ADVANCE Voice: NP

Inside Look at a Retail Clinic

2008-07-01T17:28:00Z

Have you been wondering what the inside of a retail health clinic looks like?

A video is included in this Rockford (Ill.) Register Star article about some recently opened Take Care clinics in Illinois. See what it's like behind the clinic door. More about this clinic can be found at this healthyrockford.com link.

Customer Service in Health Care

2008-06-30T19:59:00Z

A rather controversial topic among NPs talking about retail health is the value of consumer service in health care. Some say the patient's experience and comfort are just as important as their care, and others say care is the ultimate goal. A leading example in this discussion is the instance of a patient who shows up claiming to need an antibiotic and who then gets upset with the NP for not prescribing it because it wasn't necessary.

Retail health, by default, is a consumer-driven industry that hinges on customer satisfaction. NPs must carefully balance patient satisfaction with correct care. In an article featuring Take Care Health founder Hal Rosenbluth, he says he believes customer service needs a prominent place in health care:

The healthcare industry has not been known for a long time for providing excellent service, and the travel industry never has. I was fortunate in the past to surround myself with phenomenal people and lead a company that was recognized for providing fantastic service in the travel industry. We're looking to replicate that in healthcare.

Yet the customer service he touts doesn't involve the health care the NP is providing. At Take Care, when you sign in at a kiosk and there is a wait of 30 minutes or longer, the system suggests another clinic down the road with no wait (that is, it will when there are that many clinics to choose from). It remains to be seen how exactly a customer service focus will affect health care, if at all.

Arizona NPs Continue Controversial Procedure

2008-06-30T16:02:00Z

Am Arizona bill to block NPs from performing aspiration abortions failed by a vote of 14 to 12 in the Senate this session. The Douglas Daily Dispatch reported on legislative action in Arizona, including this bill, in "Arizona Legislative Briefs." The Tucson Daily Star reported on it here. One NP in particular, an employee of Planned Parenthood, was targeted by this legislation. Mary Andrews, NP, had for eight years been performing aspiration abortions into the 16th week of pregnancy. The Arizona Board of Nursing approved the practice, but has limited the timeframe to up to 13 weeks.

We blogged about this previously (see here to read the post). Physicians opposing this NP's actions claim that it is because abortion is a surgical procedure and therefore NPs should not be performing them. The question this raises for us is, does publicity about NPs performing this one controversial procedure promote or harm public awareness of NPs?

Many Still Question DNP at AANP Conference

2008-06-29T12:07:00Z

Jan Towers, director of health policy for the American Academy of Nurse Practitioners, led a session on the doctorate of nursing practice degree. She noted that far fewer NPs were in attendance to the session at this year's conference. "That's a good thing," she said, because there was much heated discussion, which at times was angry, in the session addressing the DNP last year.

About 20 session attendees raised their hands when Towers asked if there were any DNP students in the room. Towers went on to explain DNP essentials, the competencies that NONPF developed for accrediting DNP programs, and why the AANP opposes a DNP certification exam developed by the National Board of Medical Educators. She announced that seven NP groups, all member organizations, came together this month to write a position paper on three topics: the DNP, credentialing, and using the title "doctor." It is remarkable that so many groups were able to come together to put forward a unified statement.

In the Q&A session, attendees voiced concerns about not being respected as equal to DNPs. Towers responded that NPs will need to ramp up their public education, explaining that the DNP degree simply better reflects the content that was already packed into the master's-level NP programs.

NP and PA Collaboration Discussed at Conference

2008-06-27T21:42:00Z

Members of the ADVANCE for Nurse Practitioners staff, namely myself and Managing and Web Editor Jill Rollet, are in attendance at the American Academy of Nurse Practitioners (AANP) conference in National Harbor, Maryland. Over 3,500 inquisitive NPs are bustling about the grandiose new Gaylord on the Potomac resort and conference center, eager to learn and connect with one another.

I attended a session this afternoon that addressed the topic of NP and PA professions working together. Mary Jo Goolsby, director of research and education for the AANP, and Greg Thomas, vice president of professional education and alliance development for the American Academy of Physician Assistants (AAPA), presented their thoughts. Both Goolsby and Thomas stressed the collegial relationship between AANP and AAPA, but both also stressed that NPs and PAs, because they practice on two distinct models of care, cannot speak with one voice. "We work very well together, and though organizations may use 'competitor' langage, that's not the case," Goolsby said.

