“Also needing expansion are programs that train nurse practitioners, nurse-midwives, and physician assistants,” Hawkins said.
The NACHC report noted a decline in support for federal Health Professions and Nurse Training Programs (Titles VII and VIII of the Public Health Service Act). For FY2009, no appropriations have been requested for Title VII, while the administration’s request for Title VIII, at $156 million, is almost one-third less than the previous year’s funding. In addition, it was proposed that the $62 million Advanced Education Nursing program be eliminated.
Beyond funding for training programs, the report mentions some of the obstacles to full utilization of PAs and NPs as another area in need of improvement if workforce needs are going to be met. “State scope-of-practice standards set boundaries by which key primary care providers, namely NPs and PAs, can deliver care,” according to the report. “State policymakers must consider how these standards encourage or discourage primary care professionals to locate in and form teams in underserved areas.”
Eternal Conundrum of Reimbursement
During the teleconference, Hawkins, Wiltz, and Lil Anderson, Chair of the NACHC Board and President and CEO of RiverStone Health in Billings, Montana, also discussed reforming the reimbursement structure to recognize the importance of primary care. Reimbursement is a perennial issue, but in a troubled economy, can change be achieved?
“This is not going to be something that’s easily done,” Hawkins admitted.
“As we are in the process of having another national debate on health care reform, part of that debate needs to be about changing our health system from paying for illness care … to paying for prevention and primary care,” Anderson added. “That’s going to take a lot of time, [and] that is an investment that is going to be difficult to convince Congress and the American public to pay for. But it truly is the only way to change the system that we’re in right now, which really reinforces people to get care in the most expensive arena.”
Hawkins outlined a variety of reimbursement components in which reforms could be made, from reducing the use of services that are “questionable at best” to providing bonuses for the delivery of high-quality care. He also talked about the medical home concept and the proposal by its leading proponents to provide compensation for the types of follow-up and patient communication that are not usually reimbursed.
“Putting together those couple of innovations with a fee-for-service payment for the care actually provided to patients during a visit … could significantly boost revenues and payments to primary care providers,” Hawkins said. “And yet, we are convinced that in so doing it would reduce overall spending.”
NACHC estimates that a reduction in emergency department use by persons who do not have a true emergency and whose needs could be addressed in a primary care setting could produce a savings of $18 billion per year. In the case of staffing health centers to meet the needs of 30 million patients, NACHC says the return on investment could be as high as $80 billion dollars annually—“not to mention over 450,000 new jobs,” according to Hawkins.
The full report—which includes projections of how many primary care providers are needed in each state—is available at the NACHC Web site (www.nachc.com).