STATE HEALTH POLICY BRIEF SYNOPSIS: NURSE PRACTITIONERS AND PRIMARY CARE

FEDERAL HEALTH POLICY BRIEF SYNOPSIS: REDUCING WASTE IN HEALTH CARE

NURS 525: Health Care SystemsKimberly Allen

Focus

Nurse Practitioners and Primary Care: Introduction

Federal laws, state laws, and other policies limit how advanced practice nurses can help meet the escalating needs for primary care

Associated State Current Legislation

Maryland Senate Bill 0760…

Stakeholders Healthcare providers

Current and future patients requiring primary care

State and federal governments (resources and budgetary impacts).

Relevance of Problem

Nurse Practitioners and Primary Care: Overview

Shortage of primary care as direct result of population growth and increased of insured populations after 2013

Policy Proposals

Expand Nurse Practitioners practice to wider range of preventative and acute health care services

Identified Issues Resistance from various physician groups

State legislators determining non-physician scope of practice

Federal legislation impacting advanced practice nurse reimbursement

Current Problem Statistics

Nurse Practitioners and Primary Care: Context

Only 18 states and D.C. allow Nurse Practitioners to diagnose, treat, and prescribe medications without physician’s involvement

5,700 regions involving 55 million residents dealing with shortage of primary care access

More than 15,000 additional practitioners needed today

Shortage expected to grow as individuals age and attain increased insurance coverage

Largest portion of primary care can easily be provided by advanced practice nurses

Current belief and upcoming legislation outlines future restructuring of primary care delivery models involving advanced practice nurses

"Health Policy Brief: Nurse Practitioners and Primary Care," Health Affairs, October 25, 2012.http://www.healthaffairs.org/healthpolicybriefs/

Significance of Expanding Scope of Practice

Nurse Practitioners and Primary Care: Implications

Receiving primary care is more important than who provides those services

Similarity among clinical outcomes between physicians and advanced practice nurses in

Health status

Prescribing patterns

Treatment practices

Patient satisfaction with services higher when received from advanced practice nurses in areas of care coordination and cultural sensitivity

Advanced practices nurses can fill growing shortages in less time than physicians

Although paid 85% rate of physician services, advanced practice nurses provide services at less costs

Support for Needed Change

Nurse Practitioners and Primary Care: Policy Implications

Need for uniform payment for Nurse Practitioners

Recognition that all state should allow a wider scope of practice for advanced practice nurses

Medicare Payment Advisory Commission found no reason for difference in Medicare payment rates for Nurse Practitioners

More than half of states pay small Medicaid percentages to Nurse Practitioners

Institute of Medicine (IOM) recommends Congress apply enhanced Medicaid payment for primary care services to Nurse Practitioners

Major managed care organizations need to credential Nurse Practitioners

Fee-for-service plans in states being encouraged to cover services provided by Nurse Practitioners

Support for Needed Change (cont’d)

Nurse Practitioners and Primary Care: Policy Implications

Numerous awards and Affordable Care Act support efforts of projects designed to increase production and utilization of advanced practice nurses

IOM recommends states allow nurse practitioners to practice to their full potential through reformed scope-of-practice laws and regulations

IOM recommends Federal Trade Commission identify state regulations related to advanced practice nursing that have anticompetitive effect that does not contribute to health and safety of the public

Maryland Senate Bill 0760 proposes legislation to prohibit the State Board of Nursing from requiring certified nurse-midwives to have written documentation of consultation, collaboration, or referral with another health care practitioner as a condition of licensure

Nurse Practitioners and Primary Care: References

Cassidy, A. (2012). Health policy brief: nurse practitioners and primary care, Health Affairs, retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79

Maryland 2013 Regular Session, Senate Bill 0760, retrieved from http://mgaleg.maryland.gov/webmga/frmMain.aspx?id=SB0760&stab=01&pid=billpage&t...

Now, let’s look at a Federal Health Policy Brief…

Focus

Reducing Waste in Healthcare: Introduction

Identification of ways to eliminate healthcare waste (aside from fraud or abuse) without affecting quality healthcare

Associated Federal Current Legislation

Federal Senate Bill 214…

Stakeholders Healthcare providers

Ancillary healthcare disciplines

All healthcare programs

Current and future patients requiring primary care

Relevance of Problem

Reducing Waste in Healthcare: Overview

Healthcare waste in excess of 765 billion dollars exists due to unnecessary and inefficient spending in public programs, private insurance, and out-of-pocket expenses by consumers

Policy Proposals

Aggressive federal government and legislative initiatives to reduce current estimated waste to one-third of current costs spent on U.S. healthcare

Identified IssuesCurrent healthcare organization, delivery, and economic incentives favor

volume over value

Spending driven by technological advances, demand of services, and redundant health administration practices

Current Problem Statistics

Reducing Waste in Healthcare: Context

Five broad categories of waste identified including

Failures of Care Delivery

Failures of Care Coordination

Overtreatment * Excess 200 billion

Administrative Complexity Excess 240 billion

Pricing Failures Excess 100 billion

IOM (2012) estimates greater than 690 billion is wasted in U.S. (not including fraud and abuse)

Waste affects costs of services and amount of taxes paid by individuals

Such magnitudes of waste decrease available dollars for services truly needed

Excess 102 billion

Excess 25 billion

""Health Policy Brief: Reducing Waste in Health Care," Health Affairs, December 13, 2012.http://www.healthaffairs.org/healthpolicybriefs/

Support for Needed Change

Reducing Waste in Healthcare: Policy Implications

Need for legislatures to identify and implement ways to reduce healthcare spending…or at least slow its growth

Use of evidence-based guidelines will help reduce healthcare spending

Many specialty group initiatives are being implemented

Consumer report initiatives being implemented regarding routinely used procedures and tests that may not be the best to use

Standardized forms and procedures for administrative functions

IOM recommends creation of system with focus on provider-patient partnerships

IOM recommends focus on provider incentives focusing on quality, not volume

Support for Needed Change (cont’d)

Reducing Waste in Healthcare: Policy Implications

IOM recommends emphasis placed on using data from evidenced-based outcomes

Recommendation for use of digital data to improve care, increase comparative effectiveness for informed decisions, facilitate use of clinical guidelines, support coordination between providers and communities

Recommendation for financial incentives to reward low-cost, high-quality care

Recommendation to move from fee-for-service to value and outcome use of accountable care organizations

Improve transparency of provider outcomes, cost, and quality information

Federal Senate Bill 214 proposes legislation to preserve access to affordable generics. Prohibits brand name drug companies from compensating generic drug companies to delay entry of a generic drug into the market.

Reducing Waste in Healthcare: References

Berwick, D.M. and Hackbarth, A.D. (2012). Eliminating waste in US health care, JAMA, 307

(14), 1513-1516.

Institute of Medicine, Best care at lower cost: the path to continuously learning healthcare in

America, September 6, 20120 Report.

Lallemand, N.C. (2012). Health policy brief: reducing waste in healthcare, Health Affairs,

retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79

S. 214-113th Congress: Preserve Access to Affordable Generics Act. (2013). Retrieved from

http://www.govtrack.us/congress/bills/113/s214