Practitioner On Healthcare Essay

DISCUSS THE IMPACT OF NURSE PRACTITIONER ON THE HEALTH CARE PROFESSION IN THE LAST DECADE

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Who is considered a Health Care Provider/Practitioner?

Under federal regulations, a “health care provider” is defined as: a doctor of medicine or osteopathy, podiatrist, dentist, chiropractor, clinical psychologist, optometrist, nurse practitioner, nurse-midwife, or a clinical social worker who is authorized to practice by the State and performing within the scope of their practice as defined by State law, or a Christian Science practitioner. A health care provider also is any provider from whom the University or the employee’s group health plan will accept medical certification to substantiate a claim for benefits. Practitioner On Healthcare Essay.

Kelly’s personal interest in the field of health care and nursing: Relate hearing stories from mother (a nurse) when she was growing up.
Introduction
Throughout the years the challenge of creating a viable health care initiative has been of great concern for citizens, politicians, and health care providers. With recent developments, such as the Affordable Care Act (aka ‘Obama-Care’), the strategies being considered to reform health care for Americans continues to be of primary importance throughout much of society’s current conversation. Practitioner On Healthcare Essay.
Looking back at earlier attempts to forge a working health care policy, Hillary Clinton’s efforts toward managed care come to mind. A few of Mrs. Clinton’s notable issues included questions that are of growing importance today: a better health care system for the chronically ill, cost-saving through electronic medical record keeping, and the notion that rather than a single-payer system, health care should shift to ‘managed competition.’
Hillary Clinton was noted for emphasizing the importance of the ‘village’ in accomplishing some of our larger challenges and goals. With respect to health care, it is perhaps more accurate to say that rather than a village, it takes a medical home’ run by a nurse practitioner’ to make comprehensive health care work in an efficient and cost effective manner.
Defining the Medical Home Model
There are four components that comprise the Patient-Centered Medical Home (PCMH):
1) Fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership;
2) New ways of organizing practice;
3) Development of practices’ internal capabilities; and
4) Related health care system and reimbursement changes.
The intended goal of the PCMH is improving the health of individuals, communities, and populations. Additionally, the Medical Home serves to increase the value of healthcare.
The driving principle is that PCPs (NPs ‘or physicians’) are the obvious nexus from which the quality of health care can be improved. Practitioner On Healthcare Essay.
Managing Complex Patients
Providing quality care for patients that have chronic health conditions and other complex needs has arguably been a challenge for many primary care practices. Fee-for-service practices may find that they are unable to offer the best coverage for this patient population. The strategy at the foundation of the Medical Home focuses on overcoming and eliminating barriers so that patients with complex medical needs will get the quality, comprehensive, and accessible care that may be essential for the well-being of this patient population. Patients who are frail, disabled, and elderly often have to use multiple settings in order to receive adequate care. It is not surprising that their increased use of health care services may become somewhat fragmented, allow things to get lost in the shuffle, and result in less than quality care.
The patient-centered medical home model of care focuses on providing health care services that are cost-effective, high-quality, and personalized, based on the coordination of a primary care provider. Practitioner On Healthcare Essay. According to the U.S. Department of Health and Human Services, The Affordable Care Act supports patient-centered medical homes in health centers. ‘The patient-centered medical home delivery model is designed to improve quality of care through team-based coordination of care, treating the many needs of the patient at once, increasing access to care, and empowering the patient to be a partner in their own care’ (2014). The ACA, popularly known as Obamacare, provides an unprecedented opportunity to strengthen primary care and spread the medical home.
‘ Collaborative Care:
With health care being organized across various components of the health care system, patient history is carefully documented across institutions and providers. This adds the potential of better management for patients with complex needs. It also serves as a means of prevention in ordering duplicate tests and procedures.
‘ Care Plan:
Preparing and maintaining patient care plans serve to monitor the needs, concerns, goals, and progress of patients with complex needs. Medical and social information, impact on patient’s well-being, and means of helping patients achieve their desired health care outcomes benefits both patients and care providers. Practitioner On Healthcare Essay.
‘ Supporting material & patient examples:
In 2013, Jackson et al published the following in the Annals of Internal Medicine, ‘The PCMH model is being widely implemented in various health care systems and includes key principles that are encouraged in the Affordable Care Act’ This review indicated that PCMH is a conceptually sound approach to organizing patient care and appears to hold promise, especially for improving the experiences of patients and staff involved in the health care system’ (Jackson et al, 2013).
With respect to cost outcomes from PCMH interventions, a sample of specific medical homes reported the following:
‘ Community Care of North Carolina: 40% decrease in hospitalizations for asthma and 16% lower ER visit rate; total savings to the Medicaid and SCHIP programs are calculated to be $135 million for TANF-linked populations and $400 million for the aged, blind, and disabled population.
‘ Genesse Health Plan HealthWorks PCMH Model: 50% decrease in ER visits and 15% fewer inpatient hospitalizations, with total hospital days per 1,000 enrolees now cited as 26% lower than competitors.
