Healthcare Affordability in the US

Healthc ar Affordability in the USAdvanced Nurse Practitioner Scope of Practice IssuesMarina Bukhrashvili bran-new York State needed an additional 1,200 physicians to maneuver the shortage by 2012, according to a 2012 Haneys survey by the Healthcare Association of New York State (Verdon, Ritchie, Marbury Mazzolini, 2014). The scope of Certified Nurse Practitioner (CNP) suffice is reliablely debated in somewhat states. In New York State, the Nurse Practitioners Modernization Act will allow those harbours who corroborate more than 3,600 hours of experience to litigate patients without the supervising physicians signed praxis agreement (Farmer, 2014).This act will become justness on January 1, 2015. This act may fill that void however, various New York physician advocate groups reside to argue that patient natural rubber will be compromised because of the gap in training of CNPs (Verdon et al., 2014).The United States (U.S.) wellness care system faces many challenges due to demographical, economic and political shifts. There are make iting gaps in quality and accessibility of care and patient safety. U.S. population is aging rapidly and it is estimated that about 18 per centum of the U.S. population will be 65 years old or older by 2025 (U.S. number Bureau, 2012). With growing number of Medicare beneficiaries, there will be more beseech for autochthonic care providers. It is estimated that by 2020, the U.S. nation will solicit 40 percent more firsthand care providers (Hauer et al., 2008). U.S people 65 and older will have more than one chronic disease and physicians shortages will not reckon the demands that are expected (Centers for Disease command and Pr tied(p)tion, 2012).The National Governors Association (NGA) reviewed of the literature and summarized that CNPs can reduce disparities in access to care, promote terms effectiveness through policy advancement, patient advocacy and the development of forward-looking models of care to improv e patient care (NGA, 2013). The push for giving CNPs more autonomy continues with the shortage of first care physicians on the rise. The American Academy of Family Physicians (AAFP) is not supporting the idea of allowing CNPs the full scope of practice without working under the physicians supervision. One of the reasons cited is that family physicians have extensive training and education, which would ensure patients safety and provide the best quality of care (American Academy of Family Physicians, 2012). The scope of CNPs practice is authorizedly debated in some states.Researchers studied care provided by both(prenominal) nurse practitioners and physicians and showed that while quality of care was similar for both providers, patients results were same or better for NPs as compared to physicians (Bauer, J. 2010). In addition, it was found that nurse practitioners provide care at a move exist as well as more disease prevention counseling, wellness education, and health promotio n activities than physicians (Mehrota et al., 2009).Another study which used data from the Association of American Medical Colleges Consumer heap showed that consumers are open to the idea of obtaining medical care from NPs (Dill, Pankow, Erikson Shippman, 2013). Compared to physicians, CNPs traditionally are reimbursed at a lower Medicare regularize for delivery of the same services. Yet, while our healthcare desperately needs to reduce cost, it is estimated that a cost savings would remain, even if CNPs were to receive equivalent reimbursement, because they utilize fewer resources than physicians (Health Policy Brief, 2012).In 2009, on average, it cost 20% little to visit a nurse practitioner than to visit a physician (Eibner, Hussey, Ridgely Glynn, 2009). In Massachusetts, after the insurance reform was implemented, it was shown that the state could save from $4.2 to $8.4 exciteion over a 10-year period when nurse practitioners use was increased (Eibner et al., 2009).Accoun table care organizations (ACA), community and nurse-managed health centers, patient-centered medical homes success will require that CNPs have full scope of practice to have the ability to practice sovereignly without restrictions (Fairman, Rowe, Hassmiller, Shalala, 2011). Organizational barriers exist for reimbursements of care provided by CNPs. Notwithstanding that the quality and standards of preventing care scoreed in the ACA are met by these providers, their current rate of reimbursement for Medicare services to residents in long term care (LTC) facilities is only 85 percent of the rate that physicians charge for the same services (American Association of Nurse Practitioners, 2013).The unlimited contribution of CPNs will be even more important considering that with the implementation of the ACA, millions of newly insured Americans will seek the access to healthcare. Expanding the scope of practice of advanced practice nurses can possibly translate to an increased access to healthcare for many current and future patients, especially in underserved areas (National Governors Association, 2012).There is a need for the uniform standards for practice and to eliminate the dissimilarity in the level of practice among CNPs from one state to another (NGA, 2012). The scope of practice will establish which activities are reimbursed by third party payers and will have direct impact on the independent practice of CNPs (NGA, 2012). When CNPs are required to gather or to be supervised by the physician, they