[NPInfo] NPs are slowly taking on PCP role across America

[arnplaw at comcast.net]

I just printed out this article from an online news service.  I think we are reaching the "tipping point".  

Julia Pallentino

-------------- Original message -------------- 
From: Jeffrey Hazzard <jeffnp27 at yahoo.com> 

> Greetings: I found this article and thought it was worth reading. Hope you 
> learn from it, too, and find it worth your time. 
> Jeff Hazzard 
> 
> THERE IS A TREND in the medical community where third-year 
> residents are turning away from primary care medicine in favor of more lucrative 
> specialties. 
> 
> 
> According to the American College of Physicians, the number of third-year 
> residents seeking careers in general internal medicine has dropped from 54% in 
> 1998 to 20% in 2005. 
> That trend is being countered by another trend—the growing number of nurse 
> practitioners, which has risen from 30,000 in 1990 to 115,000 today, according 
> to the American Academy of Nurse Practitioners (AANP). 
> Increasingly, nurse practitioners are becoming primary care providers. 
> "The increase is related to the demand that has been generated for nurse 
> practitioners," says Jan Towers, PhD, director of health policy for AANP. "They 
> provide high-quality care. Their patients are satisfied with the service, so 
> other people want them to be their provider. As a result, they have become more 
> prevalent." 
> Towers describes nurse practitioners as a hybrid that combines both the 
> medical and nursing components of treating patients. Nurse practitioners go to 
> school almost as long as physicians, but the training is different. They can 
> prescribe under their own signature in every state. (In four states, they cannot 
> prescribe controlled substances and narcotics, however.) 
> They operate their own practices or nurse-managed primary care centers, and 
> some practice in health clinics that can be found in major pharmacy and retail 
> chains. 
> Not everyone supports the idea of nurse practitioners as primary care 
> providers. The American Medical Assn. opposes giving full autonomy to nurse 
> practitioners, saying that physicians should supervise nurse practitioners at 
> all times and in all settings. 
> 
> ACCEPTANCE BY PLANS VARIES 
> As a result of their growing popularity with the general public, nurse 
> practitioners are becoming more widely accepted by health plans, many of which 
> have added them to their basic member coverage, Towers says. She cautions, 
> however, that there is still reluctance on the part of some health plans to 
> accept nurse practitioners. 
> "Acceptance by health plans varies across the country," she points out. "Some 
> are fully onboard in certain parts of the country. But in other sections, health 
> plans are still hesitant and require strings that we believe are unnecessary. 
> "Then there are cases where you work very well with a company, but there is a 
> merger with a company that hasn't worked with nurse practitioners," Towers adds. 
> "You have to start all over again." 
> Medical Mutual of Ohio began contracting with nurse practitioners in January 
> 2004. Those nurse practitioners must be affiliated with a network provider, says 
> Jerelyn Pinkham, director of Professional Contracting & Network Management 
> (Southern Division) for the Cleveland-based health plan. 
> "Although we recognize that nurse practitioners play an important role in the 
> primary care field, we are only allowing physicians to act as the primary care 
> giver in our point-of-service and HMO products," she says. 
> Pinkham says Medical Mutual recognizes that its members enjoy the convenience 
> and accessibility of nurse practitioners. 
> A popular venue for nurse practitioners is retail-based health clinics. CVS, 
> Wal-Mart, Target and Rite Aid are among the outlets that have opened these 
> clinics during the past several years. The clinics offer patients fast access to 
> routine medical services, typically charge between $25 and $65 per visit, don't 
> require an appointment and are open during pharmacy hours, including nights and 
> weekends. 
> One such clinic is Minneapolis-based MinuteClinic, which operates nearly 200 
> facilities in 12 states. MinuteClinic is a provider for more than 30 health 
> plans, including Blue Cross Blue Shield (BCBS) Minnesota. 
> Some Blue Cross and Blue Shield of Minnesota (Blue Cross) clients have chosen 
> to waive copays for their employees if those employees choose to visit a 
> MinuteClinic rather than a physician, says Jan Hennings, a spokeswoman for the 
> health plan. 
> An analysis conducted by BCBS Minnesota between June 2004 and May 2005 showed 
> a MinuteClinic visit costs about half of a primary care physician office visit 
> ($43 compared with $87) and less than half for other related costs, such as 
> laboratory services. BCBS Minnesota paid MinuteClinic $1.13 million for 22,956 
> visits during that period. 
> According to the analysis, people who chose MinuteClinic were twice as likely 
> to be a member of a consumer-directed health plan (CDHP). 
> "With the growth of CDHPs, members are becoming more savvy with their 
> healthcare dollars," Hennings says. "There is value for members who use 
> MinuteClinic. There is also savings for the [healthcare] system." 
> 
> REDUCING HEALTHCARE COSTS 
> Towers says it is hard to determine just what role nurse practitioners play in 
> the effort to lower the overall cost of healthcare in the United States. She 
> maintains, however, that they do contribute to cost savings. 
> For example, Medicare reimburses nurse practitioners at 85% of the rate of 
> physicians. 
> "How much of that trickles down to the patient is questionable," Towers says. 
> "But it saves money for the Medicare program. That certainly helps. The program 
> can last longer and people can continue to take advantage of it." 
> Nurse practitioners advocate prevention and health promotion. As a result, 
> there are multiple studies that show lower rates of emergency room visits and a 
> lower number of hospital days by patients, Towers says. 
> "That's a good reason why health plans would like nurse practitioners, because 
> nurse practitioners as primary care providers can reduce the number of people 
> who have to go to the emergency room," she says. "People are getting sicker 
> because they can't get into a physician's office in a timely manner. You create 
> a sicker population that will cost everybody money." 
> There also is increased attention to the continuity of care and an increase in 
> the number of follow-up visits with nurse practitioners, Towers says. "The more 
> you follow up with a patient, the better chance you have to see good results," 
> she points out. 
> In some cases, it's only a matter of educating purchasers to the level of 
> service provided by nurse practitioners, Towers says. 
> "If purchasers aren't aware of what a nurse practitioner can provide, they may 
> not request it and, therefore, you don't get into the system," she says. "If 
> enough members demand that nurse practitioners be added to their coverage, 
> health plans will have little choice but to comply. 
> "It's an area we're still working on," she notes. "We are accepted in the 
> public sector. As health plans begin to see what can be done by nurse 
> practitioners, they will accept us." 
> 
> Ken Krizner is a frequent contributor to MANAGED HEALTHCARE EXECUTIVE . He is 
> based in Cleveland. 
> 
> 
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