Massachusetts Nurse Practitioners Step Up as One Solution to the Primary Care Access Problem

Craven, Gloria; Ober, Stacey

doi:10.1177/1527154409344627

Cited by 12 publications

(15 citation statements)

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“…50 Legislation was passed in 2008 requiring insurers to recognize NPs as PCPs to meet demand. 51,52 State-level policies may explain NPs' high ratings of their autonomy; the AIP mean score was higher than the midpoint of 2.5. Our findings should be interpreted in this context.…”

Section: Discussionmentioning

confidence: 99%

Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

Poghosyan

Liu

2016

J GEN INTERN MED

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BACKGROUND:The Nurse Practitioner (NP) workforce represents a substantial supply of primary care providers able to contribute to meeting a growing demand for care. However, controversy exists regarding the expanding role of NPs in primary care in terms of challenging the teamwork between NPs and physicians. To date, no empirical evidence exists regarding how to promote teamwork in primary care between NPs and physicians. OBJECTIVE: We investigated whether NP autonomy within primary care practices and the relationships they have with leadership affect teamwork between NPs and physicians. DESIGN: Using a cross-sectional survey design, data was collected from 163 p ri mary care practices in Massachusetts. PARTICIPANTS: Three hundred and fourteen primary care NPs completed and returned the mail survey yielding a response rate of 40 %. MAIN MEASURES: The Autonomy and Independent Practice (AIP) and NP-Administration Relations (NP-AR) scales were used to measure NP independent practice and the relationships with leadership, respectively. These measures were aggregated to the practice level. Teamwork between NPs and physicians was measured at the individual NP level using the Teamwork (TW) scale. KEY RESULTS: The multilevel linear regression models investigated the influence of practice-level NP autonomy and the relationship between NPs and leadership on teamwork. With every unit increase on the practice-level mean score of AIP centered at the grand mean, the mean TW score increased by 0.271 units (p < 0.0001). With every unit increase of NP-AR centered at the grand mean, the mean TW score increased by 0.375 (p < 0.001). Over one-third (41.3 %) of the variance in teamwork could be explained by the final model. CONCLUSION: The study findings demonstrate that NP autonomy and favorable relationships with leadership improve teamwork. Policy and organizational change should focus on promoting NP autonomy and improving the relationship between NPs and leadership to improve teamwork and consequently improve patient care and outcomes.

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Section: Discussionmentioning

confidence: 99%

Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

Poghosyan

Liu

2016

J GEN INTERN MED

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“…Historically, medical practitioners have had a privileged position within health care settings (Willis et al., ), leading to control of health funding (Duckett, ) and a dominant medically focused system (Craven & Ober ; Williams, ). Lack of access to government‐sponsored fee‐for‐service subsidies for health care have been reported in Australia, where traditionally access has only been accessible to medical practitioners (van Gool, ).…”

Section: Introductionmentioning

confidence: 99%

Nurse practitioner integration: Qualitative experiences of the change management process

Lowe

Plummer²,

Boyd

2018

J Nurs Manag

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“…Many MCOs across the state refused to credential NPs as primary care providers, leading the state to enact additional reforms requiring insurers to recognize NPs as primary care providers to address the problem of health care access. 16 National health care reform can learn from the Massachusetts experience, including the problems that can arise if there is not an adequate medical community ready to care for the newly insured. NPs are valuable assets in the context of health care reform, and can play a critical role in helping to alleviate the problems stemming from a shortage of primary care physicians, such as those experienced in Massachusetts.…”

Section: Discussionmentioning

confidence: 99%

Are Managed Care Organizations in the United States Impeding the Delivery of Primary Care by Nurse Practitioners? A 2012 Update on Managed Care Organization Credentialing and Reimbursement Practices

Hansen-Turton

Ware

Bond

et al. 2013

Population Health Management

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In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.

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Massachusetts Nurse Practitioners Step Up as One Solution to the Primary Care Access Problem

Cited by 12 publications

References 0 publications

Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

Nurse practitioner integration: Qualitative experiences of the change management process

Are Managed Care Organizations in the United States Impeding the Delivery of Primary Care by Nurse Practitioners? A 2012 Update on Managed Care Organization Credentialing and Reimbursement Practices

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