Healthcare Affordability in the US

wellness guard Affordability in the USAdvanced adjudge Practiti unityr range of a function of Practice IssuesMarina BukhrashviliNew York State needed an additional 1,200 mendeleviums to address the shortage by 2012, according to a 2012 Haneys survey by the Health attending sleeper of New York State (Verdon, Ritchie, Marbury Mazzolini, 2014). The orbital cavity of Certified Nurse Practitioner (CNP) practice is currently thinkd in some republics. In New York State, the Nurse Practitioners Modernization subroutine leave behind allow those maintains who have more than 3,600 hours of experience to treat patients without the supervising physicians signed practice agreement (Farmer, 2014).This act willing perish law on January 1, 2015. This act may fill that void however, various New York physician advocate groups continue to argue that patient safety will be compromised because of the gap in training of CNPs (Verdon et al., 2014).The United States (U.S.) health conduct syste m faces many challenges due to demographical, economic and political shifts. There argon animated gaps in timberland and accessibility of care and patient safety. U.S. population is aging rapidly and it is estimated that about 18 part of the U.S. population will be 65 years old or older by 2025 (U.S. Census Bureau, 2012). With growing number of Medicare beneficiaries, there will be more demand for primary care providers. It is estimated that by 2020, the U.S. nation will require 40 percent more primary care providers (Hauer et al., 2008). U.S people 65 and older will have more than one chronic disease and physicians shortages will not meet the demands that are expected (Centers for Disease Control and Prevention, 2012).The National Governors Association (NGA) reviewed of the literature and summarized that CNPs can boil down disparities in access to care, promote cost effectiveness through policy advancement, patient advocacy and the development of innovative models of care to im prove patient care (NGA, 2013). The push for giving CNPs more autonomy continues with the shortage of primary care physicians on the rise. The American Academy of Family Physicians (AAFP) is not supporting the idea of allowing CNPs the full scope of practice without ca-caing under the physicians supervision. One of the reasons cited is that family physicians have extensive training and education, which would ensure patients safety and provide the best quality of care (American Academy of Family Physicians, 2012). The scope of CNPs practice is currently debated in some states.Researchers studied care provided by both nurse practitioners and physicians and showed that dapple quality of care was standardized for both providers, patients results were same or better for NPs as compared to physicians (Bauer, J. 2010). In addition, it was found that nurse practitioners provide care at a lower cost as well as more disease prevention counseling, health education, and health promotion activ ities than physicians (Mehrota et al., 2009).Another study which used data from the Association of American health check Colleges Consumer Survey showed that consumers are open to the idea of obtaining medical care from NPs (Dill, Pankow, Erikson Shippman, 2013). Compared to physicians, CNPs traditionally are reimbursed at a lower Medicare rate for delivery of the same services. Yet, while our healthcare desperately needs to reduce cost, it is estimated that a cost savings would remain, even if CNPs were to receive equivalent reimbursement, because they utilize fewer resources than physicians (Health Policy Brief, 2012).In 2009, on average, it cost 20% less to visit a nurse practitioner than to visit a physician (Eibner, Hussey, Ridgely Glynn, 2009). In Massachusetts, after the insurance reform was implemented, it was shown that the state could save from $4.2 to $8.4 billion over a 10-year period when nurse practitioners use was increased (Eibner et al., 2009).Accountable care or ganizations (ACA), community and nurse-managed health centers, patient-centered medical homes success will require that CNPs have full scope of practice to have the ability to practice independently without restrictions (Fairman, Rowe, Hassmiller, Shalala, 2011). Organizational barriers exist for reimbursements of care provided by CNPs. Notwithstanding that the quality and standards of preventing care established in the ACA are met by these providers, their current rate of reimbursement for Medicare services to residents in long term care (LTC) facilities is only 85 percent of the rate that physicians charge for the same services (American Association of Nurse Practitioners, 2013).The unlimited contribution of CPNs will be even more important considering that with the implementation of the ACA, millions of saucily insured Americans will seek the access to healthcare. Expanding the scope of practice of advanced practice nurses can possibly translate to an increased access to healthc are for many current and future patients, especially in underserved areas (National Governors Association, 2012).There is a need for the uniform standards for practice and to eliminate the difference in the level of practice among CNPs from one state to another (NGA, 2012). The scope of practice will establish which activities are reimbursed by third party payers and will have direct impact on the independent practice of CNPs (NGA, 2012). When CNPs are required to collaborate or to be supervised by the physician, they