State and national reimbursement policies should remove barriers that make it hard for nurse practitioners and physician assistants to serve as primary-care providers, according to recommendations from a diverse panel representing medical associations, academic institutions, insurers, government representatives and not-for-profit organizations.
Let nurse practitioners, doc assistants provide primary care, panel urges
In January, the Josiah Macy Foundation—a private philanthropy focused on improving healthcare—hosted a conference to address who will provide primary care in the U.S. and how those professionals will be trained. Participants then developed a set of conclusions and recommendations about the issue, starting with the suggestion to create financial and other incentives to develop “innovative models of primary care” and advance knowledge about outcomes.
There also needs to be stronger ties between academic health centers and other primary-care sites in the communities they serve, as well as investment in health information technologies that “support data sharing, quality improvement, patient engagement, and clinical care, with the aim of continuously improving the health and productivity of individuals and populations,” according to the summary from the conference.
Regarding payment, the participants said there should be all-payment reforms that recognize the value of primary care. One way to do this, the summary noted, is through “global payments linked to patient complexity and accountability for the provision of healthcare services, including preventive services, care coordination across settings, chronic disease management, and 24/7 accessibility.”
Leading the conference participants were co-chairs Linda Cronenwett, professor of nursing at the University of North Carolina at Chapel Hill School of Nursing, and Victor Dzau, a physician who is chancellor for health affairs at Duke University and president and CEO of Duke University Health System. Other participants included Michael Barr of the American College of Physicians, Gerald Cross of the Veterans Affairs Department, Elliott Fisher of the Dartmouth Institute for Health Policy and Clinical Practice, Steve Schoenbaum of the Commonwealth Fund, Barbara Starfield of the Johns Hopkins Primary Care Policy Center and Reed Tuckson of UnitedHealth Group.
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