Nurse Practitioners Offer Prescription for Medicaid
Group says broader role would curb costs; Florida Medical Association has different diagnosis
Around the State
Stan Whittaker, chairman of the Florida Council of Advanced Practice Nurses PAC, said, "Utilizing (nurse practitioners) has significantly reduced costs to Medicaid programs in other states. We are ready and able to do the same for Florida. It is in the public interest for this to happen, and really the better question is why it hasn't happened already."
Whittaker made his comments during Friday's Medicaid reform hearing in Tallahassee, where lawmakers are exploring ways to contain costs of the $14.7 billion program.
The Institute of Medicine recently released a report that recommends full utilization of nurse practitioners as a way to drive down expenses, while increasing high-quality access to primary health care.
Tennessee, which moved to a managed-care model for its Medicaid program, cut costs by 23 percent when nurse practitioners were used as full-scope, primary-care providers, according to a Vanderbilt University study. The study also said that nurse practitioners saved the state 40 percent on drug utilization and 30 percent on labs.
Other research continues to show that nurse practitioners can deliver high-quality care within their scope of practice with outcomes that equal their physician colleagues.
“We can also create jobs if we are allowed to practice independently like many states,” contends Whittaker. “We estimate that 3,000 ARNPs would open their own practices and each of these would employ two to three support staff, creating 9,000 jobs."
There are 12,000 nurse practitioners in Florida.
All nurse practitioners in the United States receive the same basic education and training via a national curriculum. To begin practice, applicants must be registered nurses from a four-year BSN program. They must complete a minimum of three to five years as a practicing R.N. before entering a two-year master's level nurse practitioner program.
In addition to serving some 800 hours in supervised clinic practice, nurse practitioners also must pass a national certification exam.
Though Florida's nurse practitioners must meet the national standards, the state is one of just two that severely restricts their scope of practice, says Susan Lynch, a nurse practitioner in Orlando.
"When you're told how, when and where to practice, that puts a great strain on nurse practitioners," she says. Uniquely, Florida and Alabama bar their nurse practitioners from prescribing certain medicines or committing psychiatric patients.
Lynch argues that such rules restrict health-care access for indigent patients while leading to more emergency-room visits and their attendant higher costs.
Citing the Tennessee model, Lynch believes that a $1 billion Medicaid cost reduction is conservative for Florida. If Tennessee's experience were matched, Florida's savings would top $3 billion annually.
But Lynch and Whittaker said their organization has heard nothing from state lawmakers about their proposal.
"The delay is political and administrative," Whittaker said.
Timothy J. Stapleton, executive vice president of the Florida Medical Association, countered with a statement, saying:
"The FMA fully supports allowing nurses to go to medical school if they want to practice medicine. Due to increasing demands on our health-care system, we will need more nurses, physicians and other health-care professionals in Florida.
"However, we wouldn't want to put unqualified people in a position to provide day care for our children, construct our homes or enforce our laws just in the name of creating new jobs -- because we know how devastating the outcome could be. Allowing nurses to essentially serve as physicians is even worse, because millions of people's lives are at stake.”
“The average physician's office creates 19 jobs -- and ensures patient safety. If we want to maximize impact, create jobs and increase access to care, the state of Florida should consider investing in graduate medical education and creating more residency slots so that we can keep physicians in the state.
"This is a much better solution to meet Florida’s access to care needs. Allowing unqualified nurses to play doctor and putting patient safety at risk is not in the best interest of our citizens.”
Bruce Reuben, president and CEO of the Florida Hospital Association, sees both sides of the debate, but concludes, "The reality is, we don't have enough doctors."
"Can we utilize nurses who are trained health-care professionals to extend access to primary care? When 48 other states are doing it, it's something Florida will have to consider," he said.
Contact Kenric Ward at firstname.lastname@example.org or (772) 801-5341.