Health Coverage Expansion Spurs Pressure to Address Provider Shortage Dave Mason, Mason Consulting, LLC Enrollment in insurance coverage under the health reform law’s new marketplaces is only 6 months away. In spite of the political controversy and administrative complexity of creating these new markets, at least 30 million uninsured Americans will begin to gain access to health care coverage through insurance exchanges and expanded Medicaid eligibility. Alarm is spreading among Washington policy makers that the nation will face a critical shortage of primary care providerseand many are recognizing that nurse practitioners are essential to filling that gap. Senator Bernie Sanders (I-VT) called attention to the problem at a January 29th hearing of the Senate Health, Education, Labor, and Pensions Subcommittee on Primary Health and Aging. Sanders, who chairs the subcommittee, released a staff report warning that the shortage of primary care physicians would increase from 16,000 today to a shortfall of at least 52,000 by 2025, concluding: “we must take steps now to address the primary care access crisis in America.” Sanders’ hearing highlighted disagreements among physicians about changing federal funding for grad- uate medical education. George Washington University health policy professor and pediatrician Fitzhugh Mullan told the subcommittee that using Medicare Graduate Medical Education (GME) dollars in a “more constructive, pro-primary care fashion” could be the most important step to increase the number of primary care physicians. But the Associa- tion of American Medical Colleges argued that previous attempts to influence specialty choice through Medicare GME payments have failed. The subcommittee report offers a number of recommendations, including expanding community health centers, increasing opportunities for education and residences in primary care in community settings as opposed to teaching hospitals, encouraging careers in primary care, and increasing the number of schol- arship and loan repayment opportunities. It also recommends expanding the role of nurse practitioners and physician assistants to boost the primary care workforce, observing that nurse practitioners currently make up 19% of the nation’s primary care workforce and are “safe, effective, and improve access to care.” The Medicare Payment Advisory Commission (MedPAC) has also expressed concern about the shortfall of primary care providers to treat Medicare beneficiaries. This spring, the panel is examining the Institute of Medicine’s (IOM) recommendations in its landmark 2010 report, “The Future of Nursing: Leading Change, Advancing Health.” AANP met with the commission’s staff in February to discuss the IOM recommendations and stressed the importance of nurse practitioners in providing primary care to underserved populations and in provider shortage areas. The association reinforced the IOM proposals to eliminate senseless barriers to NP practice, including laws and regulations that prevent NPs from practicing at the full extent of their education and clinical preparation. MedPAC has also been interested in changing Medicare GME funding and payment policies to incentivize the training of more primary care physi- cians. But the panel is also interested in Medicare’s current demonstration funding graduate nursing education and may consider recommending expand- ing Medicare policies to educate a full range of primary care providers to meet projected shortages. While it isn’t clear how Congress or the administra- tion will respond, pressure is increasing on federal policy makers to remove obstacles that prevent nurse practitioners from helping to solve the nation’s primary care needs. A11 A A N P FORUM
Transcript
Health Coverage Expansion SpursPressure to Address Provider Shortage
Dave Mason, Mason Consulting, LLC
A A
N P
FOR
UM
Enrollment in insurance coverage under the healthreform law’s new marketplaces is only 6 months away.In spite of the political controversy and administrativecomplexity of creating these new markets, at least 30million uninsured Americans will begin to gain accessto health care coverage through insurance exchangesand expanded Medicaid eligibility. Alarm is spreadingamong Washington policy makers that the nation willface a critical shortage of primary care providerseandmany are recognizing that nurse practitioners areessential to filling that gap.
Senator Bernie Sanders (I-VT) called attention tothe problem at a January 29th hearing of the SenateHealth, Education, Labor, and Pensions Subcommitteeon Primary Health and Aging. Sanders, who chairs thesubcommittee, released a staff report warning that theshortage of primary care physicians would increasefrom 16,000 today to a shortfall of at least 52,000 by2025, concluding: “we must take steps now to addressthe primary care access crisis in America.”
