Advanced Nurses Lower Costs, Improve Care
By Bill Novelli and Sheila Burke
As our nation prepares to implement the bulk of the provisions of the Affordable Care Act, the issues of access to care and unsustainable cost continue to loom large. What can we do about an aging population with increasing chronic health issues and millions more needing care? How can we meet the increasing demand, maintain quality and not break the bank?
Legislators looking for solutions to these questions can unleash the skills of nurse practitioners by removing regulatory barriers that prevent them from practicing to the top of their education and training.
Studies find that Advanced Practice Registered Nurses who provide preventive care are as effective as primary-care physicians in accuracy of diagnosis and prescription. On indicators such as controlling patient blood pressure and glucose levels and reducing hospital re-admissions, APRNs often score higher than physicians. Benefits to long-term-care patients managed by APRNs include fewer falls, fewer urinary tract infections and fewer pressure ulcers.
In addition to providing high-quality care, nurse practitioners can reduce the cost per patient by about one-third, according to a government study, especially when they see patients independently.
It’s not just the research that tells us this, but patients, too. As one patient, Froma Harrop, writes in an op-ed published in The Columbus Dispatch last month: “I went to a superb nurse practitioner for years. … When I had a complaint she considered beyond her expertise, out came her pad and the name of a specialist to call. Her accessibility was a big plus. … Sometimes we need a doctor; sometimes we don’t. A well-trained nurse practitioner can help point us in the right direction.”
Despite this evidence, the laws regulating the care nurse practitioners can provide are a widely varying patchwork. Sixteen states and the District of Columbia allow nurse practitioners to practice independently. Yet many more states still have barriers to independent practice, including Florida, Ohio and Pennsylvania. For many states, removing barriers to care is a way to address care shortages in rural areas, where physicians are hard to find. But the issues are no longer restricted to rural or traditionally under-served communities. Access to care is a problem we are all facing, in every state, in every community.
There are just over 180,000 APRNs in the United States, most of them in primary and long-term care. APRNs complete a four-year nursing program, an advanced degree and two years of clinical training with an emphasis on diagnostics for primary care. APRNs are not substitutes for physicians, but extensive research finds they are able to handle 80 percent to 90 percent of primary care cases — and achieve outstanding results. APRNs can handle the vast majority of primary and preventive care needs and leave the more complex cases to physicians. This is a win-win situation, that frees nurses and physicians to spend more time with the patients who need them most.
Utilizing APRNs provides the fastest and most cost-effective strategy for meeting the health and health care needs of millions more Americans. That’s why legislation is pending in 14 states to unleash the potential of nurse practitioners.
This is good economic and health policy. By 2020, it is estimated that the primary-care physician shortage could be as high as 52,000. In order to utilize APRNs, we must remove legal barriers and change Medicare regulations, hospital privileges and payer reimbursement policies accordingly. This is a complicated task, and it doesn’t help that there are some in the medical profession who oppose expanding the role of nurse practitioners.
Fortunately, many physicians, nurses, businesses, payers and health and advocacy organizations recognize the importance of ensuring that every clinician practice to the top of his or her training. They include The American Hospital Association, AARP, the Robert Wood Johnson Foundation, Aetna, UnitedHealth Group, America’s Health Insurance Plans, the AFL-CIO, and many others. In a recent report, the National Governors Association recommended that states ease their scope-of-practice restrictions and modify reimbursement policies to increase the role of nurse practitioners in providing primary care. And AARP and the Robert Wood Johnson Foundation launched The Future of Nursing: Campaign for Action to create a more patient-centered system of care by maximizing the role of nurses.
Millions of Americans need help maintaining healthy lives or managing chronic conditions. Millions of older people need care in their homes. And millions of soon-to-be-insured patients need a health care provider with the time and training to listen, diagnose and educate. Unleashing the skills of nurse practitioners will improve health care. It is the right thing to do and it is the right time to act.
Article also featured on Politico.
Sheila Burke is a senior faculty research fellow at the Malcolm Wiener Center for Social Policy, Harvard University, and the chairwoman of the Future of Nursing: Campaign for Action strategic advisory committee. Bill Novelli is professor in the McDonough School of Business at Georgetown University and a member of the Future of Nursing: Campaign for Action strategic advisory committee.