges, healthcare systems are becoming increasingly scrutinized to identify a way to improve cost containment and patient access (Curits & Netten, 2007). “Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal…” (Bailey, Jones & Way, 2006, p. 381). The key to a successful healthcare reformation is interdisciplinary collaboration between Family Nurse Practitioners (FNPs) and physicians. The purpose of this paper is to review the established role of the FNP, appreciate the anticipated paradigm shift in healthcare between FNPs and primary care physicians, and recognize the potential associated benefits and complications that may ensue.
According to healthypeople.gov, a person’s ability to access health services has a profound effect on every aspect of his or her health, almost 1 in 4 Americans do not have a primary care provider or a health center where they can receive regular medical services. Approximately 1 in 5 A...
Every individual in the world deserves to enjoy health and wellness. Maintaining or achieving proper health needs enables individuals to be productive at work and leisure. Traditionally, many people have had barriers obtaining adequate healthcare due to economic constraints or personal inconveniences. Despite impressive technological advances in medicine, the challenge of delivering quality healthcare to the Americans continues to be debated amongst the nation’s political and healthcare leaders. The aging baby-boomers and the increased number of uninsured people add to the equation of population growth which results in limited access to primary healthcare for the entire public. On the other hand, this has ignited the need for advanced practiced registered nurses to unveil the profession’s fullest potential. Nurse practitioners have been called to the public to meet the demand for safe and convenient healthcare. These academically and clinically well prepared nurse practitioners demonstrate their knowledge, skill and leadership in the communities (Hansen-Turton, Miller, Nash, Ryan, & Counts, n.d.). Due to the magnified concerns for additional access to healthcare, ANA has supported nurse practitioners’ ongoing work in retail-based health clinics to reflect a positive movement towards accurate, quality medical care for all citizens.
In consequence, this will limit poor adults finding the proper treatment since many doctors do not accept Medicaid patients. High rates of uninsured populations were associated with lower primary care capacity (Ku et al., 2011). Thus, expanding insurance coverage can support more primary care practices in rural areas and can help equal the gap in primary care positions. The impact of not expanding affects APRN practice by limiting them to practice in areas where they are needed the most. This not only affects APRNs from practicing without a physician supervision but also limit those that need coverage for basic preventive measures to reduce non-paying visits to the emergency room. Ensuring access to care will be contingent upon the ability to attain progress from insurance coverage and primary
Healthcare is viewed in an unrealistic way by most individuals. Many people view a physician as the only means to find a solution to their problem. Nurses are still seen by some as simply “the person who does what the doctor says.” This is frustrating in today’s time when nurses are required to spend years on their education to help care for their patients. In many situations nurses are the only advocate that some patients’ have.
Nursing homes who receive federal funds are required to comply with federal laws that specify that residents receive a high quality of care. In 1987 Congress responded to reports of widespread neglect and abuse in nursing homes during 1980’s, which enacted legislation to reform nursing home regulations and require nursing homes participating in the Medicare and Medicaid programs to comply with certain requirements for quality of care. The legislation, included in the Omnibus Budget Reconciliation Act of 1987, which specifies that a nursing home “must provide services and activities to attain or maintain the highest practicable phys...
3. Pesis-Katz, I., Phelps, C. E., Temkin-Greener, H., Spector, W. D., Veazie, P., & Mukamel, D. B. (2013). Making Difficult Decisions: The Role of Quality of Care in Choosing a Nursing Home. American Journal Of Public Health, 103(5), e1-e7.
Over the past 5 decades, nurse practitioners have been utilized to deliver primary care, traditionally in underserved areas or to vulnerable populations. With the primary care physician workforce in decline it has been estimated, in 2020 we will see a shortage of nearly 45,000 primary care physicians. Currently, a nurse practitioners scope of practice varies widely state by state, many believe that drafting new laws to expand their scope of practice would help create a readily available supply of primary care providers to help combat the expected shortage.
When promoting primary health care services, there are many factors that must be considered when developing an effective marketing plan. Primary care providers are the gatekeepers of health care in the United States; many patients have to visit them before being referred to specialist providers (Bodenheimer, 2003). They are also being tasked with ensuring patients are receiving preventative services and managing more complex chronic diseases (Akinci & Healey, 2004). Recruitment of primary care physicians is challenging because they are expected to do more and are not being reimbursed proportionally for the added workload (Bodenheimer, 2003). In this paper, a group of primary care physicians in Washington D.C. is looking to research their consumer population base in order to provide them better services and recruit new primary care physicians to their practice (Colorado State University-Global Campus, 2013). A successful primary care marketing plan will recruit quality health care providers while improving consumer accessibility to their services, customer satisfaction rates, and patients’ continuity of care with their health care provider.