Genevieve Swenson
How nurse practitioners can impact the business of healthcare
February 17, 2023
By Genevieve Swenson, FNP-C
It is becoming increasingly clear that the US healthcare system is desperately in need of reform. Data from the Primary Care Collaborative shows that the US is facing a primary care physician shortage of anywhere from 21,400 to 55,200 by 2033. According to AAMC President and CEO, David J. Skorton, M.D.: “The challenge of having enough doctors to serve our communities will get even worse as the nation’s population continues to grow and age.”
Nurse practitioners (NPs) have the potential to fill these gaps, as research has shown that patients under the care of NPs have fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations, higher patient satisfaction and fewer unnecessary emergency room visits than those under the care of physicians. Despite this, about half the states in the US have still not granted full and unrestricted practice authority for nurse practitioners. Granting this authority could help to reduce the bureaucracy and get more NPs out to high need areas, allowing greater access to care.
It is estimated that the United States spends $3.6 trillion annually on healthcare. Of that amount a mere 3% is directed toward public health and prevention. In order to truly cut down the cost of healthcare in the US, which should drive down costs to the consumer, we must move from intervention to prevention of chronic disease. In doing this, it is important to distinguish preventive care - care that prevents an issue from occurring at all - from mere screenings that simply establish if disease is present.
While screenings such as mammograms are valid, they are not a substitute for preventive care. In fact, it can be misleading to patients leading them to believe that routine screenings are all they need to do to prevent disease. In fact, fewer than 10 percent of US adults ages thirty-five and older received the high-priority, appropriate clinical preventive services recommended for them. The lack of preventive care directly impacts healthcare costs. More than 75% of healthcare costs are due to chronic conditions and 50% of all Americans have a chronic condition.
The primary care physician shortage is one barrier that hinders patients from receiving preventive care. Nurse practitioners can bridge that gap. There are 355,000 nurse practitioners today and it is estimated to grow by 46% between 2021 and 2031. These NPs are performing more than a billion patient visits annually. According to the AANP: “As clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management, (nurse practitioners) bring a comprehensive perspective and personal touch to healthcare.”
One study that examined the impact of NPs and Physician Assistants (PAs) on medically complex patients with diabetes showed that case-mix-adjusted total care costs were 6–7 percent lower for NP and PA patients than for physician patients, driven by more use of emergency and inpatient services by the latter. The finding validated that the use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs. With a focus on illness prevention, NPs can have a significant impact on decreasing healthcare costs.
Rural residents are older and sicker than their urban counterparts and are at higher risk of death from conditions like stroke, heart disease and cancer. These residents also lack ease of access to medical care. In rural areas the patient-to- primary care physician ratio is 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. In addition, a new report from the Center for Healthcare Quality and Payment Reform indicates that more than 29 percent of rural hospitals nationwide are at immediate or high risk of closure. With a decline of physicians practicing in rural areas, and less access to hospital care, NPs can fill an urgent and growing need.
Finally, nurse practitioners are able to spend more time with patients, which can help patients feel heard and empowered. In a small University of Michigan study, patients reported that they felt that doctors “always” listened carefully 50% of the time compared to 80% of the time for NPs. This is not an admonishment of primary care physicians and the vital role they play, but highlights one of the institutional failures of our healthcare system.
Patients and the bottom line benefit from nurse practitioners being a part of the care team. Yet, NPs continue to fight bureaucracy to be granted full practice authority in many US states. Primary care shortages, inequities in access to care and the burden of chronic disease demand that we take action to implement a solution that already exists and is proven to affect both outcomes and costs.
About the author: Genevieve Swenson, COO and co-founder of Nice Healthcare, is a Family Nurse Practitioner with a diverse background in the healthcare world has partnered with patients in clinics, in their homes, via telehealth, in urgent cares and employer wellness clinics.
It is becoming increasingly clear that the US healthcare system is desperately in need of reform. Data from the Primary Care Collaborative shows that the US is facing a primary care physician shortage of anywhere from 21,400 to 55,200 by 2033. According to AAMC President and CEO, David J. Skorton, M.D.: “The challenge of having enough doctors to serve our communities will get even worse as the nation’s population continues to grow and age.”
Nurse practitioners (NPs) have the potential to fill these gaps, as research has shown that patients under the care of NPs have fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations, higher patient satisfaction and fewer unnecessary emergency room visits than those under the care of physicians. Despite this, about half the states in the US have still not granted full and unrestricted practice authority for nurse practitioners. Granting this authority could help to reduce the bureaucracy and get more NPs out to high need areas, allowing greater access to care.
It is estimated that the United States spends $3.6 trillion annually on healthcare. Of that amount a mere 3% is directed toward public health and prevention. In order to truly cut down the cost of healthcare in the US, which should drive down costs to the consumer, we must move from intervention to prevention of chronic disease. In doing this, it is important to distinguish preventive care - care that prevents an issue from occurring at all - from mere screenings that simply establish if disease is present.
While screenings such as mammograms are valid, they are not a substitute for preventive care. In fact, it can be misleading to patients leading them to believe that routine screenings are all they need to do to prevent disease. In fact, fewer than 10 percent of US adults ages thirty-five and older received the high-priority, appropriate clinical preventive services recommended for them. The lack of preventive care directly impacts healthcare costs. More than 75% of healthcare costs are due to chronic conditions and 50% of all Americans have a chronic condition.
The primary care physician shortage is one barrier that hinders patients from receiving preventive care. Nurse practitioners can bridge that gap. There are 355,000 nurse practitioners today and it is estimated to grow by 46% between 2021 and 2031. These NPs are performing more than a billion patient visits annually. According to the AANP: “As clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management, (nurse practitioners) bring a comprehensive perspective and personal touch to healthcare.”
One study that examined the impact of NPs and Physician Assistants (PAs) on medically complex patients with diabetes showed that case-mix-adjusted total care costs were 6–7 percent lower for NP and PA patients than for physician patients, driven by more use of emergency and inpatient services by the latter. The finding validated that the use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs. With a focus on illness prevention, NPs can have a significant impact on decreasing healthcare costs.
Rural residents are older and sicker than their urban counterparts and are at higher risk of death from conditions like stroke, heart disease and cancer. These residents also lack ease of access to medical care. In rural areas the patient-to- primary care physician ratio is 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. In addition, a new report from the Center for Healthcare Quality and Payment Reform indicates that more than 29 percent of rural hospitals nationwide are at immediate or high risk of closure. With a decline of physicians practicing in rural areas, and less access to hospital care, NPs can fill an urgent and growing need.
Finally, nurse practitioners are able to spend more time with patients, which can help patients feel heard and empowered. In a small University of Michigan study, patients reported that they felt that doctors “always” listened carefully 50% of the time compared to 80% of the time for NPs. This is not an admonishment of primary care physicians and the vital role they play, but highlights one of the institutional failures of our healthcare system.
Patients and the bottom line benefit from nurse practitioners being a part of the care team. Yet, NPs continue to fight bureaucracy to be granted full practice authority in many US states. Primary care shortages, inequities in access to care and the burden of chronic disease demand that we take action to implement a solution that already exists and is proven to affect both outcomes and costs.
About the author: Genevieve Swenson, COO and co-founder of Nice Healthcare, is a Family Nurse Practitioner with a diverse background in the healthcare world has partnered with patients in clinics, in their homes, via telehealth, in urgent cares and employer wellness clinics.