Sanders’ hearing highlighted disagreements amongphysicians about changing federal funding for grad-uate medical education. George WashingtonUniversity health policy professor and pediatricianFitzhugh Mullan told the subcommittee that usingMedicare Graduate Medical Education (GME) dollarsin a “more constructive, pro-primary care fashion”could be the most important step to increase thenumber of primary care physicians. But the Associa-tion of American Medical Colleges argued thatprevious attempts to influence specialty choicethrough Medicare GME payments have failed.
The subcommittee report offers a number ofrecommendations, including expanding communityhealth centers, increasing opportunities for educationand residences in primary care in community settingsas opposed to teaching hospitals, encouraging careers
in primary care, and increasing the number of schol-arship and loan repayment opportunities. It alsorecommends expanding the role of nurse practitionersand physician assistants to boost the primary careworkforce, observing that nurse practitionerscurrently make up 19% of the nation’s primary careworkforce and are “safe, effective, and improve accessto care.”
The Medicare Payment Advisory Commission(MedPAC) has also expressed concern about theshortfall of primary care providers to treat Medicarebeneficiaries. This spring, the panel is examining theInstitute of Medicine’s (IOM) recommendations in itslandmark 2010 report, “The Future of Nursing:Leading Change, Advancing Health.” AANP metwith the commission’s staff in February to discuss theIOM recommendations and stressed the importanceof nurse practitioners in providing primary care tounderserved populations and in provider shortageareas. The association reinforced the IOM proposalsto eliminate senseless barriers to NP practice,including laws and regulations that prevent NPs frompracticing at the full extent of their education andclinical preparation.
MedPAC has also been interested in changingMedicare GME funding and payment policies toincentivize the training of more primary care physi-cians. But the panel is also interested in Medicare’scurrent demonstration funding graduate nursingeducation and may consider recommending expand-ing Medicare policies to educate a full range ofprimary care providers to meet projected shortages.While it isn’t clear how Congress or the administra-tion will respond, pressure is increasing on federalpolicy makers to remove obstacles that prevent nursepractitioners from helping to solve the nation’sprimary care needs.
A11
A12
A A
N P
FO
RU
M
State of the States
Tay Kopanos, DNP, NP, Vice President of Health Policy/State Government Affairs
NPs and Team CareThe convergence of multiple factors has policy makerslooking to NPs as safe, ready-made, no-cost, no-delaysolutions to the primary care provider workforcechallenges that many states are facing. The willingnessof policy makers to modernize state practice laws hassome organized physician stakeholder groups pushingfor state licensure laws that require the formation ofa care team in order for NPs to provide patient care.
While AANP supports the use of care teams asdelivery models, AANP does not support linkingindividual NP licensure and practice to a team. Statu-torily required teams restrict the ability of patients to getfull and direct care from NPs and exacerbate theworkforce and geographic disparities that are plaguingour current health care delivery system.
Table 1. IOM Identified Principles of Team-Based Hea
Shared goals: The team—including the patient and, whe
persons—works to establish shared goals that reflect pati
understood, and supported by all team members.
Clear roles: There are clear expectations for each team m
accountabilities, which optimize the team’s efficiency and
of division of labor, thereby accomplishing more than th
Mutual trust: Team members earn each others’ trust, cre
opportunities for shared achievement.
Effective communication: The team prioritizes and contin
consistent channels for candid and complete communicat
across all settings.
Measurable processes and outcomes: The team agrees o
successes and failures in both the functioning of the team
to track and improve performance immediately and over
Mitchell, P., M. Wynia, R. Golden, B. McNellis, S. Okun, C.E. Webb, V. Rohrbach, and I. VonPaper, Institute of Medicine, Washington, DC. www.iom.edu/tbc.