‘ Johns Hopkins Guided Care PCMH Model: 24% reduction in total hospital inpatient days, 15% fewer ER visits, 37% decrease in skilled nursing facility days. Annual net Medicare savings of $1,364 per patient and $75,000 per Guided Care nurse deployed in a practice
(Grumbach, Bodenheimer, and Grundy, 2009). Practitioner On Healthcare Essay.
Cost Effectiveness
NPs are serving as the thought leaders in today’s medical care; they are already doing the work; the PCMH is one of the first steps in realizing the benefits/rewards of that work.
‘ Potential benefit to patients:
In addition to better coordination and quality of health care services, as well as more involvement in and accountability for their care, health care reform bolsters primary care by offering patient incentives to obtain preventive care. An annual wellness visit, like an adult checkup, will be covered; also, under the law, other additional expenses related to most preventive care will no longer be allowed. In summary, patients will have easier access to supportive health services, experience improved care, be supported toward healthy behaviors, and ultimately have better outcomes based on their care.
‘ Advantages of Medical Home to Nurse Practitioners:
Increase in fee schedule across the board. For medical homes to live up to their potential, health insurers will need to rethink how they pay and how much they pay for primary care. Indeed, payment reform is a significant aspect of the medical home model. The approach that is now used and has been used for some time is one that is a fee-for- service model, which may often lead to unnecessary services. Using the medical home model, however, the practices potentially may gain a bonus or enhanced payment, which is often associated with value, such as a higher quality of care. Practitioners are likely to see additional yearly income, and may also enjoy increased job satisfaction as well. In summary, practices enjoy access to community networks, better transition of care, decrease in treatment disparities, better use of preventive services, and increased patient satisfaction. Practitioner On Healthcare Essay.
‘ No ER:
With better access to improved services, Emergency Rooms will no longer have to serve as primary care substitutes for patients. Additionally, patients will be more likely to seek care sooner because they have access to what they need, rather than delaying care. Moreover, the growing use of community services that support prevention can help to reduce patient re-hospitalization.
Current Policy Barriers
1) State Licensing and Regulations:
In order to fully realize and implement the potential of NP-run Medical Homes, certain policy issues have continued to limit and delay the progress that is so desperately needed. Despite the Institute of Medicine’s 2011 report, The Future of Nursing: Leading Change Advancing Health, ‘Advanced practice registered nurses (APRNs) should be able to practice to the fullest extent of their education and training’ (IOM, 2011). The glitch, however, is the reality that many state licensing bodies, which regulate NP practice, have not caught up with the need and the significance of eliminating obstacles that would allow NPs to practice to the fullest extent of their abilities, training, and expertise. Indeed, approximately only one-third of the nation has laws that cover full practice authority for NPs (Hain & Fleck, 2014). The barriers are imposed in one of two ways:
‘ NPs are regulated by means of a collaborative agreement with an ‘outside health discipline’ in order to provide in patient care.
‘ NPs can only provide patient care under supervision, delegation, or team-management by an ‘outside health discipline’ (Hain & Fleck, 2014).
2) Physician Resistance and Opposition:
We have all heard the reports and claims that the U.S. is experiencing an increasing shortage of primary health care providers. Writing for Policy Matters Journal, Brown notes, ‘Medical students have strong disincentives to become Primary Care Physicians, including comparatively low pay, high levels of medical school debt, and the danger of medical malpractice suits’ (Brown, 2014). There is no reason to believe that the need for primary care health care providers is going to do anything other than escalate. The most obvious and readily available solution for the demand of primary care providers is clearly the role that NPs are already filling, and have been for some time. Practitioner On Healthcare Essay.
However, Brown further notes that this solution is repeatedly hampered by resistance froms physician groups. Brown writes, ‘The underutilization of nurse practitioners is largely attributable to legislative opposition from powerful political organizations and their associated lobbyists. Physicians organizations, including the American Medical Association, are reluctant to relinquish responsibilities, primarily for fear of losing wages to NPs’ (2014). This creates a need on the part of the physicians groups to ‘have it both ways,’ i.e., they do not want to be the remedy to the problem, nor do they want NPs to be the solution. This kind of resistance and obstinance serves to create unnecessary gridlock when it comes to quality patient care.
3) Reimbursement Policies:
Insurance companies hold a great deal of control over health care issues, which subsequently has a significant impact on both patients and health care providers. This is clearly the case with Nurse Practitioners and their ability to receive equitable reimbursement for the medical care they provide to their patients. Insurance companies have that degree of control because, for the most part, their policies are linked to state licensing and regulations. What this boils down to is a basic truth: ‘Nurse practitioners historically receive lower wages and reimbursement fees as compared to their physician counterparts. These lower payments make it difficult for NPs to financially sustain a primary care practice’ (Chapman, Wides, & Spetz, 2010).
Conclusion
NPs are on the cutting edge and have the opportunity to set the example of how medical care should be provided. The changes that we seek are not going to come without stepping forward in terms of advocacy, leadership roles, and taking an active role in how health care policy is shaped and changed in the United States.