are less likely to be selected by insurers and are unable to directly bill for the services they render (NGA, 2012). Instead, the bill for their services is coded under the physicians provider number. If the requirement for physician involvement is dropped, CNPs would be allowed to be credentialed as providers and directly reimbursed for their services. This is also important if a physician moves or does not want to collaborate with a CNP.Another issue think to scope of practice is the lack of universal, federal recommendations for mobility across states for practitioners involved in telemedicine. The significant discrepancy in CNP scopes of practice across states limits the ability of expert CNPs to work as consultants in a different state, which may limit the access of individuals to specialty consultations that may not be available locally. In their study of nurse migration, it was reported that nurses, including CNPs, move to states with less restrictive scopes of practice. Migration of CNPs may contribute to the shortage of primary care providers, especially in disadvantaged areas (Kalist, Spurr, Wada, 2010). Nurses are restricted to support in some state to do health care visits or stay in skilled nursing facilities, admit patients to hospitals or prescribe medications without physicians supervision and because of that nurses move to less restrictive states, and from primary to specialist care, a resulting loss of access to care a lot of patients (Eibner et al., 2009).With millions of people subscribe up for health care under the Affordable Care Act, the aging population and number of chronic illnesses growing, the demand for primary care services is project to grow. NPs will play a significant part in expansion and shaping of health care delivery. The looming shortage of primary care practitioners can be alleviating by integrating into health care delivery primary care nurse practitioners and physicians assistants. Medical profession should have an active interest in go on the role of NPs and making sure that the high standards of the profession are intact. While NPs should not be a replacement for doctors they should be allowed to practice to the full conclusion of their training. Relaxing the scope of practice laws that prevent nurse practitioners from playing the important role in providing basic primary health care services is the start-off step that should be undertaken.ReferencesAmerican Association of N urse Practitioners (2013). Issues at-a-glance Full practice authority.Retrieved from http//www.aanp.orgAssociation of Advanced Nursing Practice Educators. (2009).Universities and advanced practiceprogrammes. Retrieved fromhttp//www.aanpe.org/AANPEHEIsMembers/AANPEMemberUniversitiesCoursesProgrammes/tabid/469/language/en-US/Default.aspxBauer, J. (2010). Nurse practitioners as an underutilized resource for health reform Evidence-based demonstrations of cost-effectiveness. daybook of the American Academy of NursePractitioners 22 (2010), 228-231.Centers for Disease Control and Prevention (2012). Chronic diseases and health promotion.Retrieved from http//www.cdc.gov/chronicdisease/overview/index.htmDill, M., Pankow, S., Erikson, C., Shipman, S. (2013). Health Affairs. Retrieved fromhttp//content.healthaffairs.org/content/32/6/1135.abstractThe Role of Nurse Practitioners in Meeting Increasing Demand for primitive Care. (2012)Retrieved fromhttp//www.nga.org/cms/home/nga-center-for-best- practices/center-publications/page-health-publications/col2-content/main-content-list/the-role-of-nurse-practitioners.htmlThe, O. C., Pr, N. (2012). Education and Training Family Physicians and Nurse Practitioners.Retrieved fromhttp//www.aafp.org/ dam/AAFP/documents/news/NP-Kit-FP-NP-UPDATED.pdfEibner, C.E., Hussey, P.S., Ridgely, M,S., McGlynn, E,A. (2009). Controlling health carespending in Massachusetts an analysis of options. Retrieved fromhttp//www.rand.org/pubs/technical_reports/2009/RAND_TR733.pdfFairman, J., Rowe, J., Hassmiller, S., Shalala, D. (2011). Broadening the scope of nursingpractice. New England Journal of Medicine 364(3), 193-196.inside10.1056/NEJMp1012121Farmer, R., (2014) Milestone New York legislation eases practice restrictions on NPs.Retrieved fromhttp//news.nurse.com/article/20140505/NY02/305050020.VGAJdMnsoh0Hauer, K.E., Durning, S.J., Kernan, W.N., Fagan, M.J., Mintz, M., OSullivan, P.S.Schwartz,M.D. (2008). Factors associated with medical students care er choices regarding internalmedicine. JAMA, 300(10), 1154-1164.Kalist, D., Spurr, S., Wada, T. (2010). Immigration of Nurses. Industrial Relations A Journalof Economy and Society, 49(3), 406-428.Mehrota, A. et al. (2009). Comparing Costs and Quality of Care at Retail Clinics with that ofOther Medical Settings for 3 Common Illnesses. Annals of Internal Medicine, 151, 321-323.Nurse Practitioners and Primary Care. (2013). Retrieved fromhttp//www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79Sealey, G. (2014). U.S. Elderly to Double in 25 Years. Retrieved fromhttp//abcnews.go.com/US/story?id=91943page=1U.S. Census Bureau, Statistical Abstract of the United States 2012 (131st Edition) Washington,DC, 2011. Retrieved from http//www.census.gov/compendia/statab/.Verdon, D., Ritchie, A., Marbury, D., Mazzolini, C. (2014). (Slideshow) Scope of practicedebate in primary care spreads to 8 states. Retrieved fromhttp//medicaleconomics.modernmedicine.com/medical-economics/content/tag s/midlevel-providers/slideshow-scope-practice-debate-primary-care-sprea?page=full