Thomas said that the PA profession is dedicated to the concept of working as a team with physicians as leaders, and that wasn't going to change. But collaboration to a point is effective, he believes. He noted that learning from NPs' work to achieve legislative victories related to independent practice and prescribing status is beneficial to PAs, because, although PAs aren't working to change their supervision or prescriving status, they do need to educate the public on the profession, and NPs "are better at public awareness."

The topic of specialty practice arose, as well. Thomas said that PAs don't need certification in specialties to work in that capacity, and can easily switch specialties. A member of the audience commented that NPs certified in a specialty face challenges if they wish to change specialties because there are now multiple certification exams for different specialties. "Learn from us - don't do it!" said the audience member.

Stay tuned for more on-site blog coverage of the AANP conference.

AMA: Cigarettes and Banana Peels Are Hazardous

2008-06-24T19:59:00Z

On June 17, the AMA adopted resolutions at their annual House of Delegates meeting, including a resolution to ban the sale of tobacco products in stores that operate retail health clinics.

The Wall Street Journal Health Blog (read the post) spoke with William A. Dolan, a surgeon on the AMA board of trustees, who claims that selling tobacco in the same location as a clinic providing health care "would be akin to me spreading banana peels all around my office area, and having people break things."

If this comparison is extrapolated, Dolan believes that if a store sells tobacco and also operates a retail clinic, it is creating business for itself by encouraging patients to smoke and then offering smoking cessation education and products.

The Convenient Care Association (CCA), which represents the retail health industry, believes that adding health care to these settings can only help patients who are trying to quit smoking. CCA executive director Tine Hansen-Turton said in a statement, "We do not understand how forcing retailers to choose between having an in-store clinic and selling tobacco products serves the broader goal of providing consumers with easier access to high-quality, affordable healthcare."

Legislation banning tobacco sales in stores with retail clinics has been proposed in several states, and the AMA hopes that this resolution will help those states to achieve their goals.

Another Backer for Single-Payer Health Insurance

2008-06-24T14:06:00Z

The press release below hit my inbox this morning. Whatever you think of the single-payer national health insurance model, support for it is growing among people with influence.Lots of folks have their fingers crossed for real health care reform after this fall's elections.

Nurse practitioners are such a good deal that they're being included in state initiatives - see Pennsylvania's reform model for an example. It's your responsibility to remain informed about the different options and speak up for NPs.

Here's the full press release from Physicians for a National Health Program:

For immediate release:

June 23, 2008

Contacts:

David Prensky, D.D.S.,(561) 242-3424

Quentin Young, M.D.,(312) 782-6006, info@pnhp.org

U.S. Conference ofMayors Backs Single-Payer National Health Insurance

The U.S.Conference of Mayors, meeting in Miami, adopted a resolution this morning insupport of single-payer national health insurance.

The assembly, inunanimous vote, backed a resolution calling for the enactment of the"United States National Health Insurance Act," H.R. 676. The bill,which is also known as the "Improved and Expanded Medicare for AllAct," is sponsored by Rep. John Conyers of Michigan and 90 other membersof Congress.

"This is amajor achievement, a qualitative change in the movement for genuine health carereform," said Dr. David Prensky, a retired dentist from Palm Beach, Fla.,who helped promote the resolution. Prensky is a member of the Chicago-basedPhysicians for a National Health Program (PNHP).

"It showsthat our country's mayors now support the kind of approach that every otherindustrialized country has - an approach that guarantees health care foreveryone at an affordable cost," he said.

"Mayors, in avery real sense, are closer to the people than most elected officials,"Prensky continued. "They are closer to the grassroots, where theircommunities and constituents are suffering. Meanwhile their city budgets arebeing shattered by health costs for their own employees."

Conyers' billwould guarantee everyone care for all medically necessary services, containcosts by slashing the administrative waste and bureaucracy associated with theprivate insurance industry and assure patients their choice of doctor andhospital.

The resolution wasintroduced by Mayor Lois Frankel of West Palm Beach, Fla., and six other mayorsfrom Baltimore to Santa Cruz, Calif. Frankel worked in cooperation with thestatewide advocacy group Floridians for Health Care and the national groupHealthcare-Now.

"By takingthis action," said Dr. Quentin Young, national coordinator of PNHP,"the mayors have put, in the boldest way, single-payer national healthinsurance on top of the domestic agenda, squarely in the middle of thelegislative and presidential elections."

