Medicaid patients in Florida are finding it more and more difficult to find a primary care provider. Only 5 percent of Florida physicians accept patients on Medicaid.
In the majority of states, advanced practice registered nurses (APRNs) are legislatively empowered to provide primary care for Medicaid recipients. This past October, the Institute of Medicine (IOM) recommended removal of all scope-of-practice restrictions on all APRNs as a way to increase access to health care in our nation.
However, Florida laws restrict APRNs from providing this care. The result: patient suffering and increased costs to the state.
Florida is on the American Medical Associations list of states where patients may have trouble accessing a primary care physician. Leading health care economists have studied the evidence and recommend a proven, cost-effective and immediate solution to the primary care shortage problem. It is utilization of advanced practice registered nurses (APRNs) who are allowed to practice at their full scope of certification and educational training.
Case in point: Currently, an APRN who is certified to practice as a nurse practitioner and cares for hundreds of patients on Medicaid, may be forced to close her doors because her supervising physician is retiring. She has been unable to secure another supervising physician. There are only two providers in her county who accept Medicaid. If she is forced to close her doors, hundreds of Medicaid patients will be without a health care provider. Most will probably resort to emergency rooms for care. The nurse practitioner has so far been unable to secure a new supervising physician.
In most other states in this nation, this nurse practitioner could operate independently or with a collaborative practice agreement with a physician who agrees to take patient referrals. Nurse practitioners in these other states are solely culpable and responsible for the care they provide patients.
In Florida, however, all APRNs must work under a supervisory agreement with a physician in order to care for patients. This makes the physician jointly responsible for the care provided. Most physicians do not want the added liability that this supervisory affiliation entails, making it very difficult for APRNs to open clinics and provide care.
The IOM report, The Future of Nursing Leading Change, Advancing Health," recommends all states to change laws so thatAPRNs can practice independently at their full scope of education and training.
Studies have shown that costs to Medicaid programs decrease as much as 24 percent when APRNs are allowed to practice at full scope. This cost savings is realized by reduced emergency room visits, reduced unnecessary operations, and improved outcomes of care.
With increased numbers of Floridas citizens projected to come into the Medicaid system, APRNs could make a tremendous impact in both providing access to care and cost savings if the current barriers to practice were lifted. It is in the publics interest for this to happen, and really the better question is why it has not happened already.
All APRNs in the United States receive the same education under a national curriculum and go on to study specialized courses in their field of interest. They also take the same national tests for licensing and board certification. Depending on their specialized education, they are certified as nurse practitioners, nurse midwives, nurse anesthetists or clinical nurse specialists.
They independently manage pregnancies and deliver babies, administer and manage anesthesia, deliver psychotherapy, and provide virtually everything done in a primary care office including office procedures. APRNs offer integrated, patient-centered care and are qualified to lead health care homes for patients, as these are core nursing values.
Numerous research studies prove that APRNs are safe and give equivalent care within their scope of practice to physicians. For the 11th year, nurses were voted the most trusted profession in America in Gallup's annual survey that ranks professions for their honesty and ethical standards. Eighty-one percent of Americans believe nurses' honesty and ethical standards are either "high" or "very high."
The Florida Legislature is debating Medicaid and health care reform this legislative session. Adding APRNs as primary care providers and removing the barriers to their ability to treat patients will immediately increase care access and save money without any cost to the state.
The Florida Legislature should stop the suffering of patients and waste of taxpayer money by removing the restrictions on APRNs.
Susan Lynch is vice chairman public relations, Florida Council of Advanced Practice Registered Nurses PAC.