NPs (also referred to as Advanced Practice Registered Nurses or APRNs) are one of the four roles that encompass advanced practice nursing: nurse mid-wife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. All four roles require graduate degrees in order to qualify as a practitioner. Practitioner On Healthcare Essay. In most states, NPs must be registered nurses, graduates from accredited graduate programs, and hold certification that reflects the specialized nature of the graduate program (e.g. primary care certification if graduating from a primary care nurse practitioner program).  In addition, as NPs become more commonplace in health care settings, the licensure, accreditation, and certification requirements continue to evolve in response to changing needs. In the United States, each state sets its own requirements for practice, and NPs must meet the particular state’s criteria in which they work. Because different practice requirements are confusing and in some cases can lead to inefficiencies in care, recent efforts on the part of nurse practitioner groups have been directed towards creating standards that are national in scope. For example, a new regulatory document finalized in 2008 and released by the National Organization of Nurse Practitioner Faculties, called the Consensus Model, set new national standards for core competencies, roles, and six population-based foci (individual/family health across the life span: adult-gerontology, pediatrics, neonatal, women’s health/gender, and psychiatric/mental health). Currently, states are in the process of revising practice acts, and schools of nursing are examining their APRN or NP programs to reflect the new model, which is expected to be nationally implemented by 2015 for new practitioners.[1]​​ Practitioner On Healthcare Essay.

The Evolution of the Nurse Practitioner Movement

A major factor that supported the development and evolution of the Nurse Practitioner role in the 1960s was lack of access to health services. The American public’s struggles to gain access to primary care and preventive services are certainly nothing new, and this need crosses socioeconomic lines.

previously uninsured people into the health system, those currently without health care access are not the only ones who sometimes have difficulty finding quality services. For instance, insured Americans find they cannot get urgent care or primary care health services when needed. Nurse practitioners are situated to provide greater access to high quality, reasonable cost care if allowed by state regulations to practice to the fullest extent of their knowledge and skills.