So what makes a good team?To help answer that question, the IOM recently
published “Core Principles & Values of EffectiveTeam-Based Health Care.” In the paper, the IOMauthors noted that team care needs to be flexible,have all members functioning at the highest level oftheir education and skill, integrate core principles(as detailed in Table 1), and should be targeted tosituations where the patient care benefit willoutweigh the economic and time costs ofteam care.
To read more on teams and the role of the NPteam care delivery models, visit the AANP policytoolbox on www.aanp.org and download “CorePrinciples & Values of Effective Team-BasedHealth Care.”
lth Care
re appropriate, family members or other support
ent and family priorities, and can be clearly articulated,
ember’s functions, responsibilities, and
often make it possible for the team to take advantage
e sum of its parts.
ating strong norms of reciprocity and greater
uously refines its communication skills. It has
ion, which are accessed and used by all teammembers
n and implements reliable and timely feedback on
and achievement of the team’s goals. These are used
time.
Kohorn. 2012. Core principles & values of effective team-based health care. Discussion
AANP 2013 National NursePractitioner Health Policy
ConferenceBy all accounts, the 2013 AANP National Nurse PractitionerHealth Policy Conference, held February 24-26 in Wash-ington, DC, was a huge success. More than 200 NPs attendedthe 3-day meeting to discuss legislative issues, meet withleadership on Capitol Hill, advocate for legislation affectingNP practice, and network with friends and colleagues fromaround the country. The high-energy gathering was a greatbeginning for the “new” AANP and set the pace for futureparticipation by NPs as true advocates for both their role asproviders of high-quality health care and for their patients.
Sessions on the first day of the conference addressed majorpolicy issues in health care and how they impact NPs, withtopics ranging from challenges in multistate reimbursement tochanges in NP scope of practice regulation and relationshipswithin the workplace. A luncheon presentation by BrandeEllis of Eli Lilly and Company discussed “Risk EvaluationMitigation Strategy.” That afternoon, attendees learned howNPs fit into ACOs, heard about AARP’s involvement inaction coalitions through their “Campaign for Action,” andlearned about the role of money in politics and policy. Asession on policy messages for Capitol Hill visits ended the firstday’smeetings. AnAANPPAC fundraiser was held on Sundayevening featuring a silent auction and raffle. Among the manyitems offeredwere aCoach briefcase, a basket of gift cards fromrestaurants and shops, a signed, framed letter from EleanorRoosevelt, 3 glassWhite House Easter eggs, an Air Force Onethrow, and a framed, signed photograph from Milvina Dean,the youngest survivor of the Titanic. The PAC raisedapproximately $8,500 from the event. Thanks to all whoparticipated and helped to make the evening a success.
The second day of the conference began with a look atcompetition in health care through the role of the FederalTradeCommission (FTC). TheHealthResources and ServicesAdministration (HRSA) then shared information on keyhealthcare issues for 2013. Mara Liasson, National Political Corre-spondent for National Public Radio (NPR) and Fox NewsContributor, delivered the luncheon speech on what the 2013political environment means for the country and for healthcare. Afternoon sessions focused on theCenters forMedicare&Medicaid Services (CMS) priorities for 2013 and endedwith anopen forum on how to effectively lobby theHill. The final dayof the conference sawparticipants attending amorning politicalfundraiser and preparing for visits to legislators and their staff onCapitol Hill to discuss legislative priorities for NPs and theirpatients.
Chief among the top priorities was improving access tohigh-quality health care for all Americans. “With theshortage of primary care physicians and increasing demandfor health care services, it is critical that federal policyempower NPs to practice to the full extent of their educa-tion and experience,” said AANP President Angela Golden,DNP, FNP-C, FAANP. “Legislators should expect to hearmore from AANP leaders and members about the necessityof key policy changes.”
The 2013 Health Policy Conference was such a successthat we are already planning the 2014 event. More infor-mation will be available as plans are developed andconfirmed. We thank everyone who participated in the 2013conference and invite you to view photos from the event athttp://bit.ly/ZX17iB.
