Nurse practitioners can help reduce health costs

On June 9, more than 500 business leaders and health-care professionals attended the Virginia health-care conference, "Transforming Health Care Through Effective Partnerships," sponsored by the Virginia Chamber of Commerce at the Richmond Marriott.

The conference addressed the needs and role of businesses as decisions are beginning to be made regarding federal health-care reform, and it included comments from Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services.

Dr. Berwick emphasized innovative ways to reduce rising health-care costs for businesses but failed to mention a key component of an October 2010 Institute of Medicine report — relying on nurses and nurse practitioners (NPs) to help transform the health-care system.

Nurse practitioners are registered nurses with master's or doctorate degrees who have advanced training in the diagnosis and management of routine and complex medical conditions. They diagnosis and treat acute and chronic conditions; order, perform and interpret diagnostic tests; prescribe medications; and provide health education and counseling to guide patients in making smart health and lifestyle choices, an important component of health-care reform and one that ultimately reduces health-care costs for individuals and businesses.

During his presentation in Richmond, Dr. Berwick stated, "Almost everything you do and use has gotten steadily better over time. Not by cutting, but improving the way something is made, the way something is performed or something is designed."

The Virginia Council of Nurse Practitioners (VCNP), the statewide professional association for the more than 6,000 NPs licensed in the commonwealth, believes embracing NPs as a part of the health-care solution will improve health-care delivery in Virginia by expanding access to care for all patients, especially those in rural and underserved areas.

Unfortunately, current scope-of-practice standards prevent effective team practice and health-care access in Virginia. In fact, the recent Pearson Report, which annually rates states on patient access to NPs, awarded 21 states, including Maryland and Washington, D.C., with A's and Bs. The same study ranked Virginia in the bottom 14 states because of "poor to restricted patient access due to regulatory barriers."

Nationally, there are more than 6 million visits to nurse practitioners each year. Patients report satisfaction with their care, and studies show they have fewer emergency room visits and hospital admissions and shorter hospital stays, translating into reduced health-care costs.

Statistics from the National Practitioner Data Bank, which collects data regarding malpractice reports across provider disciplines, also attest to the quality and safety of the care delivered by NPs. Safety ratios based on the number of malpractice actions reported per provider type reflect very favorably on the safety of NP care in comparison to medical doctors and doctors of osteopathic medicine.

The data also frequently indicate that NPs practicing in autonomous states are actually even less likely to have incidents collected by the Data Bank than those in supervised states. Several analysts have commented regarding this phenomenon that supervisory restrictions can negatively impact outcomes. The competence and training of the practitioner does not significantly vary across state lines, however statutory restrictions on scope of practice do vary significantly and definitely affect patient access to safe, effective care.

Nurse practitioners have been collaborating with physician colleagues for more than 45 years. Today, more than 325 colleges and universities, including nine in Virginia, educate nearly 8,000 new nurse practitioners a year. Similar to other health-care providers, nurse practitioners offer skilled and quality health care to all patients, treating when they're able and referring to specialists when necessary. In fact, studies have shown that NPs can add substantially to physician productivity, while proper utilization of NPs can result in better-quality and more coordinated care.

Earlier this year, VCNP began discussions with the Medical Society of Virginia with the hope of improving, if not rectifying, the patient access situation. The issue is also being examined through the Health Reform Initiative's Capacity Task Force created by Gov. Bob McDonnell last fall and by Virginia Secretary of Health and Human Resources Bill Hazel through the Virginia Board of Health Professions.

As the cost of health care continues to rise, VCNP urges Virginia's citizens and business owners to embrace NPs as a vital component of the solution for providing cost-effective, high-quality, comprehensive health care to all Virginians.