Below is Peter Ferrara's opinion of the Health Care Reform Bill that is being considered. I am offended by two points that he makes while referencing health care providers. Read and then go to below to see what I was having a problem with..

One confusion arising from the House bill is that its provisions are phased in over several years. Over the first 10 years of full operation, the House bill actually cuts Medicare by $800 billion, as scored by CBO. The cuts for Medicare Advantage plans will be close to $200 billion, and despite President Obama's phony shtick that if you like your health plan you can keep it, the Administration itself estimates that 8 million seniors will lose their Medicare Advantage plan as a result, 73% of those with such plans.

This is the beginning of health care rationing for seniors, as the payments to their doctors and hospitals for the care that currently maintains their health will be slashed back. In addition, as Betsy McCaughey explains in the Journal, the House bill moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home." The medical home is this decade's version of HMO restrictions on care. A primary care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary care provider. Medical homes begin with demonstration projects, but… HHS…is authorized to "disseminate this approach rapidly on a national basis."

What this means is that your doctor is paid a flat monthly fee for your care, and referring you to a specialist or for a diagnostic test effectively comes out of his pocket. So if you need an MRI or a CT scan to see if you have cancer, or to check if that pain in your chest is due to clogged arteries, or if you need to see a specialist to treat cancer or heart disease, the doctor has a financial interest to delay or deny it. Financially, if you are actually this sick, he will be better off if you die sooner rather than later. That is the result of the perverted, inverse incentives the House health bill creates for medical providers.

I don't like the inference that one would have to "settle" for a Nurse Practitioner. If you ask my patients, they will tell you that they prefer to see a NP over a physician anyway.

His idea that primary care providers are the gatekeepers is nothing new. It's been that way since I can remember. Most specialists require referrals from a patient's primary.

My biggest gripe is the insinuation that ANY health care provider would EVER not use whatever resources it takes to accurately diagnose a patient. If a doctor or NP or PA ever kept a patient from being diagnosed because it would take money out of their own pockets, they should be run out of health care immediately! True health care professionals are not just in it for the money. They really like helping patients and feel a moral obligation to do so. Of course we all need to pay the bills and I can't afford to do it for free. One day, I will be able to donate my services as so many do. Till then, I will keep on taking care of the patients who prefer me! Carry on..

P.S. This is the response I left on this blog article.

I find it a little insulting that you think that patients "settle" for a NP. My patients prefer me to other physicians and will tell you so. I am a great health care provider with patients who actually come back and do the necessary maintenance to remain as healthy as they can be. I serve in a rural community who is having a very hard time attracting physicians. I find it appalling that you would think that any health care provider would keep a patient from appropriate testing in order to line their own pockets. If they are doing so, they need to be run out of health care. I take care of patients because it's a calling and not just because it pays well. I am curious to see if you have ever seen a nurse practitioner in action before you make snap judgments about the quality of our care.

Once again it's Nurse Practitioner's week. Please take some time and visit your favorite NP and let them know just how much you appreciate their hard work and time taking care of you and yours. Also, stop by and leave a nice comment on your favorite NP's blogsite. They'll love it!

I am sick of pink.

Pink runs, pink toothpaste packages, pink yogurt.

I am sick of pink articles, pink signs, pink nail polish.

Every time I see pink it reminds me that my mom has cancer.

It reminds me that the first time an “expert” saw her breast mass two years ago they said it was nothing.

You bastard.

You fucker.

You may have taken my mother away from me. If you would have done your job she may not be going through chemo. She may have had no lymph node involvement.

22

TWENTY-TWO LYMPH NODES

EVERY

FUCKING

ONE

You should wake up for the rest of your life and explain to her grandchildren about why their first lesson in death wasn’t their dog, it was their Beama.

Please nurses, doctors, techs at Mayo Clinic.

Please, Please take care of my mom.

Please make up for the mistakes of another.

Please give her more Christmas mornings, more afternoons of knitting, more time to teach her grandchildren all of the things she has taught me.

I cannot fathom a day without my mom. My teacher, my guide, my wisdom, my strength.

Not yet.

Not now.

The pink that is so empowering, that gives hope.

Please be my hope too.

Go over and let her know that you are thinking of her and her Mom during these trying times.

