Wonkblog is reporting on some good news that will continue to bend the cost curve while providing better access to healthcare to more people:
The most recent wins came in West Virginia and Florida, where after many years of trying, lawmakers passed measures freeing up “advanced practice” nurses — those with more graduate education than just a nursing degree — to administer a wider range of care and prescribe most drugs without having to maintain a relationship with a physician….
They also had political muscle. After years of sitting on the sidelines, AARP made the bill a top priority, arguing that freeing up nurses is essential to care for the state’s aging population. The liberal West Virginia Citizen Action Group got involved. And Americans For Prosperity, the Koch-funded free markets organization, took up the cause as part of a broader push to wipe out barriers to entry in skilled fields.
Certified Registered Nurse Practitioners (CRNP) are mostly practicing in either a primary care specialty or a first tier specialty (endocrinology, cardiology, gerontology etc). These are the areas that the US doctor guilds have limited numbers and limited pay. They are also the areas where we need more people practicing. Most people who are touching the medical system in any given year don’t need a lot of complex care. They need monitoring, they need coaching, they need early warning, they need management and they will eventually need a trusted relationship to tell them either bad news or that they need to get their act together to prevent bad news. Primary care is where there is a great need, especially in rural and economically depressed areas where it is hard to recruit doctors because being in the middle of nowhere is no fun.
CRNP’s and physician assistants are not a cure-all, but they are a source of relief on the PCP shortage in this country and they are a chance to increase the probability of more effectively managing, minimizing and preventing long term lifestyle/wellness based chronic conditions. Fewer people transitioning from pre-diabetes to medication controlled diabetes is a cost win and a health win.
Furthermore, these types of political fights are the next wave of cost control challenges as this is the nitty gritty of cost control, breaking local barriers to entry and practice:
This is not sexy, this is not lucrative, this is not the way political programs are built as the slogan “Minor administrative changes to marginally increase competition by redefining scope of service delivery laws when do we want them —NOW” does not fit on a bumper sticker.
However these are the types of gains that need to be made to reduce the guild power of high end medical providers. Most of the people, most of the time, don’t need high end care. Their basic needs can be met by trained individuals who are not over-trained. Part of the training, of course, needs to be on the recognition of situations which are above the current level of training and therefore the patient needs to go up the ladder of care. But basic dental services, basic primary care services, basic preventative services can often be performed perfectly adequately at the master or bachelor level clinician level instead of a doctorate level clinician level. Those rules are overwhelmingly determined at the state level, so that is where the long slow slog of reform needs to come.