U.S. policymakers have implemented major changes to the health insurance industry with the goal of improving the experiences and outcomes of patients. Yet there are still many health care consumers as well as employer sponsors - who express deep dissatisfaction with their plans, and its no wonder. Premium cost-sharing rates with employees continue to go up with no end in sight and with no pronounced outcome improvement.
One solution to this problem is for more health plans to reimburse for primary care services provided by nurse practitioners. These highly educated and widely used clinicians have been shown to provide care that is just as safe and effective as physicians, but with much more cost efficiency. Thus, reimbursing for their services meaningfully expands provider choices for employees in a 100 percent cost-neutral manner a win for both patients and human resources/benefits professionals.
For 50 years, nurse practitioners have been practicing primary, acute and chronic care in a broad range of health care settings. In 2013, more than 900 million visits were made to nurse practitioners, who provided such services as: evaluating patients; making diagnoses; ordering, performing, interpreting and supervising diagnostic tests; writing prescriptions; and treating and managing acute and chronic illness.
Independent researchers have consistently proven the safety and effectiveness of these nurse practitioner-provided services. For example, in a 2012 policy paper, The Robert Wood Johnson Foundation stated that the patient-centered nature of nurse practitioner training, which often includes care coordination and sensitivity to the impact on health of social and cultural factors, such as environment and family situation, makes nurse practitioners particularly well prepared for and interested in providing primary care. The report cites a systematic review of 26 studies published since 2000 [which] found that health status, treatment practices, and prescribing behavior were consistent between nurse practitioners and physicians.
In addition, the report outlined: how studies show that [nurse practitioners] do better than physicians on measures related to patient follow up; time spent in consultations; and provision of screening, assessment, and counseling services, and also how nurse practitioner patients report high levels of satisfaction with their care.
Some analysts have gone as far as to suggest that patients who see nurse practitioners have lower work absentee rates, the result of keeping patients healthy and out of the emergency room. This is especially significant when considering the growing number of working Americans suffering from chronic illnesses like diabetes and heart disease major cost drivers in health care.
Nurse practitioners see such patients in growing numbers and are shown to help them get these conditions in check. They decrease hospital admissions, increase treatment adherence, stem disease progression and better outcomes improvements that keep patients healthy and on the job.
It is also significant that while there is a well-documented physician shortage, nurse practitioners remain one of the fastest growing clinical professions. This trend is expected to continue, especially as the nurse practitioner profession becomes more publicized. For example, U.S. News & World Report ranked nurse practitioner as the fourth best overall job of 2014.
With such findings, its difficult to imagine why more employee health plans dont already include vast numbers of nurse practitioners. The sad truth is that for many years medicine has followed a physician-led system one that is now being modernized to enhance value and improve care.
Consider the Nondiscrimination of Health Care section of the PPACA (Section 2706), which states that an insurer shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that providers license or certification under applicable state law. The intent of this provision is to provide patients with access and choice of health care provider, including such providers as nurse practitioners, without discrimination.
Ken P. Miller, PhD, RN, CFNP, FAAN, FAANP, is president of the American Association of Nurse Practitioners, the largest professional membership organization for nurse practitioners in the country.
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