We are in St. Petersburg enjoying the arrival of our second grandson. His name is Edward Clayton Cunningham and is just as cute as I knew he would be. It was nice that his Auntie Ciara was able to come down to see him too. I can't believe that my first grandson William is already almost a year and a half. How time flies.

On the first smilebox, click on the button on the lower right side to turn the pages. On the bottom one, click on each pic to make them pull into the larger middle box. Enjoy!

Make a Smilebox scrapbook

Make a Smilebox postcard

The following was an email that I received from a nursing student and I thought that it would make a great post.

Hi there.. I am a nursing student and have to write a paper about advanced practice nursing including speaking to an advanced practice nurse. While researching, I actually ran into your blog a few times and enjoyed reading through your posts, so I figured I would just ask you a few questions, that is, if you don't mind of course. brief answers are sufficient - I know you're a busy woman! and I don't need to take up much of your time =)

I see from your blogs that you are an FNP in Florida in a rural health clinic and have your own patient base. Also that you were at the bedside for while before returning to school (with a
family!...there are no words to describe how much credit you deserve for finishing successfully and still working and maintaining a family- very impressive)

-How would you describe your roles and responsibilities in your current office?
My roles in the office include patient care, patient education, lab draws (the ones that the nurse can't get), and supervising the nursing staff. I also do callbacks to the patients for questions that they have, and consult with the MD on cases.

-What kind of experience and education was required for your degree. I started with my RN and then went on to complete my BSN and then my MSN. I worked in the hospital setting as a floor nurse for almost 7 years while completing my degrees. I served as a stand by charge nurse as well. This experience was vital in my education as an advanced practice nurse. In my opinion, to be a successful nurse practitioner, you must have the clinical experience to recognize the nuances in disease process in person. One cannot get this from book learning only. Often MDs say that nurse practitioners aren't as good at diagnosing patients because we didn't do a "real residency" in their traditional sense. Working in the trenches at the hospitals managing several patients daily plus doing clinicals side by side with other doctors while in school is a residency in it's self.

-What roles other than direct health care to find yourself providing obviously education is a big part of your service to patients, but do ever feel like a case manager or advocate to patients or an administrator in teh office, etc)
I do case management and advocate for my patients, especially for medications not covered by their plans (prior auths). I don't do much administrative duties because this is not my own practice.

-Who do you work with in the office?
I work with an office manager/front desk person and two LPNs and one medical assistant. I also have a MD that works in the office four days a week.

What impact does interdisciplinary relationships have on you or your practice?
It has a huge impact. If I don't get along with my coworkers or they don't work well together, it can hugely impact the flow and patient satisfaction. It can also seriously effect patient health if an office staff does not listen to a patient's concerns or pass on critical information.

-What are the benefits and challenges you run into?
The benefits are that I can FINALLY take care of my patients like I need to without having to ask for an order from a MD. Challenges I face is the fact that I cannot write for controlled substances which makes working in rural health very frustrating. If there isn't a MD on site to sign for controls that I cannot call in, then I have to send them to the nearest office that I am connected to. This is a hardship to some of my patients because of lack of transportation and money for gas. Some have to make the decision whether to eat, pay their rent or pay for their medications. Some actually walk more than a mile to my office to be seen for care. This is the reason why it's vitally important to contact our Florida congressmen and senators and let them know that we need the ability to write for controls. After all, all but two states have given NPs that right without any major events that I know of.
-Lastly, are there any major issues r/t current nurse practitioners that you are concerned about. (I did read your post about the article you found on MDs vs NPs capability to handle 'serious' patients vs 'snotty-nose' patients - how frustrating ! the author is obviously uneducated regarding np education and skill levels!)

From the above question, you can tell that not having controlled substance rights is a big one. I also have a huge gripe with pharmaceutical companies who advertise "Talk to your doctor" instead of saying health care provider. How hard it that! I think they would be shocked to find out just how many prescriptions we nurse practitioners write. Most insurance companies in Florida do not put us on their provider panels and therefore do not pay the pharmacies. They have to submit the medications under the MD's name so we don't get "the credit" and therefore are still under the radar. I actually think that we are very responsible prescription writers and take care to make sure that what we write is appropriate for our patients. In fact, I think that we write less medications due to the enormous patient education that we give the patient. Patients often take us seriously and follow our advice because of their trust in us as primary medical providers.