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Three ways nurse practitioners are transforming healthcare delivery from hospital to home
Hospitals have employed nurse practitioners (NPs) for decades, but only recently have they begun to capitalize on NPs’ potential.
Changes in NP licensure laws, a swiftly aging patient population and increasing pressures from Medicare to focus on care quality has elevated the profile of NPs as key players in a new age of cost-conscious, quality hospital care. Here are three reasons why hospitals are turning to NPs and improving patient care in the process.
NPs are the lynchpin in achieving continuum of care. While most hospitals embrace the idea of delivering a more seamless continuum of care, connecting the dots between primary care, specialists, ER teams and follow-on home health can be a complex task. Often the biggest challenge is finding the provider that can cure hospital fragmentation – someone who has the expertise to diagnose and treat patients with the consultative skills to facilitate their journey through the labyrinth of care. This role is increasingly being filled by an NP.
This is especially critical for hospitals struggling to transition patients between in- and out-patient care. Approximately 20 percent of Medicare patients admitted to U.S. hospitals each year are readmitted within 30 days of discharge, running up a $15 billion hospital tab for the U.S. annually. Even more staggering, more than half of all surgery patients either died or were readmitted to the hospital within a year. The Medicare Payment Advisory Commission (MEDPAC) estimates that three-quarters of those readmissions (and about $12 billion in Medicare spending) might be avoided with a better continuum of care, including better discharge planning. And therefore, Medicare is cutting payments to hospitals that experience high rates of potentially avoidable readmissions.
Increasingly, NPs are helping to reverse this trend. One study assessing the impact of adding an NP to the oncology surgery department cited improvements in oversight and care after discharge – including a 64 percent increase in phone follow-up and a 14 percent increase in the use of home care and physical/occupational therapy services. More significantly, having an NP facilitate the discharge process resulted in a 50 percent decrease in the number of unnecessary follow-up hospital visits and $800,000 in hospital savings. In California, reducing avoidable readmission hospital stays by just one day could save healthcare programs $227 million a year ($179 million in Medicare savings plus $48 million in Medicaid savings).
A seamless handoff between hospital staff and community caregivers has proven to drastically reduce patient bounce-back. From giving detailed discharge instructions, to teaching patients to flush a gastric tube, to arranging for follow-up appointments and in-home healthcare, NPs are bridging an otherwise widening gap between hospital stay and outpatient care.
NPs are advancing the shift towards community care. By the year 2030, one in five Americans will be over the age of 65. The focus of these baby boomers on controlling their care and staying in their communities, along with the increasing number living with chronic disease, will put strain on our healthcare delivery system – especially hospitals. As a result, an increasing number of hospitals are looking for progressive solutions to improve efficiency.
This involves turning to healthcare providers to deliver advanced clinical and primary care in patients’ homes after discharge to improve patient outcomes and avoid readmissions, all at a reduced cost. NPs are more likely to provide home-based care than physicians, and NPs also deliver care over the widest geographical area. In 2013, NPs performed over one million home care visits, accounting for more than 20 percent of all residential visits to Medicare fee-for-service beneficiaries.
The potential savings realized through home health is significant and extends beyond the clinical visit. The daily cost of home oxygen for Medicare patients is 1/268th the cost of a single-day stay in the hospital. A home intravenous antibiotic program under Medicare is $122 a day, compared to $798 in an inpatient setting.
Legislation must pass congress to relieve this significant barrier to these home-based health services. Although NPs typically assess the need for and are, by and large, the provider of these services, outdated Medicare regulations does not grant NPs the authority to prescribe home health services without physician certification, resulting in provider duplication and costly delays – ironically for a service designed to eliminate these very problems. Passing new legislation would expedite patient care, prevent patients from unnecessarily seeking hospital treatment and increase access for home reliant seniors, especially in rural areas. Authorizing NPs to certify home health services will result in upwards of $275 million in cost savings by 2020, which has hospitals taking note.
NPs have greater practice authority and can provide care in more places. Currently 22 states plus the District of Columbia have granted nurse practitioners full practice authority (FPA) to work to the full scope of their education and training without physician oversight or collaborative agreements. More states are considering doing the same. This year, South Dakota was the latest to grant full autonomy to NPs, while Massachusetts, Pennsylvania and North Carolina continue to weigh similar licensure legislation.
Increasing autonomy and intensifying recognition from the healthcare community are driving factors in job growth projections for NPs over the next several years. The Bureau of Labor Statistics anticipates a 31 percent increase in NPs by 2024, far outpacing other professions, which is good news for hospitals preparing for a steady influx of new patients. In the coming years, more than 60 percent of the 61 million baby boomers will need treatment for one or more chronic conditions, and many will turn to hospitals for care. Currently one-thirdof NPs practice in hospitals, and this number is expected to rise as the number of practicing NPs increases.
As hospitals rethink healthcare delivery to meet the challenges of an aging baby boomer population and address rising healthcare costs, nurse practitioners represent a critical solution. With healthcare costs expected to reach $4.8 trillion by 2021 (compared to $2.6 trillion in 2010), reducing spending without sacrificing patient care is an obvious priority. Focusing on improving the continuity of care, transitioning peripheral hospital services into the community and increasing SOP rights for NPs will set a new standard for healthcare delivery in the next decade, and hospitals leveraging the untapped value of NPs will have a significant advantage.
David Hebert is the Chief Executive Officer of the American Association of Nurse Practitioners (AANP).
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