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HEALTHCARE AND NP NEWS
H1 N1 Update
For the most up to date information as of 10/25/2009 concerning H1N1 virus including at risk populations, recommendations for treatment and resources Click Here. You may also visit past reports on recommendations and resources Click Here.
NP Feature
Click Here to view an article featuring our own legislative chair Susan Delean Botkins in the Cheapeake Business Ledger. This article focuses on lawsuit abuse and the need for Nurse Practitioners to practice defensive medicine.
NP's Pick Up the Slack in Providing Primary Care
Baltimore Sun Article - August 9 2009
By Kelly Brewington | kelly.brewington@baltsun.com
Nurse Practitioners pick up the slack in providing primary Care – Health care reform, bringing with it more covered by insurance, expected to increase need.
Like so many primary-care providers strapped for time, Tricia Angulo-Bartlett crams as much as she can into a 15-minute patient visit. At one last week, she counseled Amy Tucker about her coming surgery, evaluated her chronic sinusitis and scribbled a few prescriptions, taking time to explain the side effects and directions of each one.
The complete article can be viewed at:
http://www.baltimoresun.com/health/bal-md.nurse09aug09,0,1842988.story
Visit baltimoresun.com at http://www.baltimoresun.com
Avoiding Conflict of Interest Between Industry and Association
By Sandi Nettina
A recent article in the Journal of the American Medical Association (JAMA. 2009;309:1367–1372.) calls for stricter guidelines to avoid conflict of interest between professional medical associations (PMAs) and the pharmaceutical and medical device industry. David J. Rothman, PhD, president of the Institute on Medicine as a Profession and Professor at the College of Physicians and Surgeons at Columbia University, authored the article along with individual physicians in leadership positions at a variety of medical societies such as the American Academy of Pediatrics the American College of Physicians, however they were not officially representing their organizations. Their recommendations address industry support of PMAs in a variety of forms such as general budget support; conventions; funding for research, fellowships and training programs; support for guideline development and publications; and support of affiliated foundations. The authors recommend working toward banning any financial support other than journal advertising and exhibit hall fees.
The authors urge PMAs to adopt an interim goal of limiting industry support to no more than 25% of the PMAs operating budget. They also suggest more safeguards for conferences such as strict conflict of interest policies, separating exhibit hall and educational spaces, and removing any branded or gift items. The board of directors for the PMA should also be required to be free of any conflict of interest during their tenure.
While NPAM does not accept industry support for anything other than meetings and conferences, we follow both PhRMA and ANA continuing education guidelines.
Medicare Reimbursement Change By Sandi Nettina
Center for Medicare and Medicaid Services (CMS) instituted a “clarification” in January that now requires a physician to be physically present when hospital based outpatient therapeutic services are being provided, in order to be reimbursed for those services. This applies to outpatient departments that may be on or off campus but are owned by a hospital. The therapeutic services include chemotherapy, injections, psychiatric services, and other treatments administered by nurses or ancillary staff. This policy does not affect a nurse practitioner billing for evaluation and management services, who would bill independently in a hospital outpatient setting. However the therapeutic service fee would require a physician to be present to allow for billing.
A number of health care organizations (American Hospital Association, National Rural Health Association, Catholic Health Association) are requesting that this policy be reconsidered or delayed because it was instituted without sufficient time for public comment. Hospitals were not given time to change their work flow to allow for physician coverage at outpatient facilities. If you are an NP who works in a hospital based outpatient facility providing therapeutic services, please contact Sandi Nettina at nettinas@verizon.net for more information or to let the reimbursement committee know how this is affecting your practice.
NPs Join Physician Rally in Annapolis Regarding Insurance Problems
By Sandi Nettina
Annapolis Maryalnd, February 18, 2009: MedChi organized a Doctor-Patient Rally in Annapolis on February 18, 2009 to highlight poor insurance reimbursement practices and high malpractice insurance premiums that are forcing doctors out of Maryland. About 300 people attended the rally, held outdoors on Lawyer’s Mall outside of the State House. Numerous speakers described how the high cost of running a practice and low payments by the insurance monopoly were forcing them out of clinical practice or out of the state entirely, as attendees braved the wet snow and cold to show support.
NPAM made the decision to attend because the payment issue affects us as well as physicians. We wanted to bring the message that NPs are part of the health care team, and can be part of the solution. So while doctors held signs reading “Keep your Doctor in Maryland”, NPs held signs reading “NPs Part of the Solution”, “Nurse Practitioners Access to Care”, “Increase Access to Care through Fair Payment”, and “Remove Barriers”. Thanks to Gina Friel (and her son), Vijay Ramraj (and her husband), Susan Delean Botkin (and friend), Diana Heffner, and Sandi Nettina who wore our bright blue NPAM t-shirts, waved banners, and did not perish in the snow, ice and rain. NPAM president, Diana Heffner, was prepared to speak at the podium about the NP role, but our lobbyists were unable to secure the arrangements for this ahead of time. Nevertheless, the stalwart crew led the cheering when Med Chi president, Ron Sroka, acknowleged NPs and PAs for serving an important role in Maryland health care.