AANP Unveils FederalHealth Policy Team
AANP is pleased to announce the creation of a new teamthat will lead the organization’s federal health policy efforts.Based in the Washington, DC metro area, the team willinclude professionals fromwithin AANP and policy expertsfrom outside the organization. Jan Towers, PhD, NP-C,CRNP, FAAN, FAANP, has accepted the position ofSenior Policy Advisor and will continue to help shape theorganization’s federal health policy efforts. Throughout hercareer, she has worked to advance federal legislative andregulatory efforts that benefit NPs and their patients sincehelping to establish the American Academy of NursePractitioners in 1985. MaryAnne Sapio joined AANP inearlyMarch andwill lead the organization’s lobbying effortsas Vice President of Federal Government Affairs. A veteranof Washington policy and politics, Sapio previously served
as Senior Director of Government Relations and FederalAdvocacy for the American Health Care Association(AHCA). She also served as a consultant to the AmericanAssociation of Colleges of Nursing (AACN), where shedeveloped and implemented federal legislative and regula-tory initiatives involving appropriations, nursing education,mental health funding, higher education, and biomedicalresearch. Having previously served with the AmericanCollege of Nurse Practitioners (ACNP), Debra Swan willcontinue advancing the role of NPs in her new position asAssociate Vice President of Federal Government Affairs. Analumna of IndianaUniversity, Swan is a former Capitol Hillstaffmember for IndianaCongressman JohnBrademas,whoserved in theUSHouse of Representatives for two decades.For more information, read the press release at aanp.org.
The CECenter offers more than 100 programs on a varietyof topics, including professional issues, acute and chronicillnesses, and health promotion to enhance the knowledge
and skills of NPs, as well as help meet the CE requirementsfor licensure and certification. We encourage you to checkthe CE Center often for newly added programs.
Opportunity for NP AuthorsDo you have a practice focus on musculoskeletal issuesand have a desire to publish an article for CE? If so, wecurrently have an open call for manuscripts for theupcoming issue of our new online, peer-reviewed CEpublication, NP Professional Practice Compendium. Eachissue focuses on a general topic and the next will be
musculoskeletal issues. The deadline for manuscriptsubmission on this topic is June 28, 2013. To learn moreabout the requirements and the process for submission,access the Compendium Call for Manuscripts or [email protected]. We plan to announce the topicsfor the Fall and Winter editions soon.
Florida AHCA Appoints NursePractitioner to Advisory Board
AANP member Stan Whittaker, an NP and Board Chairof the Florida Association of Nurse Practitioners(FLANP), has received an appointment to the Agency forHealth Care Administration’s Medical Care AdvisoryCommittee. Federal law requires each state to establisha committee to serve in an advisory capacity on issues
pertaining to Medicaid. Members may be asked to reviewor provide input on issues pertaining to Medicaid,including rules and regulations. Whittaker is the first NPappointed to this board and will draw on his past expe-rience in reviewing agency rules and consumer access tocare advocacy work.
Heart Matters: Livingwith Atrial Fibrillation
The new “Heart Matters: Living with Atrial Fibrillation”toolkit includes educational material created by expert NPsto support your education of patients at-risk for or diag-nosed with atrial fibrillation. AANP produced this educa-tional toolkit with support from Boehringer Ingelheim
Pharmaceuticals, Inc. A limited supply of hard copies of thekit, which includes references and talking points for clini-cians, is available for order. Copies are also available todownload. To learn more, go to the following URL:http://www.aanp.org/education/education-toolkits.
Job Postings Have Soaredon AANP CareerLink
There are now over 1,000 available positions on our jobboard, averaging 300 new jobs each month. Find yourlife’s calling and explore the career center to see what’savailable right now. Registering with AANP CareerLink
provides job seekers the perfect place to search relevantpositions for their next career move. Find jobs easily andquickly without sifting through irrelevant nursing jobs.Visit www.healthecareers.com/aanp today!
