Obamacare Update: 'It's All Going to Get Down to Nurse Practitioners'

Yesterday, my father-in-law sent me an e-mail titled 'It's All Going to Get Down to Having Nurses and Nurse Practitioners Do More!'.  After reading the Wall Street Journal article attached to his message, I think he's right.  More importantly, both medical and non-medical academic communities are taking note of nurse practitioner's potential.  

As part of the Affordable Care Act, hundreds of 'Accountable Care Organizations' are cropping up across the U.S. according to the Wall Street Journal.  Similarly to Health Maintinance Organizations, or HMO's, these programs attempt to coordinate medical care my grouping health-care providers with the goal of cutting costs of health care while increasing quality.  Dr. Jeffrey Flier, Dean of Harvard Medical School, along with Clayton Christensen, professor at Harvard business school, and Vineet Vijayaraghavan, research fellow at Innosight Institute, believe this plan is seriously flawed.

Flier, Christensen and Vijayaraghavan point to attitudes of physicians as one reason ACO's are bound to fail.  To reach the goal of cutting costs and increasing quality of care, physicians must emphasize use of evidence-based protocols and use greater discretion in recommending expensive procedures like surgeries to their patients.  This model, however, is not how most doctors have been trained.  "ACO's aren't designed or equipped to transform physician behaviors on the scale that will be needed" comment Flier and Christensen.

So, who can provide patient care while cutting costs and increasing quality in accordance with the changing structure of the U.S. health care system?  Nurse practitioners, of course!  NP's are trained to follow evidence-based protocols and recommend lower cost treatments.  Their education highlights preventative medicine keping patients healthier ultimately leading to a lower cost of medical care.  Flier and Christensen recommend shifting medical care to less expensive venues such as retail health clinics staffed by nurse practitioners.  They also advocate for loosening state laws governing advanced practice nurses allowing them to practice to a fuller extent.  

With physician organizations traditionally against expanding the nurse practitioner scope of practice, I was thrilled to see Dr. Flier, Dean of Harvard Medical School, recognizing the potential nurse practitioner's hold.  Whether or not you align with Obamacare politically, the Affordable Care Act promises to expand career opportunities and the scope of practice for nurse practitioners making us the solution to providing lower cost, higher quality medical care.

In what ways do you think the NP scope of practice will expand over the next few years?  Have you already seen changes in your community?

 

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