Health reform pushes more care into hands of nonphysicians, including patients

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The spotlight on nonphysician practitioners (NPP) is brighter than ever, as these professionals are increasingly viewed as the solution to improving healthcare access and costs amid health reform. A recent editorial in The New York Times, for example, ran with the title, "When the Doctor Is Not Needed."

Indeed, one recent study in Annals of Family Medicine estimated that 77 percent of preventive care could be delegated, leaving the most serious and acute cases to physicians. With 30 million new patients expected to soon flood doctor's offices--many of them suffering from multiple chronic conditions--physicians would certainly have their hands full providing only this high level of care.

With the Affordable Care Act helping to drive an existing trend, demand for nurse practitioners (NP) and physician assistants (PA) has already begun to increase substantially. However, healthcare organizations that increase their reliance on such providers should take certain precautions to ensure patient safety and minimize legal risks, noted a recent post from Physicians Practice.

For example, it's critical to ensure not only that an NPP is operating within the scope of his or her licensure, but also that the malpractice insurance covering NPPs accurately matches their job descriptions. In addition, practices must be clear on how they are allowed to bill for NPP services in their state, what types of written supervision agreements may be required and the extent of an NPP's prescribing authority, if any.

The Times article, which received more than 260 reader comments so far, discussed not only the expanding roles of NPs, PAs and pharmacists in filling healthcare gaps, but also the potential for low-cost community aides and even patients themselves to conduct more routine services and tests. Community aides, for example, cost $17 per call or visit, compared with Medicaid payment rates of $200 for a clinic visit in Houston and $175 for an emergency room in Harrisonburg, the article noted. What's more, a hospital in Sweden found that by allowing some patients to do their own hemodialysis, it not only cut costs in half, but also reduced patients' rates of complications and infections.

To learn more:
- read the editorial from The New York Times
- see the post from Physicians Practice

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