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Another state widens NPs’ practice authority


South Dakota Gov. Dennis Daugaard, a Republican, has signed a bill that lets nurse practitioners practice independently after completing 1,040 hours of work under physician supervision.

The American Association of Nurse Practitioners reports that South Dakota thus becomes the 22nd state to enact full practice-authority legislation, which lets nurse practitioners provide services without physician supervision.

The organization says the move could save the state $71,000 annually in regulatory costs.

State policymakers are increasingly turning to nurse practitioners and physician assistants to meet the burgeoning demand for primary care.

Healthcare Dive reported: “The  {federal} Health Resources & Services Administration predicted that demand for primary care physicians would grow by 14% over a ten year period from 2010 to 2020. According to these estimates, the healthcare system needs about 241,200 primary care providers to meet that demand. Legislation that lifts restrictions on nurse practitioners could bring that figure down to 6,400.
“There are far more nurse practitioners and physician assistants graduating from training programs than there are primary care physicians. In 2016, there were a total 4,944 medical school graduates matched with primary care residencies. …Meanwhile, 17,900 nurse practitioners graduated from primary care programs in 2015.’’

To read more, please hit this link



3 emerging primary-care functions for R.N.’s

Thomas Bodenheimer, M.D., and Laurie Bauer, R.N., write in The New England Journal of Medicine about the expanding role of nurses in the primary-care workforce. Among their observations:

“Clearly, more and more patients will see an NP or a PA {physician assistant} as their primary care practitioner. Physicians will probably focus on diagnostic conundrums and lead teams caring for patients with complex health care needs. A large and growing body of research demonstrates that care delivered by NPs is at least as high quality as that delivered by physicians. In addition, patient-satisfaction scores are similar for NPs and physicians. Moreover, care may cost less when it’s provided by NPs rather than physicians: Medicare beneficiaries assigned to an NP had primary care costs that were 29 percent lower and office-visit and inpatient costs that were 11 to 18 percent lower than those of beneficiaries assigned to a primary-care physician.

“Even with the increased numbers of NP and PA graduates, the ratio of primary care practitioners to population will decline, because only 50 percent of NPs and 32 percent of PAs choose primary-care careers. Thus, other professionals will be needed to care for the growing number of U.S. adults with chronic conditions and geriatric syndromes. Enter the enhanced role of the RN.

While the NP role begins to approximate that of the physician, RNs are assuming three important emerging primary care functions: managing the care of patients with chronic disease by helping them with behavior change and adjusting their medications (e.g., for hypertension and diabetes) according to physician-written protocols; leading complex care management teams to help improve care and reduce the cost of care for patients with multiple diagnoses who are high users of health care services; and coordinating care between the primary-care home and providers of other health care services — in particular, assisting with transitions among hospital, primary care settings, and home.”

To read their whole article, please hit this link.

Greater use of primary-care NPs seen as perhaps cutting costs

study compares the cost of care provided to Medicare beneficiaries assigned to primary-care nurse practitioners and physicians. It suggests that increasing the use of nurse practitioners to meet the demand for primary-care services for Medicare beneficiaries is unlikely to cost more and may actually reduce  overall costs.

Tom G. Bartol, a nurse practitioner, perhaps not unexpectedly, writes:

“Some might argue that NP care is cheaper because the care is not as good, that NPs have fewer years of education than physicians, and that the extra cost of physician care means better care. However, more years of education does not inherently equate to better care. What this study indicates is that NPs may be providing excellent care at a better price, or more efficient care.”

“Three years ago in my family practice setting, I changed from 15-minute appointments to 30-minute appointments. This gave me time to get to know my patients better, and to have time to understand whether chest pain might be caused by anxiety or cardiac issues, or whether rising blood sugar levels meant that the patient needed more medications for diabetes or was experiencing issues at home that were resulting in poorer eating habits, stress, or unhealthy coping behaviors. Since increasing visit length, the number of prescriptions, diagnostic tests and referrals attributed to me for all of my patients has declined significantly. Using electronic health record data, I have found I write about one half as many prescriptions as the average clinician in our multiclinic practice (with 57 total clinicians), order less than one third the number of diagnostic tests, and make less than one half as many referrals.”

“The goal in healthcare must not be to give cheaper care, but to give more efficient care. Better patient-centered care, where the patient is involved and feels heard and understood, will result in the ‘side effect’ of lower-cost care. NPs are not cheaper. They have been trained to go beyond the medical condition or symptoms to the biological and psychosocial factors that may be affecting each person. This is the heart of nursing. Investing more time in patient care is a key to achieving the triple aim of quality, cost, and patient experience.”

NPs do well vs. physicians in diagnostics study



A comparison of the diagnostic abilities of physicians and nurse practitioners in New Zealand found that  the latter were almost as good in diagnosis as the doctors in a complex inpatient case of a seriously ill man.

The correct diagnosis was made by 61.9 percent of physicians and 54.7 percent of NPs. The correct problem was identified by 56.3 percent of physicians and 53.3 percent of NPs. The correct actions were identified by 34.4 percent of the physicians and 35.8 percent of the NPs.

The study concluded that NP diagnostic reasoning in a complex-case scenario compared favorably with that of physicians.

Such studies, of course, give more firepower to U.S. hospital C-suites seeking to use more NPs and fewer physicians because the former, while well paid, aren’t anywhere nearly as well compensated as physicians. The latter are by far the highest paid doctors in the world.

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