The U.S.Conference of Mayors is a nonpartisan organization of mayors representingcities with a population of 30,000 or more. It currently has about 1,100members.

###

Physicians for aNational Health Program (www.pnhp.org) is an organization of over15,000 physicians advocating for non-profit national health insurance. PNHP haschapters and spokepersons across the country. For contacts, call 312-782-6006or info@pnhp.org.

Text of Resolution adopted by the U.S.Conference of Mayors, June 23:

Resolution in supportof the United States National Health Insurance Act, H.R. 676

Submitted By:

The Honorable LoisJ. Frankel, Mayor of West Palm Beach, Fla.

The HonorableWayne J. Hall Sr., Mayor of Mayor of Hempstead, N.Y.

The HonorableCarolyn K. Peterson, Mayor of Ithaca, N.Y.

The Honorable JohnE. Marks, III, Mayor of Tallahassee, Fla.

The HonorableSheila Dixon, Mayor of Baltimore, Md.

The HonorableBecky Tooley, Mayor of Coconut Creek, Fla.

The Honorable RyanCoonerty, Mayor of Santa Cruz, Calif.

WHEREAS, everyperson deserves access to affordable quality health care; and

WHEREAS, thenumber of Americans without health insurance now exceeds 47 million; and

WHEREAS, millionswith insurance have coverage so inadequate that a major illness would lead tofinancial ruin, and medical illness and bills contribute to one-half of allbankruptcies; and

WHEREAS, proposalsfor "consumer directed health care" such as Health Savings Accountsor Health Reimbursement Accounts (HRAs) would only worsen this situation bypenalizing the sick, discouraging prevention and saddling many working familieswith huge medical bills; and

WHEREAS, managedcare and other market-based reforms have failed to contain health care costs,which now threaten the international competitiveness of U.S. manufacturers; and

WHEREAS,administrative waste stemming from our reliance on private insurers consumesone-third of private health spending while the single payer Medicare system hasadministrative costs of less than 5 percent; and

WHEREAS, U.S.hospitals spend 24.3 percent of their budgets on billing and administrationwhile hospitals under Canada's single payer system spend only 12.9 percent; and

WHEREAS, Harvardresearchers estimate that more than $300 billion could be recovered byreplacing private insurance companies with a single public payer, enough tocover the uninsured and to improve coverage for all those who now have onlypartial coverage; and

WHEREAS,entrusting care to profit-oriented firms diverts billions of dollars tooutrageous incomes for CEOs and threatens the quality of care; and

WHEREAS, TheUnited States National Health Insurance Act (H.R. 676) would assure universalcoverage of all medically necessary services, contain costs by slashingbureaucracy, protect the doctor patient relationship, assure patients a completelyfree choice of doctors, and allow physicians a free choice of practicesettings; and

WHEREAS, mostpolls show that the majority of Americans support universal health care; and

WHEREAS, as of thedate of this resolution, the majority of American physicians (59 percent)believe that Single Payer is the best method of securing universal health care;and

WHEREAS, TheUnited States National Health Insurance Act (H.R. 676) will guarantee everymayor that all residents and employees of his/her city will be fully coveredfor health care and save millions of taxpayer dollars now spent on premiums toprovide less than full health insurance coverage for government employees; and

NOW, THEREFORE,

BE IT RESOLVED, that theUnited States Conference of Mayors expresses its support for The United StatesNational Health Insurance Act (H.R. 676), and calls upon federal legislators towork towards its immediate enactment and further urges the adoption of aprocess to insure that health care providers justify any increase in healthcare costs.

A Spy in Your Exam Room?

2008-06-17T14:23:00Z

A woman comes in to see you about migraines. You take a history, you spend time getting to know her, you treat her to the best of your ability. But what would you do if you found out she was hired to "fake" her illness to check up on your work?

This is what USA Today reports is happening in hospitals and health systems across the country: using "fake patients" to track and assess health care. According to the article Henry Ford Health System in Detroit spends $35,000 to $60,000 a year on these patients. Critics claim that their time is being wasted when they could be treating patients who truly need the care. Proponents say they like the feedback. And the AMA ethics committee is meeting to discuss endorsing the practice during its House of Delegates meeting this week.

This is a practice that has been in use for years in retail settings. A "fake patient" interviewed by USA Today said she preferred to call herself a "mystery shopper." Perhaps this is another case of health care trending toward retail.

