With much of the United States suffering from shortages of primary care physicians, especially in rural regions, nurse practitioners (NPs) and physician assistants (PAs) are becoming the primary care clinicians for many patients. To help fill this shortage, and what will eventually be a gap in primary care, the Practicing Clinicians Exchange recently pointed out that legislation is currently being considered by the US House of Representatives and Senate to expand the roles of NPs and PAs.
The legislation, known as the Home Health Care Planning Improvement Act of 2010, (H.R. 4993), was introduced in the House by Representative Allyson Schwartz (D-PA), and in the Senate (S.2814) by Senator Susan Collins (R-ME).
When Congresswoman Schwartz introduced the bill, she noted in a statement that although NPs and PAs can currently order nursing home care for Medicare patients, only physicians can sign home healthcare plans and certify Medicare patients for home healthcare. As a result, Medicare will still not certify payment for these services until a physician signs the order, which forces seniors and disabled citizens who see these medical professionals as their primary care providers to make an extra office visit with an unknown physician in order to get the care they need.
To alleviate this burden, Schwartz introduced this legislation to allow NPs and PAs, as well as clinical nurse specialists and certified nurse-midwives, to assume these duties in accordance with state laws. She asserted that doing so would not only codify practices that these clinicians are more than capable of doing, but it also helps keep patients safe.
The legislation is important because as Schwartz pointed out, “Many seniors see a nurse practitioner or physician assistant as their primary care provider and this outdated rules means they have to jump through hoops before they are able to get the home health care they need.”
Consequently, the Practicing Clinicians Exchange emphasized support of the Home Health Care Planning Improvement Act of 2010 because it represents another step to removing the physician-centric language that characterizes most federal health bills. They pointed out that such language was most recently seen in the Patient Protection and Affordable Care Act, which states that only physicians can lead patient-centered medical homes.
Accordingly, with a shortage of primary care physicians and an aging population in need of chronic care, public policy is showing signs of recognizing the expanding role of NPs and PAs in the nation's healthcare. With the support and use of PAs and NPs, there will also be a great need for education of these clinicians, and continuing medical education (CME) will also play a vital role in expanding the services PAs and NPs are able to perform to help address our current shortages.