Increasing reliance on nurse practitioners (NPs) and physician assistants (PAs) as well as on telehealth and related technologies have a common root: a lack of primary care providers. Analysts do not see these trends abating.
By 2030, the Association of American Medical Colleges predicts, the United States will face a shortage of potentially more than 43,000 primary care physicians. That has necessitated new ways of thinking about how to deliver care, and healthcare organizations are turning with greater urgency to NPs, PAs and telehealth.
“When you look at the vast majority of our healthcare system today, overwhelmingly the greatest percentage of diagnostic and procedural tests come from about 14 percent of our population, and that’s [individuals] over 65,” says Travis Singleton, Senior Vice President at Merritt Hawkins, a Texas-based healthcare professional recruiting firm. “Not only are [these patients] likely to need different types of services, but they access their physicians anywhere from five to seven times more per year than, say, a patient 20 to 30 years their junior.”
That has potentially staggering implications as the U.S. population ages and the incidence of chronic illnesses requiring frequent care continues to rise. Increased utilization of NPs and PAs as well as expanded use of telehealth may be indispensable contributors to better management of these patients.
“Telehealth is really a scalable solution for physicians, for hospitals, for payers and even for societies to ... grapple with the health of a population and kind of move it forward to achieve [improved] outcomes.”
Tom Edmondson, MD, CMD, AGSF, FACP, Physician Director of Ambulatory Solutions at Philips Hospital to Home
Riding to the Rescue?
The Bureau of Labor Statistics projects employment for NPs, nurse anesthetists and nurse midwives will increase 31 percent from 2014 to 2024, and PAs, who often provide similar levels of care, are projected to see job growth of 30 percent. While these categories of providers are not new, how patients perceive them is.
“Nurse practitioners have played a vital role in health care for more than 50 years,” says Joyce Knestrick, PhD, FNP, FAANP, President of the American Association of Nurse Practitioners and Associate Professor of Nursing at Georgetown University School of Nursing and Health Studies. “What is changing today is the extent to which patients are choosing NPs as their healthcare provider, and how [providers] are capitalizing on their potential.”
That potential is both to provide care and to do so at a lower cost. A 2015 Columbia University School of Nursing literature review in the International Journal for Quality in Health Care concluded, “There were few differences in primary care provided by [advanced practice nurses] and physicians; for some measures APN care was superior.” Researchers also found care provided by advanced practice nurse groups was equal to or better than that provided by physician groups in terms of cost and patient satisfaction.
Majorities of primary care physicians surveyed for a 2013 study published in The New England Journal of Medicine said a greater supply of primary care NPs would improve timeliness of care and access. However, most physicians said the quality of their patient examinations was higher than that of exams provided by NPs — a claim most NPs disputed.
“With over 58 million Americans residing in primary care shortage areas and the Health Resources & Services Administration projecting a 30 percent increase in the supply of primary care NPs over the period 2010-2020, the rise of the NP profession has the potential to cut the expected shortage of primary care providers in 2020 by about two-thirds, to 6,400 — but only if legislation enables the profession to be effectively integrated into the healthcare delivery system.”
Joyce Knestrick, PhD, FNP, FAANP, President of the American Association of Nurse Practitioners and Associate Professor of Nursing at Georgetown University School of Nursing and Health Studies
In 2016, adoption of telemedicine technology by hospitals was at 61.3 percent, up from 54.5 percent in 2014, according to a HIMSS Analytics study. Home-based vital sign-monitoring devices are a key component of telemedicine, making it possible for physicians to better follow and triage patients, particularly those with chronic illnesses. Examples of these devices include electrode patches that continuously capture data such as heart and respiration rates, as well as portable devices that measure blood pressure and pulse oximetry and transmit it to patients’ EHR.
“As people are aging, we’re all becoming more comfortable with technology ... [and] we’re now turning to technology to help us with health care,” says Tom Edmondson, MD, CMD, AGSF, FACP, Physician Director of Ambulatory Solutions at Philips Hospital to Home.
Research suggests patients have positive perceptions of this treatment model, he says, believing it improves their care and helps them remain at home longer.
Banner Health, a Philips partner, utilizes telehealth for its patient population, many members of which have multiple chronic conditions. It found treatment costs for its most complex patients fell 35 percent as a result of the use of telehealth technologies, according to Dr. Edmondson. Another client found use of telehealth in nursing homes reduced rates of hospitalization.
It will take a multipronged approach to ensure access to care, according to observers.
“The stakes are high for patients and our nation as we ride the age wave of baby boomers entering their senior years and the rise of chronic disease,” Knestrick says. “Patient-centered care demands that all stakeholders — nurse practitioners, physicians, hospitals, payers, policymakers and most importantly, patients — work together to remove barriers that prevent health consumers from gaining access to affordable, high-quality health care with excellent patient outcomes. Together, we can reform licensing laws and utilize technology to improve patient health.”