In a recent op-ed in The Hill, former Sens. Tom Daschle (D-S.D.) and Olympia Snowe (R-Maine) made a compelling argument that limited access to health care in rural states will be a significant voter issue in the 2020 elections. I agree with that prediction, because limited access to quality primary health care is a serious issue in almost every state. But it’s a problem that can be addressed by health care providers like me: nurse practitioners.
According to the U.S. Department of Health and Human Services (HHS), 80 million Americans lack access to adequate primary health care, and shortages are much worse in rural areas than in urban areas. The primary care workforce is shrinking. By 2030, it is estimated that the country will face shortages of more than 120,000 primary care physicians needed to address patient demand.
The good news? There are more than 270,000 nurse practitioners (NPs) licensed in the United States, and they are an under-utilized asset in the struggle to strengthen and expand primary care access. NPs start their careers as registered nurses and then go on to complete graduate, master’s or doctoral degree programs for advanced clinical education before receiving national board certification in their clinical focus area.
NPs are qualified to assess patients, order and interpret diagnostic tests, develop treatment plans and prescribe medications in all 50 states. NPs practice under the laws of the state in which they are licensed, providing health care services in rural and urban areas in a wide array of locations – hospitals, clinics, private NP and physician practices, nursing homes, schools and many others.
And most importantly, more than three-quarters of NPs are trained in primary care focus areas, including family care, adult and geriatric care, women’s health and pediatrics. While the pool of primary care physicians is shrinking, the NP primary care workforce is growing, with 26,000 new NPs completing academic programs in 2017-2018. According to a recent report from a respected health care economist, the number of NPs in the workforce between 2016-2030 is expected to grow by 6.8 percent annually, and they will be far more likely to practice in rural and underserved areas.
While 40 percent of U.S. states authorize full practice authority (FPA) for NPs providing patients with full and direct access to NP care, unfortunately a whopping 60 percent of states have yet to modernize their state licensure laws to grant the same access. In those states, outdated regulations restrict NP practice rights, which in turn reduces access to care for patients.
States with FPA have healthier residents and consistently rank higher on state health report cards. In fact, eight of the top 10 healthiest states – Colorado, Connecticut, Hawaii, Iowa, Minnesota, Rhode Island, Vermont and Washington – have FPA laws, which enable patients to directly access NP care without restrictions. By contrast, the 11 lowest ranking states have laws which directly limit NP practice.
In addition to modernizing FPA laws, states should take steps to streamline care delivery by allowing NPs to sign the forms for the care they deliver instead of being forced to get redundant third-party signatures and create flexible and sustainable reimbursement methods to ensure that NP care is covered and reimbursable.
At the federal level, Congress can take steps to support expanded access to NPs by passing the bipartisan Home Health Care Planning Improvement Act (S. 296/H.R. 2150), which would make it possible for NPs to provide necessary services for their Medicare patients by allowing them to certify that patients are eligible for home health care services. Passage of this legislation will reduce Medicare spending by eliminating duplicative services, while also improving the quality and timeliness of care for the beneficiaries who require home health services.
NPs are a top-notch option for primary care. Their whole-person orientation that focuses on wellness and prevention keeps patients coming back – resulting in 1 billion patient visits per year. NP-provided care is associated with decreased hospitalizations, decreased re-admissions, and improved health care outcomes. These cost savings are compounded in states with FPA, where there is less unnecessary provider duplication and involvement in matters that can be fully handled by an NP.
NPs are uniquely qualified to provide high-quality, comprehensive and cost-effective primary health care to all patients. It’s time that policymakers at both the federal and state level take the steps needed to ensure that all Americans, regardless of where they live, have access to the primary care they deserve.
Sophia L. Thomas, a licensed NP in the state of Louisiana, is the new president of the American Association of Nurse Practitioners.