SI Review: November 2013

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Expert’s Corner: The Opportunity Cost

Much work is needed to boos care provider availability

By Grace Paranzino

It is no secret that nurse practitioners (NPs) serve as valuable healthcare providers in today’s healthcare environment. NPs combine clinical expertise that focuses on diagnosing and treating a multitude of chronic and acute health conditions and health promotion and disease prevention, thereby providing patient-centered care.

Further, NPs are clearly positioned in primary care to reduce the economic and financial burdens placed on both patients and the healthcare system as evidenced by their ability to coordinate and provide clinical care to the population who needs it the most. Research has also shown that quality of care and patient satisfaction is high, reflecting low malpractice rates.

They also cost much less than physicians. In 1981, the hourly cost of an NP was approximately one-third to one-half that of a physician. The compensation structure remains about the same 30 years later. In 2010, when the median total compensation for primary care physicians ranged from $208,658 (family) to $219,500 (internal medicine), the mean full-time NPs salary across all types of practice was $97,345.

That’s the good news. The not-so-good news is that despite the demand for NPs, there is a supply shortage especially in rural areas, which negatively impacts patient access to care. This is primarily driven by gaps in the educational system and suggested redesign of the healthcare system. According to the American Association of Colleges of Nursing, enrollments in master’s and doctor of nursing practice programs has grown since 2010 by 33 percent and graduates of these programs has increased by 40 percent. But it could be even better. Qualified applicants are turned away from NP programs due to faculty shortages and dearth of clinical sites.

In 2011, the Institute of Medicine released a report called The Future of Nursing: Leading Change, Advancing Health. One particular section discussed the removal of scope of practice barriers such as the expansion of the Medicare program to include coverage of services similarly provided by physicians such as authorization of services related to home care; and to amend the requirements for hospital participation in the Medicare program to ensure NP eligibility for privileges and membership on medical staff.

Clearly, there are three main issues that remain contentious regarding scope of practice: the need for independent practice, expansion of prescriptive practice, and reimbursement to third party payers. The Affordable Care Act’s prevention and public health fund is supporting the training of 600 new nurse practitioners and nurse midwives by 2015.

NPs are very capable of filling the gaps left thanks to physician shortages. This could be an area of opportunity for healthcare staffing firms who could plan long-term to meet the evolving market needs.

[SIDEBAR]

Statistics Corner

According to the American Academy of Nurse Practitioners (AANP), there are approximately 167,000 nurse practitioners (NPs) practicing in the U.S. In a 2012 survey, AANP found that the most common clinical setting of NP practice is private physician practice, the largest category of which was family NPs (48.8 percent), with adult NPs (28.9 percent) as the second largest category.

  • 18 percent of NPs practice in rural or frontier settings
  • 88 percent of NPs are prepared in primary care; 68 percent of NPs practice in at least one primary care site
  • 87 percent of NPs see patients covered by Medicare and 84 percent by Medicaid
  • 43 percent of NPs hold hospital privileges; 15 percent have long-term care privileges
  • 96.5 percent of NPs prescribe medications, averaging 20 prescriptions per day
  • NPs hold prescriptive privilege in all
  • 50 states, with controlled substances in 48
  • The early-2011 mean, full-time NP base salary was $91,310, with average full-time NP total income $98,760
  • 60 percent of NPs see three to four patients per hour; 7 percent see over five patients per hour
  • Malpractice rates remain low; only 2 percent have been named as primary defendant in a malpractice case

Grace Paranzino is chief clinical officer, healthcare products, for Kelly Service Inc. She can be reached at parangk@kellyservices.com

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