While a lack of insurance clearly drives emergency department utilization rates so does limited access to providers. After all, waiting six weeks isn’t a great option for someone who is sick right now.
And the problem is only expected to worsen with predicted shortages in primary care physicians coupled with heightened demand from an aging population that is increasingly sicker, thanks in large part to the obesity epidemic and its comorbidities. But the Tennessee Nurses Association (TNA) and Tennessee Academy of Physician Assistants (TAPA) believe there is a viable solution … allowing their members to maximize their skill sets to lighten the load on the system .
The PA Perspective
“The biggest concern we have right now is maintaining our current scope of practice and ensuring PAs can practice to the fullest extent of their skills and training, and that there are no limitations on them,” said Katherine Moffat, executive director of TAPA.
Currently, a PA is able to practice remotely with a physician supervisor who is on site once every 30 days and conducts a set percentage of chart reviews. “We’re not asking for them (current standards) to be relaxed,” she stressed. “We’re just asking to maintain the status quo.” Moffat added physicians are typically on site more often than required by law, and the physician-PA teams frequently communicate to discuss the best options for patients.
However, she continued, there have been increasing efforts to place heightened restrictions on PAs. “We’ve spent several years in the legislative arena battling attempts to curtail our scope of practice,” Moffat said, adding the so-far-unsuccessful pieces of legislation don’t promote patient care and aren’t evidence-based. “If anything, they add to access to care issues.”
She added Tennessee’s rural nature means some communities would have little or no nearby access to primary care providers without physician assistants and nurse practitioners. Even in more urban settings, demand often outpaces supply. “Our stance is that our healthcare needs as a nation are growing, and to limit the ability of PAs to practice to their full extent is taking a huge step backwards.”
Moffat noted physicians who use PAs in their practice see an array of benefits including having a provider available to spend more individual time with patients, resulting in higher satisfaction rates. In fact, she said, “I talk to my members all the time. For the most part, they have excellent working relationships with their supervisory physician. There’s a lot of collaboration as far as patient care.”
The Bureau of Labor Statistics Occupational Outlook Handbook predicts the employment of PAs to increase by 30 percent between 2010 and 2020, much faster than the average for all occupations. As the handbook noted, “As more physicians enter specialty areas of medicine, there will be a greater need for primary healthcare providers, such as physician assistants.”
Moffat said Tennessee has five PA academic programs spread throughout the state — Lincoln Memorial University to the northeast, South College in Knoxville, Trevecca Nazarene University in Nashville, Bethel University in the northwest and Christian Brothers in Memphis. Trevecca has the oldest program, and Christian Brothers the newest … it launched in January of this year.
The Future of Nursing
Carole R. Myers, PhD, RN, who serves as the chair of the Government Affairs Committee for the Tennessee Nurses Association, said the organization is really focusing its efforts toward implementing the recommendations of the Institute of Medicine report “The Future of Nursing: Leading Change, Advancing Health,” which was released in October 2010.
Myers, who is an assistant professor in the College of Nursing and co-director of the Center for Health Policy and Services Research at the University of Tennessee – Knoxville, said the report has broad national implications and “offers us a blueprint for transforming the delivery of healthcare.”
She noted the provisions of the Affordable Care Act place a stronger emphasis on areas other than the actual delivery mechanism. “Certainly the Affordable Care Act takes us part of the way, but to truly change the delivery of care, you need to go further,” Myers said. “The transformation of the delivery of healthcare will come from the bottom up … it will come from the providers of care.”
The IOM report calls on nurses, as the largest sector of the healthcare workforce with more than 3 million members, to play a prominent role in that transformation. However, Myers was quick to add the Future of Nursing takes a collective approach. “I in no way see that the transformation of the delivery of care is going to come from nurses only,” she stressed. “It’s going to take close and effective collaboration among all healthcare professionals.”
The report finds a number of barriers currently exist that keep nurses from being able to respond effectively to a rapidly evolving healthcare system. To better position nurses to help lead change and advance a system of health and wellness, the report makes four key recommendations:
1) Nurses should practice to the full extent of their education and training.
2) Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
3) Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States.
4) Effective workforce planning and policy-making require better data collection and an improved information infrastructure.
“The Robert Wood Johnson Foundation, AARP and the AARP Foundation came together and formed this group called the Center to Champion Nursing to facilitate state-by-state implementation of the recommendations,” said Myers. “This recognizes the delivery of healthcare is local.”
She continued, “When we put the spotlight on Tennessee, we know we already start at a place where our health status is relatively low.” Myers noted that while there has been some improvement in state health rankings, Tennessee has a number of obstacles to overcome. Still, she said, even before the release of the IOM report, individuals and stakeholder groups across the state had already begun to make improvements in evidence-based care delivery and the advancement of the nursing profession.
“The Future of Nursing report definitely gave us a boost,” she added. The Center to Champion Nurses has fostered the formation of state-based action coalitions to address the four key areas of focus in the IOM report. Myers, who helps lead Tennessee’s coalition, said the group was commissioned in late February.
Scope of practice issues, which speak to the Future of Nursing’s first recommendation, continue to be a source of concern in Tennessee. “We’re under-resourced in primary care, which is the foundation of the Affordable Care Act and the Future of Nursing,” said Myers. “There are significant barriers in the state of Tennessee that prevent advanced practice registered nurses from practicing to the full extent of their training and experience.”
Like the PAs, Myers said, “Not only do we have barriers today, the past few years we’ve actually faced the threat of legislation that would make it even more restrictive.” She added it doesn’t make sense to become more restrictive given the state’s relatively low health status and dearth of primary care providers.
“This is contrary to the direction the country is going in. It’s contrary to the Future of Nursing Report, and it’s contrary to the evidence,” Myers concluded.
TAGS: Tennessee Academy of Physician Assistants, Tennessee Nurses Association, TAPA, TNA, Katherine Moffat, Carole Myers, Scope of Practice, Future of Nursing, Institute of Medicine, Healthcare Reform, Affordable Care Act, ACA
Predicted that up to 650,000 Tennesseans will gain health care coverage in 2014 if individual mandated implemented.