Nurse Practitioner Perspectives on the Future of Health Care

It's a historic moment for health care in America. Never before have so many uninsured patients been in need of health care, and never before have health care providers been in such great demand. Nurse Practitioner opinions run the gamut: some fear things will only get worse, while others see this as the hour before the dawn. The one thing they all agree on is that change is on the horizon.

"If this health care reform does come though, there's all of a sudden going to be this influx of people that are going to need primary care," Family Nurse Practitioner Peggy O'Donnell, ANP, BC, MS, RN, says. "There are just not enough primary care doctors out there, so it's a perfect place for Nurse Practitioners to find a home, because we're good at primary care. I think we're fitting in nicely with the reform coming down the pipe."

Psychiatric Nurse Practitioner Susan Ouellette, CRNP, CSP, APRN-PMH, (www.sueouellettespeaks.com) expresses some misgivings about the pace of the changes. "You can't just ram a program in; you have to fix it incrementally," she says. "This is being shoved through in a year, and it's such a complex problem, you don't have all the answers."

Will we have enough providers to handle the number of newly insured patients? Ouellette worries that we won't. On top of that, she says, existing providers are already working to capacity. "We're going to have to work harder to make the same money....What's going to happen is practices are going to stop taking Medicare, and these people are not going to be able to get the care that they need. I think it's going to be a disaster."

Jan Towers, PhD, NP-C , CRNP, FAANP, FAAN, has a sunnier outlook on the numbers. "We don't have any shortage of students, so if we have the capacity to prepare them we're certainly going to be able to," says Dr. Towers, who is the Director of Health Policy for the American Academy of Nurse Practitioners (www.aanp.org). "If we actually get the full complement of new patients, it will stretch everything, but we're ready to step in, and one of the things we're trying to do is making [the healthcare system] function so that people can have access to it."

Dr. Towers recently attended President Obama's health care reform bill meeting, to which she was invited as an expert to discuss thoughts on how the use of nurse practitioners will increase if the bill is passed. She says that the health care reform bill should make it possible for nurse practitioners to function more effectively. In the past, nurse practitioners have sometimes been blocked from working to their full potential by the language of the law. For example, coverage policies and reimbursement packages might specifically refer to physicians rather than providers.

In the health care reform bill, however, "There's a lot of language that makes it clear that nurse practitioners are primary care providers," Towers explains. "There's language that authorizes nurse practitioner practices to be medical homes, we have money for nurse-managed centers and school based clinics which are all run by nurse practitioners, there's a lot of provider-neutral language and non-discrimination language, which opens the door for us a little bit better in terms of being limited by the physician word being thrown around all over the place. So we're hoping that this is going to be the age of enlightenment."

What form might this "age of enlightenment" take? The focus in the future will be on preventive care and early access, say nurse practitioners. In theory, governments, healthcare centers and patients will all save money with the new trend.

"Early access saves so many healthcare dollars," points out O'Donnell. "Instead of people using the emergency rooms for their healthcare, which is extraordinarily expensive for all of us, come see a nurse practitioner! We're known for being complete and thorough, but we're good at managing healthcare dollars. The nurse practitioners who are based in the hospitals usually have very good rates of getting people through the system quickly, getting them discharged safely, fewer revolving doors with the hospitals."

However, there may be some initial push-back from insurance companies, who make a higher profit from expensive emergency care. "For me this dates back to the 1980s," reflects Ouellette. "Diabetics started to test their blood with blood sugar monitors, and it was a new thing, because we had always used urine testing. I was writing letter after letter after letter to insurance companies, because they didn't want to pay the $200 for the meter, but they paid fully for an ICU stay when a patient got really sick."

With a model of preventive care, personal accountability will play a strong role. For today's society, in which Americans don't have a habit of seeking preventative care, a long-term transformation may require a phase of public education. "For years, this nation has not put any stipulations on people," Ouellette says. "I think you're going to have to start making people be accountable."

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