Politics and Practice
I started this last month and was called away to care for my father. These are a few of the thoughts that fill my head when I look to the future of my practice and my profession.
On the heels of an historic election, we continue to fight the good fight. Politics is as important to your practice as education and equipment. Whether we need to be "politically correct" in approaching a problem with our peers, are involved in the latest catastrophe on the job or observe what is happening with health care reform around the nation. It is time for all of us to take notice of what is going on in the political arena and make our voices heard.
I recently read the "resolutions" approved by a state medical group. The current group of resolutions includes one that hits close to home. This group is seeking legislative support requiring all insured persons to identify a "medical home." This primary care provider would be the "gate keeper" for referrals and preventive care as well as case management services and education for chronic health conditions. (Sound familiar?)
While I applaud this idea (once again), I am very angry and a bit nervous about their insistence that, while nurses, nurse practitioners, physician assistants, physical and occupational therapists and mental health providers may be involved in the care of a patient, the physician must be designated as the "team leader" and in charge of the Medical Home. If you own your primary care practice, you may want to keep your eyes on this.
A newsletter from one of the larger medical insurance companies crossed my desk this past week. They are rolling out a new program that will provide their members disease management services. The company will assign a disease management coordinator to the patient when they have received a diagnosis. The patient can call this person and ask questions about their condition and ask for recommendations for treatments that would help the patient in managing their condition including information about prescribed medications, outside interventions, diagnostic tests or procedures and expected course of the disease or condition. Patients would be given pricing information so they could choose where and how they would like their condition to be managed.
I am encouraged by this company's effort to help their members manage their conditions. I am fortunate to be able to provide this information while I care for the patient in my office. Nurse practitioners have recently received a 15% reduction in reimbursement by this company due to economic woes.
Individual states are working on health care reform. One of the proposals that captured the attention of the legislators involves identifying "baskets of care" for certain diseases and conditions and encouraging health clinics and systems to set pricing based on the elements included in these baskets of care. Consumers would have another piece of information when choosing their health care providers -- pricing. It is similar to "capitation" processes of yesteryear. The state awarded a grant to three organizations to help define the criteria for each basket of care. None of the organizations represents advanced practice nurses.
I am excited about the general direction that health care reform seems to be headed -- greater patient control and responsibility, access, medical homes, programs for underinsured and uninsured, abolition of health insurance, single-payer systems, focus on wellness and optimum health achievement, health education, and all the elements of NP practice. Changes in leadership of our country have brought bipartisan hope toward a better future. We cannot be silent in the coming days. We cannot be left out of the decision making. Keep your eyes and ears open, listen for opportunities to make your voice heard. Do big things in small ways.
As a business owner, I am worried about the economy and its impact on my business. As a health care provider I am encouraged by the potential for real reform. As a nurse practitioner, I cannot be silent and see what may pass my way. As the CEO I am the visionary. I encourage people to be what they can be. Make your own destiny.
Rah! Rah! Rah!