Primary Care Workforce: An Advanced Practice Nurse Solution?

CHI estimates that federal health reform will result in more than 540,000 Coloradans (10 percent of the state’s population) becoming newly insured by 2014, leading to increased use of primary care services across the state. Here at CHI, we’re looking at how health providers will accommodate these new patients.

CHI research analyst Athena Dodd, in a talk sponsored by the Area Health Education Center at the Anschutz Medical Campus last week, said that advanced practice nurses (APNs) - and nurse practitioners in particular - may play an important role in responding to the challenge of increased demand for primary care services.

View Athena's presentation here:

[slideshare id=9683805&doc=100311ahecoctoberscopeofpractice-111013163345-phpapp01]

Dodd said that about 68 percent of the 2,000 or so practicing nurse practitioners in Colorado specialize in primary care. This is almost half the size of the state’s primary care physician workforce.

Changes to the Colorado Nurse Practice Act in 2010 made Colorado one of fifteen states in which APNs can diagnose, treat and prescribe medication for patients with common conditions without a physician’s supervision. State law lets Colorado’s APNs practice independently of physicians after they obtain prescriptive authority, which requires a physician’s mentorship. Still, they may encounter obstacles that prevent them from practicing to the full extent allowed by Colorado regulations, often called the full scope of practice.

While nursing groups have advocated for expansion of their scope of practice, some physician groups are opposed to the change, citing inadequate training and potential quality issues. APNs working independently of physicians may encounter financial barriers to providing care to patients. Medicare and Medicaid accommodate direct billing by APNs, but typically reimburse below what physicians earn for the same service.  APNs may also experience difficulty being recognized as a “covered provider” by private insurers and have trouble getting paid for their work. In 2011, a bill was introduced that would have required private insurers to give equal consideration to APNs seeking to become covered primary care providers, but it failed.

As health reform increases the demand for primary care services and as nurse practitioners become  more fully integrated into the primary care workforce through initiatives such as health homes and accountable care organizations, the new landscape will most likely require all health providers to practice at their full scope. CHI will be watching to see how these new models of health care will affect the debate surrounding APNs.

Westley Mori is a research analyst at CHI.