Expanding Nurse Practitioners Primary Care Role Could Lower Medical Bad Debt Balances

When President Obama met earlier this week with health care industry representatives, one group who says they can and should play a vital role in health care reform wasn’t in attendance.  

The American Academy of Nursing  (AAN) says the administration’s goal of getting millions of uninsured Americans health coverage and access to affordable health care cannot happen without the nearly 145,000 nurse practitioners who can serve as primary care providers.  

The AAN, which advocates for consumers and the nursing profession, is in the midst of national campaign to deliver the message that nursing offers real solutions to the health care crisis.  It has called on a former Clinton administration official, state governor, and a private foundation to help it get Washington lawmakers’ support.  

 If the AAN succeeds in having nurse practitioners recognized nationally as primary care providers, the average medical bad debt balance that consumers rack up each year will likely decrease.

“Our nation’s health care crisis cannot be solved by insurance alone. Enhanced nurse practitioner involvement in primary care has the potential to dramatically increase access to health care, improve care for patients with chronic diseases, and improve the efficiency of the health care system, all by maximizing the use of our existing health care resources,” said Donna Shalala, University of Miami President and former Secretary of the U.S. Department of Health and Human Services (HHS) during the Clinton Administration.

The AAN wants lawmakers to:

• expand the concept of the medical home to include nurse practitioners
• increase funding for nurse managed care centers through grants and incentives
• establish a credentialing clearinghouse to eliminate unnecessary administrative costs

An aide for Montana Sen. Max Baucus told insideARM that the chairman of the Senate Finance Committee supports higher Medicare and Medicaid reimbursement rates for nurse practitioners and physician assistants. But she stopped short of saying Baucus supports a national effort that allows nurse practitioners to work as independent primary care providers.

“He supports having them on a team that can work together to better coordinate patient care,” the aide said.  

About 90 percent of the services currently offered by a physician primary care provider can be done by a nurse practitioner, said Susan Sherman, of Independence Foundation, a private philanthropy that helps support early 250 Nurse Managed Home Centers located in low-income urban and rural communities throughout the United States. And studies have shown that the services provided by nurse practitioners cost on average at least 20 percent less than if performed by a physician, said Tine Hansen-Turton, executive director of the National Nursing Centers Consortium, an association of community-based health centers. The savings are even greater when compared to the cost of a visit to a hospital emergency department, which is why many private insurers reimburse members who use nurse managed health centers and retail clinics, she said.  

The savings and improved access to care led Pennsylvania Governor Edward Rendell to seek regulatory changes in the state that now allow nurse practitioners to serve as primary care providers.  

“The ‘Prescription for Pennsylvania’ experience, which two years ago focused on implementing innovative, non-physician models of heath care in the state has been nothing short of a major success,” Rendell said last week during an AAN news conference. “Our chronic care and patient centered medical home model, provides high quality health care to tens of thousands of patients that otherwise would find it difficult to access and pay for these services. . . We believe our model should be followed nationally.”

Hansen-Turton said there already are more than 250 nurse-managed health centers across the U.S, providing primary care services to 2.5 million of Americans. And the AAN estimates that these existing health centers could be expanded to provide primary care to 20 million more patients, giving a medical home to a significant number of the estimated 46 million uninsured Americans.

“If (health care reform) doesn’t include nurses and nurse practitioners, it’s not real health care reform,” Hansen-Turton said.