Competition Flourishes in Retail Health

2008-06-16T19:26:00Z

Earlier this year, the state of Massachusetts adopted regulations for retail health clinics that Boston Mayor Tom Menino denounced, saying, "allowing retailers to make money off of sick people is wrong." We reported on the retail health regulations in the April news section of ADVANCE, and told of Menino's reactions in the April Retail Health Report. The Boston metro area has been a sensitive spot for prospecting retail clinic chains since that time.

The regulations were developed by the Massachusetts Department of Public Health after MinuteClinic applied to open several locations in the state. The regulations were a victory for retail health in that they laid very reasonable ground rules that are similar to other health care providers' requirements.

MinuteClinic now is moving forward with its plans to open 10 clinics in the state, and other clinic chains are following suit. Take Care, owned by Walgreens, applied to open 16 clinics in Walgreens stores in Massachusetts, with one in Boston. The Wall Street Journal's Health Blog reports that the mayor is "wary" of a clinic opening in the city. But the bigger story here seems to be that, even in what could be construed as a volatile environment for clinics to operate in, retail health is able to move forward and even create a healthy competitive environment.

A picture of competition is painted more clearly in Modern Healthcare's article from June 12 titled "MinuteClinic, Walgreen ready to duel in Boston." According to these reports, both MinuteClinic and Take Care clinics are scheduled to open in the fall. It will be interesting to see if the public's reaction will be as positive in Boston as it has been elsewhere, and what kinds of changes may come about with increased competition.

Canada’s Health Minister Criticizes Physician ‘Territorialism’

2008-06-16T12:03:00Z

In an attempt to get adequate health care to rural and underserved areas, Ontario is planning to set up 26 nurse-led clinics in the province. One is already in operation in the city of Sudbury.

But according to an article in last week's Daily Observer, the Ontario Medical Association is "concerned perhaps about the level of contact that nurse practitioners will have with physicians in some of these proposed clinics."

The government's response?

"I feel that is actually territorialism," Ontario Health Minister George Smitherman told the newspaper.

He [Smitherman] says the doctors can't have it both ways when they complain there is a doctor shortage.
"If you want to argue, as the physicians do, that there is a shortage of doctors, and we all agree that it takes quite a long time to make a new doctor, is their alternative to say, 'don't take advantage of the skills of these health care practitioners, let the patient wait?'" he asked.

In 2005, Health Canada, the government body responsible for the nation's health care, awarded an $8.9 million grant to the Canadian Nurses Association to determine how to fully integrate nurse practitioners into Canada's national health care system. That project was part of a larger, ongoing government effort to ensure that every has access to an appropriate health care provider at all times.

Survey: NP Is Top-Paying Job

2008-06-13T17:43:00Z

According to a Yahoo! article, the nurse practitioner profession is ranked as one of the top-earning job in the country (those that pay at least $50K a year).

In the article, NP ranks among professions such as investment banking analyst, junior associate attorney, and electrical engineer. The article claims that a typical starting salary for NPs is $67,166. However, according to the ADVANCE for Nurse Practitioners salary survey, the average starting NP salary was $76,802. So, although the Yahoo! article may not have its facts straight, it at least promotes the profession as a lucrative one.

Medical Society Blasts NPs

2008-06-13T17:12:00Z

The Kansas Medical Society (KMS) put forth a resolution to the American Medical Society House of Delegates concerning retail health clinics because "The proliferation of 'in store' or 'retail' health care clinics poses multiple dilemmas to Kansas physicians." The KMS stated the following: "The Kansas Medical Society ask the KMS ARNP Task Force to specifically address the issue of 'retail health clinics' as a part of their on-going study and make specific policy recommendations that protect the health and well-being of patients."

The KMS attacks nurse practitioners in their resolution, calling them mid-level providers and claiming that their qualification to provide quality care is suspect:

A second significant concern existing in this approach to health care is quality of health care delivered by a mid-level professional practicing in a semi-autonomous setting and the quality of the supervision delivered by the attending physician. Clear scope of practice limits will be critical to appropriately manage such service options. Additionally, proof that evidenced based health care is being delivered will be important to protect the patients seeking services.

What is the best way for nurse practitioners to respond to these claims?

Don’t Be Metabo!

