Within the health care system, a triad of issues seems to perpetually top the list of items to be addressed: access, quality, and cost-effectiveness. These three have become buzzwords, yes, but they are concepts that NPs and PAs understand and fulfill better than many outside the health care system recognize. Both professions see themselves as part of the solution to many of America’s health care problems.
The major priority, according to Jan Towers, PhD, NP-C, CRNP, FAANP, Director of Health Policy for the American Academy of Nurse Practitioners (AANP), needs to be “removing barriers to providers other than physicians and hospitals. We think we can make a significant contribution to the access problems, if barriers were lifted. We’re making a significant contribution as it is—there are 125,000 NPs out there, and if we all could function at our full scope, we could really have a major impact.”
PAs feel the same way. As American Academy of Physician Assistants (AAPA) President Cynthia B. Lord, MHS, PA-C, says, “We certainly are qualified and experienced members of the health care team. And I think that’s a key word, team.”
One of the hottest topics right now—brought up individually by representatives of both AANP and AAPA—is the medical home. Originally introduced by the American Academy of Pediatrics (AAP) in 1967, the concept has evolved to include comprehensive, coordinated care provided by a physician-led team of health care professionals. Last year, AAP, the American Academy of Family Physicians, the American College of Physicians, and the American Osteopathic Association issued joint principles for the medical home (available at www.medicalhomeinfo.org).
“There shouldn’t be islands of care,” Lord says. “Everyone talks about the medical home. When you look at the physician–PA team, whether it’s in a surgical or medical subspecialty or in primary care, it is the solution to improving access. We’ve got quality and safety, as well as cost-effectiveness. All of those things are directly related to the way that PAs practice medicine with their physicians.”
“If you take those principles for a medical home, and just change the word to ‘nurse practitioner,’ that’s what we do!” Towers says. “But we’ve been having difficulty getting into the framework, in particular at the federal level. It’s something that needs to be recognized, that NPs do this and do it well.”
Towers adds that nonphysician providers need to be included in the development of the reimbursement structure for this type of health care system. “The provider system is really already there. What they’re trying to do is turn it into a payment system,” she says. “And what we’re saying is, ‘We already do it, and if you want to look at demonstrations and that sort of thing, you really need to include us.’”