Saturday, August 29, 2009

Drivel In It's Finest Towards NPs Masked As Health Care Reform

I was surfing the net for some articles on health care reform when I came across this article. At first glance, it looks promising and I agreed with the start of the argument.

The financial structure of most health insurance policies encourages overuse and misuse of the health care system, with resulting increases in health care costs, as well as pervasive inefficiency.

One consequence of third-party payment is that the consumer of the service (in this case, the patient) is shielded from the true cost of the service. If you ask most people what a doctor's visit "costs," they will probably respond with whatever amount their copay is. The true cost is much higher -- probably $100 for a 15-minute visit.

As a result of this "cost-shielding," people are much more likely to see a doctor, for many more reasons, than if they had to pay full price for a doctor's visit. Many visits to the doctor are due to the common cold and allergy symptoms, for which very little can be done to alter the course of the condition except for rest, proper eating and hydration, and over-the-counter symptom control treatments.

I actually agreed with the statements due to the fact that many patients that I see come into the office with minor ailments that would resolve on their own. But I also realize, as a nurse practitioner, that patients often come to the office seeking care that isn't just medical in nature. Some is stress relief and some is psychiatric. I have seen patients come in for what seems to be a trivial issue, but is actually an ailment that is actually quite complex and dangerous. These complaints occasionally go unlistened to and can be deadly.

Going further into the article, I came to read this:

Most common cold or allergy complaints do not require a visit to a highly-trained physician -- a nurse practitioner can treat the patient just as effectively, and at much lower cost. I would expect a comparable 15-minute appointment with a nurse practitioner would cost about $25.

So let me see... Scenario A- Patient comes to the office complaining of chest pain. The doctor does a history and physical. Doctor runs several differentials through their head, discusses with patient, does an EKG, writes a script and sets up follow up visit. 15 minute visit.

Scenario B-Patient comes to the office complaining of chest pain. The NP does a history and physical. NP runs several differentials through their head, discusses with patient, does an EKG, writes a script and sets up follow up visit. 15 minute visit.
Do you see any differences in these scenarios? Nope, didn't think so. What makes the author think that we are not able to perform the same tasks and NOT be highly trained? Why would he assume that I shouldn't be paid for my time appropriately just as well as the MD? I seriously don't think that I should just be delegated to treating the "snotty nosed colds" and leave the "big people stuff" like hypertension, diabetes, and COPD to the illustrious MD just because he went to medical school for a year longer than I did (if he is a family physician.)


The point is that many office visits to physicians are unnecessary, with money and time being wasted by the patient. Additionally, the physician could be using his/her time on much more sick or injured patients. But, since it only costs $20 or $25 to see "the expert," why wouldn't you? People would certainly think twice about making an appointment if it would cost them $100, especially if appropriate care could be obtained for a quarter of the cost by a nurse practitioner.

Ummmm... First off.. Obviously, this author thinks that patients are just wasting doctors time. But an NP's time must be okay to waste? I certainly don't think that most of my patients are wasting my time. It's how I get paid. Supply and demand was the way of the free market system last time I checked.

NPs usually receive 85% of the billing that an MD does in most states. Why would my time and effort be delegated to 1/4 of the docs? Oh yeah.. the insurance company rules. Certainly not because I can't do the exact same job in the same amount of time. I am in NO way pretending to be a MD because I didn't go to medical school and didn't do the traditional residency. I, instead, did the NP track while working full time in the trenches of the hospital spending 12 hours at the bedside instead of the MAYBE 5-6 minutes that the MDs took. Some actually walked out in the middle of a patient's question which royally pissed me off because I know that they were running late to the office because their golf game ran over. I overheard plenty of those conversations as a floor nurse.

The second change, increasing the scope of services by nurse practitioners, is already gaining traction via some physician practices and urgent-care clinics. It only makes sense to have patients treated by a practitioner who is well -- but not excessively -- trained to provide the care necessary to heal the patient.

If you are hungry, in a hurry, and without much cash, it does not make sense to order a meal at a four-star restaurant; a fast-food establishment better meets your needs. However, if an important occasion is arriving, for which the added expense and time is worthwhile, then fast food might be counterproductive, and a fine restaurant is warranted. The same "triage" could apply to your choice of healthcare practitioners.

The net result of having the cost of office visits borne by the consumer/patient would be a greater ownership of one's health care. Office visits for (apparently) minor illnesses or injuries could be managed by a nurse practitioner. The nurse practitioner could triage the patient (via questions or observation), with potentially serious conditions being transferred to a physician.

From the physician's perspective, insurance compliance costs could be reduced, as fewer claims would need to be submitted and tracked. The physician would still "keep" the patient, but the nurse practitioner would be handling the majority of visits.

If you come to my office where I work side by side with an extremely intelligent physician with 40 plus years in medicine, who values my insights and opinions very much,and ask my patients if they care what letters are behind our names, you would get run out on a rail. I have my own patient base and my collaborating MD has his own patients whom we try to share on occasion because sometimes it takes more than one pair of eyes on a case. PSST! It's called collaboration. Some patients prefer to see me and some the doc. If I left the office tomorrow, probably more than half of those patients would follow me (the lowly NP). According to this author's opinion of NPs, we should just be happy to "handle" patients and let the MD do "all the stuff that requires any thought process and training."

I don't know about you. I would want a trained health care provider regardless of the initials behind their name who listens to my concerns and has excellent diagnostic skills any day. It's life and death out here buddy. Do yourself a favor and see an NP one day. They may save your life.

PS. This is what I replied on his blog..

I certainly think from this article that you have a huge misconception of what NPs actually do on a daily basis. I am offended that you seem to think that my time and expertise is considered 1/4 that of a MD. NPs and MDs collaborate with each other and I "keep" my own patients thank you very much.
There are providers in various levels of expertise who don't know what they are doing. It's very irritating that you want the docs to delegate the "snotty nosed visits" and leave the important visits to them to manage. My patients are not wasting my time and would be insulted if you suggested that they see a doctor instead of me. It's articles like yours that sets us further apart, when according to multiple studies, NPs give just as good care as physician. Wow...