Six research reports released today by the Health Care Cost Institute show how the health insurance system is working and failing to work in such six major areas. Researchers report, for example, that mental health parity laws have not increased access to mental health services for some patients, and that consolidation among providers drives up treatment costs for cancer patients.
The research also shows that: Continue reading
On Wednesday, I wrote about “scope of practice” – what health care providers, particularly nurse practitioners, who aren’t physicians are or are not allowed to do in their state. I provided several resources, reports and links to understand these fights, and the role nurses or physician assistants or other providers can have in providing primary care in underserved areas. Today I want to look at two stories:
The first was published earlier this fall online by Tina Rosenberg on The New York Times Opinionator section, part of a series called “Fixes” on solutions to social problems . She profiles a clinic in Indiana that provides full-service health care to 10,000 people – without any doctors. It’s one of about 250 clinics in the country run by nurse practitioners. Rosenberg reviews the reasons that there aren’t enough primary care doctors serving the poor or practicing in rural areas. She writes:
It might seem that offering the rural poor a clinic staffed only by nurses is to give them second-class primary care. It is not. The alternative for residents of Carroll County was not first-class primary care, but none. Before the clinic opened in 1996, the area had some family physicians, but very few accepted Medicaid or uninsured patients. When people got sick, they went to the emergency room. Or they waited it out — and then often landed in the emergency room anyway, now much sicker.
She says nurses are trained to do what many doctors do not learn – how to treat a patient more holistically, how to listen, how to “coach more, and lecture less.” All those skills are part of what’s needed to treat and manage chronic disease – which is what so much of primary care is about. Because nurses at the clinic are salaried, they aren’t stuck in the 15-minute-appointment hamster wheel of fee-for-service medicine. “At the Family Health clinics, appointments last half an hour — an hour for a new diabetic or pregnant patient.” Continue reading
Susan Presley, writing for the American Journal of Nursing, examines the role nurse practitioners are playing in addressing the well-documented shortage of primary care physicians in rural areas. The number of rural NPs is growing, but those looking to work in underserved and often remote areas still face numerous practical challenges.
Mary Jo Goolsby, director of research and education for the American Academy of Nurse Practitioners, said that just over 20% of NPs practice in rural areas. “This is actually about the same percentage of the U.S. population we have living in rural areas and more than twice the percentage of physicians who practice in rural areas.” And the trend is moving upward, albeit slowly. Thirty years ago, a small cohort study from the Department of Health, Education, and Welfare (published in the October 1978 issue of the American Journal of Public Health) showed that only 16% of NPs worked in rural settings.
She then enumerates the challenges facing NPs who are looking to practice in rural areas, challenges which include setting up their own private practices, insurance, relatively low salaries and opposition from physician groups.
Rural health journalism workshop
AHCJ’s one-day workshop on covering rural health issues will take place tomorrow (June 4) in Kansas City. It’s free to AHCJ members, go here to register or to learn more about the day’s training.
Kaiser Health News’ Andrew Villegas reports that the nation’s 125,000-plus nurse practitioners (and physician assistants, certified nurse midwives and dental therapists) are stepping up to fill the void created by America’s shortage of primary care physicians.
The Association of American Medical Colleges projects that the shortage of primary care physicians will reach 46,000 by 2025 and it will only increase if health care reform efforts succeed and millions of Americans are added to the ranks of the insured, Villegas writes. Nurse practitioners typically handle basic services such as physical exams, common health issues and some drug prescriptions.
Debate over national health overhaul legislation has heightened the sense of urgency about primary care and given nurses ammunition for their argument. “The biggest group of clinicians that will be in shortage with universal (insurance) coverage will be those who provide primary care — and that’s what nurse practitioners are so extraordinarily good at,” says Mary Mundinger, dean of the Columbia University School of Nursing.
There is precedent: Massachusetts’ 2008 health insurance overhaul recognized the 5,600 nurse practitioners as primary care providers who would be reimbursed through private insurance and Medicaid at the same rates as doctors. The nurses, however, must work under written protocols that designate a physician who can provide medical direction.
Despite questions from the American Medical Association, proponents argue that practitioners, who are typically required to have a master’s degree in nursing and work under a doctor’s supervision, know their limits and have proven their competence and effectiveness over several decades.