Guest writer

Solution in waiting

Nurse practitioners close care gap

It’s well-documented that Arkansas suffers from a shortage of primary health-care providers, yet the state seems all too complacent-if not backwardly stubborn-about addressing one solution to the problem: recognizing nurse practitioners as primary-care providers in Arkansas Medicaid, and in that portion of the health insurance exchange that affects Arkansans up to 138 percent of the poverty level.

House Bill 1190, currently before the Legislature, would make this happen in a state that the Association of American Medical Colleges ranks as the third-lowest nationally for active physicians. A 2011 study by the University of Arkansas for Medical Sciences Center for Rural Health spotlighted 514 vacancies for primary-care physicians in Arkansas, with the number expected to climb to 860 within five years. A study released last month by the Arkansas Center for Health Improvement says the state has about 15 percent fewer primary-care physicians than it needs, particularly in more rural areas.

Yet, despite those telling statistics-and the fact that published reports show a growing trend among medical-school graduates to choose more lucrative specialty practices over primary care-Arkansas is one of just a few states that fails to recognize nurse practitioners as primary-care providers in its Medicaid program.

Consider the following: Nurse practitioners already routinely evaluate, diagnose and treat patients, and numerous studies have shown that they do so with an excellent record of safety and quality.

Many nurse practitioners already practice in rural and under served areas of Arkansas, where the demand for their services will only increase when an estimated half-million Arkansans obtain health-care coverage in 2014. Across the U.S., nearly 20 percent of nurse practitioners practice in cities and communities with fewer than 25,000 in the population, according to published statistics.

Eighty-nine percent of nurse practitioners are prepared in a primary-care focus, such as adult, family, gerontology, pediatric or women’s health. The family nurse practitioner focus is the most prevalent.

Nurse practitioners are prepared to provide primary care from first contact through ongoing management of acute and chronic conditions, health promotion and care coordination, according to the American Association of Nurse Practitioners.

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The Arkansas Medical Society contends that there are insufficient quality and safety studies to support the use of nurse practitioners as primary-care providers. This contention, however, contradicts a 2013 Arkansas Center for Health Improvement-commissioned report that states: “… the quality of primary care-across the field’s range of services-delivered by [advanced practice nurses] practicing autonomously, to be at least as high as that of physicians.”

Dave Herbert, chief executive officer of the American Association of Nurse Practitioners, says a large primary-care role by nurse practitioners would both maintain quality and reduce health-care costs. He calls practice restrictions on nurse practitioners “artificial controls in place simply as a result of lobbying.”

A 2009 report by RAND Corp., a California-based policy institute, found no evidence that nurse practitioners provide lower-quality care. The group also estimated that nurse practitioners could reduce the cost of office visits by 35 percent.

A policy brief from the National Institute for Health Care Reform, released in February, found that state scope-of-practice laws and payment policies are two of the biggest challenges to expanding primary care provided by nurse practitioners. Author Tracy Yee, whose six-state report included Arkansas, said states “need to also look at their Medicaid programs because they have control over that.” Yee says one solution is for Medicaid and private payers to allow nurse practitioners to be reimbursed directly or to be listed as preferred providers.

House Bill 1190, introduced by Rep. Kim Hammer, R-Benton, would pave the way for increased-and needed-primary health care in Arkansas by clarifying the law for Medicaid reimbursements for nurse practitioners.

This measure affords lawmakers the opportunity to take a major step forward in providing primary health care for Arkansans, particularly in those areas where primary care already is sorely lacking.

This is an opportunity for lawmakers to exhibit concern and understanding for their constituents-and to show that Arkansas can indeed move forward.

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Mary Garnica is an advanced practice nurse in central Arkansas, and the chair of the Arkansas Nurses Association’s Health Policy Committee.

Editorial, Pages 17 on 04/06/2013

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