Nurse Practitioners – The Bedrock of Primary Care
When you need a physical exam or management of a medical issue, whom do you usually see? In our area, we are fortunate to have a sophisticated and wide range of medical services, available. Many will see a Nurse Practitioner, either by choice or as part of their medical care team. In Sandpoint, NPs provide primary care as well as work in specialty clinics, outpatient facilities and at our local hospital, Bonner General Health.
But, what are Nurse Practitioners? Nurse Practitioners are registered nurses with a Bachelor’s degree in nursing with additional education at a Master’s or Doctorate level. They have over 6 years of education to prepare them to practice in a variety of medical settings.
Nurse Practitioners are qualified and licensed to make medical diagnoses, prescribe medications, order and interpret radiology studies and lab work. They refer patients to other providers as they deem medically appropriate. In the state of Idaho, Nurse Practitioners can practice independently of a physician. They have independent practice in 22 states, and practice in all 50 states.
We are part of the solution for the health care crisis in our country. There are over 1000 Nurse Practitioners in the state of Idaho, and this progressive state law recognizes us as Primary Care Providers. We practice in primary care and serve both rural and urban areas. Many NPs also work in specialty areas including women’s health, anesthesia, psychiatry, cardiology, orthopedics and pulmonary medicine.
Despite extensive education and a wide scope of medical capability, Nurse Practitioners still have barriers to providing the best and most cost effective care for their patients. These barriers to practice affect quality, costs and timely access to care.
Currently NPs are unable to refer a patient to Home Health, Hospice, or order diabetic shoes without that patient first seeing a physician. This requires an additional visit, additional cost, and a burden to both patient and the health care system.
Perhaps the most important barrier to care is the lack of pay parity. In Idaho an NP is paid 85% of what a physician is paid when performing the same service. When an NP owns and operates a medical clinic, they have the same expenses as any other medical clinic, but have to cover those same costs with 15% less income. In Oregon there is a pay parity requirement that has eliminated this disparity. When trying to recruit more NPs to come to Idaho, salary reimbursement is important, especially when other states in the Northwest are competitive with the salaries they offer.
These barriers are being addressed at the federal level. I was recently in Washington D.C. where I met with other Nurse Practitioners and Idaho legislators to discuss solutions. Currently a bill is being introduced into the Senate that will allow NPs to refer for Home Health. This is Senate Bill 445.
There is also a resolution in the House, Res 1160, which will include NPs in the matrix that insurance companies use to measure health care outcomes. Health care is moving away from a fee-for-service payment structure to reimbursing health care providers for outcome measures. In other words the better care you give and the healthier your patients are, the better the state of Idaho will be graded on its health care. That also means Idaho would be able to receive more money for health care. Currently this matrix is only measuring physicians who provide primary care. Since NPs provide primary care and in some communities are the bedrock of primary care, this insurance structure does not count the care provided by NPs.
According to the Institute of Medicine, NPs have been shown to have excellent outcomes and are cost effective. They are frequently the front line for access to health care. Insurance companies tend to follow the guidelines established nationally by following Medicare guidelines, so changing the language of the rules and regulations at the federal level will help provide better care at the local level.
by: Cynthia Dalsing, Advanced Registered Nurse Practitioner
Cynthia Dalsing, & Tabitha Barron are Master’s prepared Advanced Registered Nurse Practitioners. Cynthia received her Master’s degree from the University of Utah in 1981. She has practiced in both University settings and private practice. She has practiced in Sandpoint since 19095. She grew up all over the world as her father was in the Air Force. Tabitha received her Master’s degree from Arizona State University in 2011, and has practiced in Sandpoint over 2 years. She grew up in Oregon.