Wednesday, May 21, 2014

Redefining Primary Care

This is a guest post by Jennifer Brennan, a nurse practitioner in Southeast Texas (and my daughter) on the merits of advancing and expanding the role of Nurse Practitioners as primary care providers. Enjoy!

Redefining Primary Care
By Jennifer Brennan, RN, MSN, FNP-C

Jeff Guillory, a Family Nurse Practitioner practicing in Lumberton, Texas, has owned and operated his primary care clinic, NP Health Clinic, for over 8 years and sees approximately 100-150 patients per week. He manages a variety of health conditions-both acute and chronic- including, but not limited to, colds, diabetes, high blood pressure, high cholesterol, well-woman and well-child examinations, and annual recommended screening tests for both children and adults. He performs labs tests, EKGs, suturing, immunizations, and sports physicals in his office.  Mr. Guillory is one of a limited number of primary care providers in Hardin County, a relatively rural county of 54,635 people which has seen the ratio of medical providers-to-population decrease a whopping 33% since 2001.  (source: Texas Department of State Health Services).   

Mr. Guillory is typical of  Nurse Practitioners, having practiced for years as a Registered Nurse, developing and sharpening clinical skills and knowledge, before attending an accredited graduate school, completing a rigorous masters degree program in Nursing and passing a state board examination in order to be credentialed as a Nurse Practitioner

Each state has different laws governing the specifics on what a Nurse Practitioner can do.  In Texas, Nurse Practitioners must have a collaborating physician and must have a Prescriptive Authority Agreement in place, an agreement between the physician and the Nurse Practitioner, describing the delegated categories of drugs and devices a Nurse Practitioner can or cannot prescribe. In the United States, 19 states and The District of Columbia have passed legislation giving Nurse Practitioners Full Practice Authority, meaning NPs in those states work as independent medical providers. They can deliver primary care commensurate to their education.

Last week, an article featured in the Texas Tribune and NY Times illustrated a story about a Nurse Practitioner in Katy, Texas facing difficulties keeping her primary care clinic open due to state regulations not allowing NPs to be reimbursed by insurance companies unless the delegating physician has a contract with those specific insurance companies.

Mr. Guillory is facing similar hardships in his primary care clinic as are many Nurse Practitioners in the state of Texas. Because NPs in Texas must have a collaborating physician to practice, when that physician does not have a contract with certain insurance companies, the Nurse Practitioner cannot see patients with those specific insurance plans. This has left many patients unable to see their chosen Primary Care Providers, and especially in rural settings, may leave patients with no primary care at all.

So, what exactly is a Primary Care Provider?  A primary care provider (PCP) is a health care professional who sees people that have common medical problems.  This person is your main health care provider, the “gatekeeper” who coordinates care and provides referrals to specialists when appropriate.  The role of a PCP is to:

Provide preventive care and teach healthy lifestyle choices
  • Identify and treat common medical conditions
  • Assess the urgency of your medical problems and direct you to the best place for that care
  • Make referrals to medical specialists when necessary
Mr. Jeff Guillory, NP, is a primary care provider.

Increasingly, a PCP is not limited to physicians.  In practical terms, NPs have been acting in the role of primary care providers since the 1960’s. Whether the associating physician works alongside the NP on a day-to-day basis or visits the clinic periodically in an oversight capacity, the reality is that NPs carry their own patient loads, assessing, diagnosing, and prescribing in a setting that is essentially independent of all but cursory supervision.

With the burgeoning patient base introduced by the Affordable Care Act, a broad range of medical professionals is needed to provide adequate and affordable services. Nurse Practitioners are capable and prepared to fill the void caused by the projected shortage of primary care physicians in the United States.

Nurse Practitioners have been proven for decades to be safe and effective healthcare providers exhibiting positive outcomes and satisfaction in patient care. This is not the issue nor is comparing NPs to physicians and debating which is better. Often patients have a clear preference for one or the other, and for those who prefer to see a Nurse Practitioner for primary health care needs, making access and reimbursement easier and more accessible is key. It is time that the term “primary care provider” encompasses both physicians AND nurse practitioners and that current state regulation and insurance companies delineate and recognize the role that NPs play in society’s health care needs.
By appropriately redefining the primary care provider terminology, patients throughout Texas can have easier access to their chosen PCP, avoiding unnecessary constraints in their health care needs and ultimately improving the common goal of centering patient care as priority. Nurse Practitioners are and will continue to be PCPs and should be fully integrated into health care delivery.