are less likely to be selected by insurers and are unable to directly bill for the services they render (NGA, 2012). Instead, the bill for their services is coded under the physicians provider number. If the requirement for physician involvement is dropped, CNPs would be allowed to be credentialed as providers and directly reimbursed for their services. This is also important if a physician moves or does not want to collaborate with a CNP.Another issue related t o scope of practice is the lack of universal, federal recommendations for mobility across states for practitioners tough in telemedicine. The significant discrepancy in CNP scopes of practice across states limits the ability of expert CNPs to work as consultants in a different state, which may limit the access of individuals to specialty consultations that may not be available locally. In their study of nurse migration, it was reported that nurses, including CNPs, move to states with less restrictive scopes of practice. Migration of CNPs may add together to the shortage of primary care providers, especially in disadvantaged areas (Kalist, Spurr, Wada, 2010). Nurses are restricted to certify in some state to do health care visits or stay in skilled care for facilities, admit patients to hospitals or prescribe medications without physicians supervision and because of that nurses move to less restrictive states, and from primary to specialist care, a resulting loss of access to car e a lot of patients (Eibner et al., 2009).With millions of people signing up for health care under the Affordable Care Act, the aging population and number of chronic illnesses growing, the demand for primary care services is projected to grow. NPs will play a significant part in expansion and shaping of health care delivery. The looming shortage of primary care practitioners can be alleviating by integrating into health care delivery primary care nurse practitioners and physicians assistants. Medical profession should have an active interest in advancing the role of NPs and making sure that the high standards of the profession are intact. While NPs should not be a replacement for doctors they should be allowed to practice to the full extent of their training. relaxing the scope of practice laws that prevent nurse practitioners from playing the important role in providing basic primary health care services is the first step that should be undertaken.ReferencesAmerican Association o f Nurse Practitioners (2013). Issues at-a-glance plentiful practice authority.Retrieved from http//www.aanp.orgAssociation of Advanced Nursing Practice Educators. (2009).Universities and advanced practiceprogrammes. Retrieved fromhttp//www.aanpe.org/AANPEHEIsMembers/AANPEMemberUniversitiesCoursesProgrammes/tabid/469/language/en-US/Default.aspxBauer, J. (2010). Nurse practitioners as an underutilized resource for health reform Evidence-based demonstrations of cost-effectiveness. Journal of the American Academy of NursePractitioners 22 (2010), 228-231.Centers for Disease Control and Prevention (2012). Chronic diseases and health promotion.Retrieved from http//www.cdc.gov/chronicdisease/overview/index.htmDill, M., Pankow, S., Erikson, C., Shipman, S. (2013). Health Affairs. Retrieved fromhttp//content.healthaffairs.org/content/32/6/1135.abstractThe Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care. (2012)Retrieved fromhttp//www.nga.org/cms/home/nga-center-for- best-practices/center-publications/page-health-publications/col2-content/main-content-list/the-role-of-nurse-practitioners.htmlThe, O. C., Pr, N. (2012). Education and Training Family Physicians and Nurse Practitioners.Retrieved fromhttp//www.aafp.org/dam/AAFP/documents/ watchword/NP-Kit-FP-NP-UPDATED.pdfEibner, C.E., Hussey, P.S., Ridgely, M,S., McGlynn, E,A. (2009). Controlling health carespending in Massachusetts an analysis of options. Retrieved fromhttp//www.rand.org/pubs/technical_reports/2009/RAND_TR733.pdfFairman, J., Rowe, J., Hassmiller, S., Shalala, D. (2011). Broadening the scope of nursepractice. New England Journal of Medicine 364(3), 193-196.doi10.1056/NEJMp1012121Farmer, R., (2014) Milestone New York legislation eases practice restrictions on NPs.Retrieved fromhttp//news.nurse.com/ expression/20140505/NY02/305050020.VGAJdMnsoh0Hauer, K.E., Durning, S.J., Kernan, W.N., Fagan, M.J., Mintz, M., OSullivan, P.S.Schwartz,M.D. (2008). Factors associated with medical stu dents career choices regarding internalmedicine. JAMA, 300(10), 1154-1164.Kalist, D., Spurr, S., Wada, T. (2010). Immigration of Nurses. Industrial Relations A Journalof providence and Society, 49(3), 406-428.Mehrota, A. et al. (2009). Comparing Costs and Quality of Care at Retail Clinics with that ofOther Medical Settings for 3 ordinary Illnesses. Annals of Internal Medicine, 151, 321-323.Nurse Practitioners and Primary Care. (2013). Retrieved fromhttp//www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79Sealey, G. (2014). U.S. Elderly to Double in 25 Years. Retrieved fromhttp//abcnews.go.com/US/story?id=91943page=1U.S. Census Bureau, Statistical Abstract of the United States 2012 (131st Edition) Washington,DC, 2011. Retrieved from http//www.census.gov/compendia/statab/.Verdon, D., Ritchie, A., Marbury, D., Mazzolini, C. (2014). (Slideshow) Scope of practicedebate in primary care spreads to 8 states. Retrieved fromhttp//medicaleconomics.modernmedicine.com/medical-econ omics/content/tags/midlevel-providers/slideshow-scope-practice-debate-primary-care-sprea?page=full