NPs are part of the constant change, however subtle, in how the public decides who has the authority to provide health care. Physicians traditionally were considered the normative providers of medical services by patients and the state. Indeed, it is the physicians’ perspective that guides much of what is understood about patients, health policies, and institutions.Practitioner On Healthcare Essay.  However, as access to physicians has dwindled, it has been midwives, nurse practitioners, and physician assistants that have emerged as primary care providers within the mainstream health care system. For example, independent nurses and lay providers were and are the norm in many rural clinics, but, until recently, not in urban academic institutions or in places with many physicians. One of the only consistencies across types of practices is the satisfaction of patients with nurse practitioner services which has always been and remains quite high.

Over the years, the role of the nurse has expanded in response to advances in scientific knowledge and changes in health care needs. As a consequence of the broadening of the role of the nurse within health care, the need for additional formal education and training became more commonplace. Such was the case with the development of the advanced practice nurses.[2]

Many contextual factors supported the development and growth of the nurse practitioner clinical role. For instance, by the 1960s, American medicine had become highly specialized with growing numbers of medical students moving into more economically and socially lucrative specialty practices. The general practitioner, long a staple for primary care in suburban and rural communities, was slowly disappearing from the health care landscape. At the same time, the demographics of the American public were changing and marked by an aging population as well as a growing number of chronically ill adults and children. Medical education, situated primarily in academic acute care hospitals, failed to reconceptualize​ medical education and residency offerings in a way that could offset the specialization trend. Practitioner On Healthcare Essay. Even the development of family practice specialties and medical schools that focused on community-based medicine could not counterbalance a trend that was supported by higher payment and status for specialists. At the same time, nurses were looking for ways to apply the skills and knowledge they already possessed through experience or their own education programs. Nursing’s growth occurred organically in clinics, as well as visiting nurse associations and private offices, where daily interactions with physician colleagues facilitated a vast amount of new and advanced knowledge and skills.  Over time, it became clear that many in the nursing profession were particularly eager to formalize further and expand their clinical practice responsibilities. In pockets across the country, in poor rural and urban areas, individual nurses and physicians began to work together in response to the shortage of primary care physicians, growing numbers of people with health insurance, and population changes to improve patient care. Soon, formal education and training programs followed at the University of Colorado, spearheaded by nurse Loretta Ford and pediatrician Henry Silver; at the University of Kansas, with Barbara Resnick and Charles Lewis and at the University of Rochester, with nurses Joan Lynaugh and Harriet Kitzman and physicians Barbara Bates and Evan Charney—the latter funded by the Division of Nursing of the U.S. Public Health Service. Practitioner On Healthcare Essay.

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As reports of these experiments were published, the number of programs for nurse practitioners grew rapidly, supported in part by federal funding through the Nurse Training Acts in the next two decades, and through the largesse of private foundations which supported new types of service models and training programs. Nursing education responded to both the opportunity for funding and to the numbers of nurses demanding access to nurse practitioner programs. The number of programs increased, and so did specialization. Early on, pediatrics and gerontology programs were the most common programs, but by the 1990s, NPs specialized in oncology, neonatology, and cardiology. Certification programs that focused on training the practitioner to work in a specific field followed specialization, and were sometimes tied to state licensure requirements.

By the early 1980s, nurse practitioner education moved into graduate programs and by 1981, most states required graduate degrees for nurse practitioner practice.  In response to the scientific knowledge explosion, programs kept adding new courses, expanding their length and their credit loads. By the turn of the 21^st century, most nurse practitioner programs credit hours far exceeded those in other graduate programs. Practitioner On Healthcare Essay. At the same time there was a growing movement towards practice doctorates in other professions and this led educators to think about new types of nurse practitioner programs. By 2005, the Doctorate of Nursing Practice (DNP) became the newest level of practitioner training, giving credit for the breadth of content in the nurse practitioner programs.

Conclusion

Today, NPs have proven their effectiveness in delivering high quality, lower cost heath care services. Health care consumers, recognizing the value of a good service flock to NPs for numerous health care needs. While it remains unclear at this time how health care reform effort will change health care delivery, it is abundantly clear that nurse practitioners will be a vital component of future American health care services.  Practitioner On Healthcare Essay.