2008-06-13T16:49:00Z

Here’s a health care reform from Japan that’s right out of Orwell. According to an article in today’s New York Times, a new national law requires Japanese companies to measure the waists of their employees, employees’ family members and retirees 40 to 74 years old. Local governments are charged with measuring anyone who falls between the cracks.

Measurements are supposed to enforce waists of 33.5 inches or smaller for men and 35.4 inches or smaller for women. People exceeding these sizes are subject to escalating education requirements until they meet the limits. And the companies responsible for these larger folks who don’t lose weight will be fined.

The new law uses waist measurements as an indicator of disease risk:

The campaign started a couple of years ago when the Health Ministry began beating the drums for a medical condition that few Japanese had ever heard of — metabolic syndrome — a collection of factors that heighten the risk of developing vascular disease and diabetes. Those include abdominal obesity, high blood pressure and high levels of blood glucose and cholesterol. In no time, the scary-sounding condition was popularly shortened to the funny-sounding metabo, and it has become the nation’s shorthand for overweight.

Here’s my favorite part of the article:

Still, at a city gym in Amagasaki recently, dozens of residents — few of whom appeared overweight — danced to the city’s anti-metabo song, which warned against trouser buttons popping and flying away, “pyun-pyun-pyun!”
“Goodbye, metabolic. Let’s get our checkups together. Go! Go! Go!
Goodbye, metabolic. Don’t wait till you get sick. No! No! No!”

AMA Proposes Resolutions Affecting NPs, DNPs

2008-06-10T19:37:00Z

Several state delegations of the American Medical Association have proposed resolutions that would limit NP education and NP practice. The AMA House of Delegates will gather to consider these resolutions at its annual meeting, which will take place this week from June 14 to 18.

Three resolutions could be potentially damaging to NPs. Resolution 214, "Doctor of Nursing Practice," would require physician supervision for DNPs. Resolution 303, "Protection of the Titles 'Doctor,' 'Resident' and 'Residency,'" would limit the use of these terms to physicians, dentists and podiatrists. Resolution 716, "AMA Model Agreement with Advanced Practice Nurse Clinicians, Nurse Practitioners and/or Clinical Nurse Specialists," recommends that collaborative agreements address "quality of care, continuity of care, and scope of practice" of NPs. These resolutions are currently only statements of proposed policy, but they could set the stage for future legislative action to be taken by state medical associations and the AMA.

All of these resolutions can be found on AMA's Web site, on the Reports and Resolutions page.

Representatives from the American Nurses Association will be attending the AMA meeting to provide comments, and they have already submitted letters to the AMA in response to the resolutions. In reponse to Resolution 214, the ANA states the following:

Our comments are directed toward the last statement in Resolution 214 which proposes to require physician supervision of DNPs’ practice. State law, state boards of nursing, and the nursing profession itself are the only appropriate entities to regulate the practice of nursing. It is not appropriate for the AMA or the medical profession to regulate the practice of nursing, any more than it would be appropriate for the nursing profession to attempt to regulate physicians and the practice of medicine. The medical profession is not the "starting place" from which all other healthcare professions must seek authorization to practice. This diminishes the unique contribution and role of nurses and other healthcare providers, and assumes a level of knowledge of nursing care, education and practice that is simply not the province of the medical profession.

And, in response to Resolution 303, the ANA says, "Those who have earned a doctorate degree may be called a 'doctor.' There is no legitimate reason to exclude nurses from this practice."

Eileen Shannon Carlson, associate director of government affairs for the ANA, told ADVANCE that groups including the American Association of Nurse Anesthetists have responded to these resolutions, and that four nursing groups, including the ANA, have been granted observor status for the AMA meeting.

Interested groups can send responses to these resolutions by e-mail to roger.brown@ama-assn.org by close of business on Wednesday, June 11.

AMA Recommends NP Hiring Agreement

2008-06-09T19:35:00Z

The American Medical Association published an article that lays out a plan for practices hiring nurse practitioners. They recommend drawing up a nurse practitioner employment agreement, designating all job responsibilities in addition to determining whether an NP is an employee or an independent contractor. The author states that this protects both parties:

When a nurse practitioner is hired, the terms of the relationship should be clearly defined in an agreement and should not be based merely on a handshake.

Memorializing the terms of the agreement legally protects both the medical practice and the nurse practitioner if a dispute arises.

Read the free preview of this article here. And please add your comments; if you were hired by a physician, did you sign a contract of employment that detailed responsibilities and abilities?