The demand for accessible, quality healthcare is undeniable. But in many communities across the country, there is a shortage of providers.
Enter nurse practitioners, who are proving to be the linchpin for effective health care in 2020 and beyond.
“NPs are actually stepping up to meet the need,” Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of American Association of Nurse Practitioners (AANP), tells Florence Health.
This year, according to the association, the number of NPs topped 270,000—nearly double the number in 2010. Annually, NPs complete more than 1 billion patient visits.
Here are the top five trends, according to Dr. Thomas, driving the growth of the NP profession.
Shortage of Primary-Care Physicians
Only 8 percent of physicians enter a primary-care residency, according to AANP’s latest figures, published in 2019. That has led to shortages in PCPs, especially in rural areas. At the same time, Baby Boomers are aging, and the number of those 65 and older is estimated to reach 55 million by 2020, according to AARP.
“NPs are filling those gaps,” says Dr. Thomas, who notes that the vast majority of NP’s deliver primary-care services and 83 percent take Medicare. Many also are choosing to practice in rural areas, crucial to good, easy-to-avail healthcare in those communities.
Consider Dr. Thomas’ own experience. When she returned to school for her NP credentials, the nurse trained in rural Tallulah, Louisiana, and then stayed to practice.
“When I was there doing my training, there was one nurse practitioner and five physicians in that small Louisiana town,” she says. “Now, 25 years later, there is one physician and six nurse practitioners.”
Executive Order on Medicare
On Oct. 3,2019, President Trump issued an Executive Order titled “Protecting and Improving Medicare for Our Nation’s Seniors.” Among other tasks, it directs the Secretary of Health and Human Services to reduce the Medicare regulatory requirements — many of which are stricter than state and federal laws addressing NPs — that limit NPs (and PAs) from practicing to the full extent of their licenses.
The order also seeks parity in reimbursement for services offered by NPs. Currently, NPs bill at 85 percent of the Medicare fee schedule, while physicians bill at 100 percent, Dr. Thomas notes.
Popularity of Medicaid Medical Homes
A medical homes is patient-centered delivery model where one provider leads a team of specialists and other clinicians in providing comprehensive care. It’s especially beneficial for Medicaid patients, who are older and often have complex health problems.
Eighty percent of NPs provide care for Medicaid patients in medical homes, ensuring better outcomes, according to Dr. Thomas. “It’s really giving the patient access to care that they need, providing total care for them so care is not done piecemeal,” she says.
Telehealth is all about providing healthcare services remotely. It includes patient portals that allow for ease of scheduling appointments and accessing test results; videoconferencing with a healthcare provider for an exam, remote glucose monitoring and more.
Dr. Thomas expects telemedicine to grow in popularity — not as a replacement to in-person office visits, but as a complement.
“It’s important to think of it in the context of expanding access to care, expanding access to information,” she explains. “Telehealth is an important pillar for NPs’ delivery method, especially for patients in rural areas.”
Walk-In Clinics and Urgent-Care Centers
The popularity of walk-in clinics offering same-day care is growing. For example, last year, CVS announced 1,500 additional clinics with expanded services by 2021. Ditto for urgent-care centers, which offer an even wider range of hours and services. In 2014, there were 6,400 in the country compared to 9,279 in 2019 — a 45 percent increase, according to the Urgent Care Association (UCA).
Many of these facilities are staffed with NPs, and in some cases, they’re led by these highly skilled nurses. The UCA predicts that staffing models relying on NPs and PAs will “predominate as the primary care physician deficit continues and more states legislate enhanced scope of practices for these advanced practice clinicians.”
The popularity is largely a result of patient demand, according to Dr. Thomas. “Patients are expressing frustration about access to primary-care services,” she says. “They’re using urgent-care centers for primary-care needs.”
As a result, NPs in these practice settings are guiding patients on healthy lifestyle habits and disease prevention.
Regardless of where they work, though, NPs will continue to fight for patient-centered care in 2020 and beyond. As Dr. Thomas says, “We really want to have the potential to make a positive impact on the health of our patients.”