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DNP Answers

NPs as PCPs

Published August 27, 2014 3:20 PM by Walton Reddish

Since the Affordable Care Act (ACA) first made headlines, a frequent topic in the media has been the shortage of primary care providers (PCPs) to accommodate the influx of newly insured patients. At the time of its implementation, it was estimated that there would be a shortfall of 45,000 to 60,000 PCPs to provide care for the millions of newly insured Americans (Rosenberg, 2012; "Survey reveals", 2012). The concerns continue.  Recently USA Today cited that the demand for primary care providers cannot be met (Krasselt and O'Donnell, June 30, 2014).

While many of these articles note that NPs and PAs are qualified to serve as PCPs, a recent survey of Health Maintenance Organizations (HMOs) by the National Nursing Centers Consortium (NNCC) revealed that 25% of the HMOs do not credential NPs as PCPs. Compounding this problem, it was also revealed that many companies will credential the NPs but will not reimburse them directly or that the company will place restrictive stipulations in their contracts.Some will not list the NPs among their published list of credentialed PCPs for that HMO ("Survey reveals", 2012).

Health insurance without health care is of little value. The seemingly obvious answer is that the federal government can mandate that NPs (and PAs) must be empaneled as PCPs. Even if that occurred, the disparity between the scopes of practice of various states must be evened out. Currently, only 18 states allow independent practice by NPs while the remaining 32 states require physician oversight of diagnosis, treatment, and/or the prescription of medications (Cassidy, 2012). In order to fulfill their potential as PCPs, NPs must have some continuity of practice from state to state. While some of us may rue the entrance of the federal government into healthcare, that die has been cast. Federal intervention may be necessary to achieve the stated goals of the ACA.

There is, of course, opposition to the expansion of the role of NPs in primary care. The American Medical Association (AMA) has argued that the doctor shortage is not a reason to turn over primary care responsibilities to the NPs. They have contended that each NP should be supervised by a physician at all times (Mahar, 2010). The American Academy of Family Physicians (AAFP) suggests that NPs as independent practitioners creates a "two tier" system with the Physicians offering the highest level of care and the NPs representing the "less qualified" tier (Rosenberg, 2012). The implication is that the NP cannot be trusted to work alone.

Nurse practitioners stand trained and ready to offset the upcoming shortage of primary care providers that will result from the implementation of the PPACA. Facing an access to care debacle, it would be unwise to ignore the ready supply of providers trained in primary care and, in many cases, already employed in primary care offices.

 

This article was condensed from:

Reddish, W. (July 2014). Policy paper: NPs as PCPs. Unpublished Doctoral Paper for Maryville University.

Cassidy, A. (October 25, 2012). Nurse practitioners and primary care. Health Affairs. 31(11) Retrieved from http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_79.pdf

Krasselt, K. and O'Donnell, J. (June 30, 2014). Supply won't meet growing demand for primary care. Retrieved from http://www.usatoday.com/story/news/politics/2014/06/29/primary-care-shortage-health/11101265/

Mahar. M. (2010). The battle over letting nurse practitioners provide primary care. Retrieved from http://takingnote.tcf.org/2010/04/the-battle-over-letting-nurse-practitioners-provide-primary-care.html

Rosenberg, T. (October 24, 2012). The family doctor, minus the M.D. Opinionator, Exclusive Online Commentary from The Times. Retrieved from http://opinionator.blogs.nytimes.com?2012/10/24/the -family-doctor-minus-the-m-d/?nl=opinion&emc-edit-ty-20121024

Survey reveals that more health insurers recognize nurse practitioners as primary care providers. (2012, September 25). PHMC: A Non-profit Institute for Public Health. Retrieved from http://www.phmc.org/site/index.php?option=com_content&view=article&id=768:survey-reveals-that-more-health-insurers-recognize-nurse-practitioners-as-primary-care-providers&catid=67:2012&Itemid=1574

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