The need for the rally was based on the Maryland Physician Workforce Study (2008),
commissioned by the Maryland Hospital Association (MHA), with the support of MedChi,( The
Maryland State Medical Society). The study found that overall Maryland is 16 percent below the national average for number of physicians available for clinical practice. The most severe problems occur in rural parts of the state and will get much worse by 2015, based on the study’s results. The biggest statewide gaps occur in Primary Care, Emergency Medicine, Anesthesiology, Hematology/Oncology, Thoracic Surgery and Vascular Surgery, Psychiatry, and Dermatology. The study also found Maryland has only a borderline supply of orthopedic surgeons. The situation in Southern Maryland, Western Maryland, and the Eastern Shore is the most troubling. All three regions fall significantly below national levels in active practicing physicians. Southern Maryland already has critical shortages in 25 of the 30 physician categories (83.3%), Western Maryland 20 of 30 (66.7%), and the Eastern Shore 18 of 30 (60.0%). Payments for services rendered by physicians and nurse practitioners in Maryland now fall below the 25th percentile in the US, while Maryland ranks number 15 in cost of living expenses.
FOR IMMEDIATE RELEASE February 17, 2009
Internists Issue Policy Statements on Critical Roles of Physicians and Nurse Practitioners in Improving Access to Care
American College of Physicians Recognizes Common Goals of Providing High-Quality, Patient-Centered Care and Improving Health Status of Those They Serve
Washington, February 17, 2009 – “The American College of Physicians (ACP) has always recognized the unique role that a personal physician plays in meeting the needs of individual patients,” Jeffrey P. Harris, MD, FACP, president of the American College of Physicians, noted today upon the release of a new policy monograph. “But even the most committed physician can’t do it alone. Today, ACP shares its ideas on how nurse practitioners and physicians can work together—as teammates that respect and recognize each profession’s unique contributions and skills—to provide patients with the best possible care.”
By covering seven positions, Nurse Practitioners in Primary Care updates and clarifies ACP stands in areas that include:
• Coverage of physician and NP training, knowledge, skills and abilities
• Coordinated care to of primary importance in improving health outcomes
• Licensing and certification exams
• Multidisciplinary care in the patient-centered medical home model
• Research efforts for patient management among physicians and NPs
• Education and training of all health professionals
• Workforce policies to improve patient access to quality care
The 18-page monograph’s executive summary notes that “anticipated and actual shortages of primary care physicians have led policymakers to consider the roles of nurse practitioners (NPs) in improving access to primary health care services. “Physicians and nurse practitioners not only share a commitment to providing high quality care, the paper says, but also face similar challenges regarding reimbursement and workforce outlook. Recognizing and building on the common ground between the two professions is vital to improving collaboration to meet the complex health care needs of the population.
However, the paper also cautions “that advanced practice nursing should not substitute for, or replace, primary care medical practice as provided by general internists, family physicians and other physicians.”
“The ACP hopes that this paper will strengthen the dialogue between the medical and nurse practitioner communities to improve future health care delivery,” said Dr. Harris. “A high-quality and efficient health care system requires effective multidisciplinary teams that collaborate to provide patient-centered care.”
Over the past 20 years, the ACP paper notes, an increase in the numbers of nurse practitioners, enactment of state laws expanding scope of practice, prescriptive authority and third-party reimbursement, and national efforts to improve health care access, have resulted in expanded roles for NPs in providing primary care services. However, greater autonomy of NPs has been a point of contention between the medical and advanced practice nursing communities. At times, questions have been raised about the adequacy of NP training and certification, comparisons drawn by NPs to the care delivered by physicians, quality of patient outcomes and perceived intentions to displace or replace primary care physicians.
ACP’s paper cited a study by the Association of American Medical Colleges that warns that the demand in the coming years for primary care physicians will outpace supply faster for primary care than for any other specialty group. It notes that another study published in Health Affairs projects a growing shortage of primary care physicians for adults, even as the contributions of nurse practitioners, as essential members of the primary care workforce, are taken into account.
In the process of developing its recommendations, ACP consulted with highly-regarded members of the nursing profession to gain a better understanding of their perspectives.
ACP intends to continue its dialogue with nurse practitioners, and to similarly engage in discussions with other professions—particularly physicians assistants—who play a vital role in meeting the nation’s growing need for primary care.
“The key to high performance in multi-disciplinary teams is an understanding of the distinctive roles, skills, and values of all team members,” Dr. Harris concluded. “Our hope is that ACP’s new paper will help contribute to a better understanding of how physicians and nurse practitioners can work together to provide patients with the best care possible.”
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The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.
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