Tag Archives: Primary Care

Uncovered California: What’s Holding Back Nurse Practitioners?

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Uncovered California: What’s Holding Back Nurse Practitioners?

NPnurses4

Nurse practitioners, or NPs, are registered nurses with “advanced clinical training at the master’s and doctoral levels, providingprimary, acute and specialty health care services,” according to the American Association of Nurse Practitioners. Most NPs (55 percent) specialize in family care and in adult gerontology (nearly 21 percent). A significant number provide acute, pediatric, neonatal, women’s and psychiatric health care services.

According to a 2014 study published in Nursing Outlook, nurse practitioners are significantly more likely than primary care physicians to “practice in urban and rural areas, provide care in a wider range of community settings and treat Medicaid recipients and other vulnerable populations.”

“Uncovered California”is a three-part series of stories and videos examining how the Golden State is trying to fill holes in its health care coverage. Sasha Abramsky’s articles look at working people who are falling through coverage cracks, and at what’s being done to help community college students gain access to mental health services. Debra Varnado reports on efforts to expand the role of nurse practitioners to increase medical services for low-income Californians.

 

Doctors Get Innovative To Escape Insurer-Driven ‘Hamster Wheel’ Model Of Care

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https://ww2.kqed.org/futureofyou/2016/08/11/dropout-docs-primary-care-physicians-exit-the-system-to-go-it-alone/

She’s one of a growing number of doctors who have cut loose from what she calls the “assembly-line, volume approach” and is now using a health care delivery model called direct primary care. She has scaled back the number of patients she sees and takes longer with the ones she does. She doesn’t take insurance and deals mostly in cash; she charges each time she sees a patient, but most direct primary care doctors charge a monthly fee for unlimited visits. In her previous practice, (Lorraine) Page says, the pressure to see more patients in less time wore her down, as did the need for an army of support staff to process the copious paperwork required by insurance companies.

 

Is UC Davis Medical Center Skimping On Care For The Poor?

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Is UC Davis Medical Center Skimping On Care For The Poor?

Leslie Love_770

For at least 20 years, Leslie Love relied on the UC Davis Medical Center’s hospital and clinics for her health care. Her children and grandchildren went to the same doctors there.

“They cared about me,” said Love, a 57-year-old teacher’s assistant who lives near the academic medical center, which is located in Sacramento. “There’s people there that I can trust.”

But that trust was recently broken: Love has been fighting for follow-up care since her knee surgery at UC Davis in 2014. Love’s current Medi-Cal managed care plan, Health Net, ended its contract with the UC Davis Health System in January 2015. As a result, Love could no longer see the physicians there who had treated her knee.

The pullout, which affected an estimated 3,700 patients at the time, means that Health Net’s now nearly 123,000 Medi-Cal managed care enrollees in Sacramento County can no longer seek primary care at UC Davis.

Ever since, tension has been building over what some critics say is limited access for Medi-Cal patients at UC Davis’ health clinics.

Because it is financed partly by state taxpayers, the UC Davis Health System — like all University of California hospitals and clinics — is considered a public institution with a mandate to care for the poor.

That’s why some patients and their advocates are frustrated. They say UC Davis is not fulfilling its mission as a public hospital because the health system generally no longer accepts primary care patients covered by Medi-Cal managed care contracts. Medi-Cal patients still can receive specialized and emergency room care, as well as in-hospital stays.

Sometimes Tiny Is Just The Right Size: ‘Microhospitals’ Filling Some ER Needs

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http://khn.org/news/sometimes-tiny-is-just-the-right-size-microhospitals-filling-some-er-needs/

The two-story SCL-Health Community Hospital-Westminster opened outside Denver last fall. The microhospital offers emergency medical care, labor and delivery services, inpatient beds, two operating rooms, radiology services and an on-site laboratory. (Courtesy of Emerus and SCL Health)

http://www.healthcaredive.com/news/think-small-making-the-case-for-microhospitals/423710/

Eyeing fast-growing urban and suburban markets where demand for health care services is outstripping supply, some health care systems are opening tiny, full-service hospitals with comprehensive emergency services but often fewer than a dozen inpatient beds.

These “microhospitals” provide residents quicker access to emergency care, and they may also offer outpatient surgery, primary care and other services. They are generally affiliated with larger health care systems, which can use the smaller facility to expand in an area without incurring the cost of a full-scale hospital. So far, they are being developed primarily in a few states — Texas, Colorado, Nevada and Arizona.

“The big opportunity for these is for health systems that want to establish a strong foothold in a really attractive market,” said Fred Bentley, a vice president at the Center for Payment & Delivery Innovation at Avalere Health. “If you’re an affluent consumer and you need services, they can fill a need.”

SCL Health has two microhospitals operating in the Denver metropolitan area and another two in the works. Microhospitals “are helping us deliver hospital services closer to home, and in a way that is more appropriately sized for the population compared to larger, more complex facilities,” said spokesman Brian Newsome.

The concept is appealing, and some people suggest they should be developed in rural or medically underserved areas where the need for services is great.

 

Your Zipcode is Your Healthcare Destiny

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http://www.healthcaredive.com/news/study-nearly-a-third-of-the-worlds-population-has-high-blood-pressure/424112/

“The high and increasing worldwide burden of hypertension is a major global health challenge because it increases morbidity and mortality from cardiovascular and kidney diseases and financial costs to society,” the authors concluded. “Implementation of innovative, cost-effective, and sustainable programs for hypertension prevention and control should be a public health priority for these [low- and middle-income] countries.”

California Doctors And Hospitals Tussle Over Role Of Nurse-Midwives

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http://khn.org/news/california-doctors-and-hospitals-tussle-over-role-of-nurse-midwives/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=32615438&_hsenc=p2ANqtz-8ImMNfbaboVFE98SiaPvCTZ4yTpxm1jcBnGL_CYvqxvYvZwPQNFNecHArS_UOxcmh7DeSB55A1rlnC8y5IjYTjPqcSTg&_hsmi=32615438

mother-baby-hospital_770

A California bill that would allow certified nurse-midwives to practice independently is pitting the state’s doctors against its hospitals, even though both sides support the main goal of the legislation.

The California Hospital Association and the California Medical Association, which represents doctors, agree that nurse-midwives have the training and qualifications to practice without physician supervision.

But they differ sharply over whether hospitals should be able to employ midwives directly — a dispute the certified nurse-midwives fear could derail the proposed law.

The bill would override an existing law that requires certified nurse-midwives to practice under the supervision of medical doctors. California is one of only six states that requires full supervision. Several other states mandate other forms of collaboration, such as in prescribing medications.

The American College of Nurse-Midwives has been chipping away for decades at state laws that require physician supervision, and it has finally passed the tipping point nationally, said Jesse Bushman, director of federal government affairs for the organization. Nurse-midwives aren’t seeking permission to go off and do whatever they want without consulting anyone, Bushman said. “They’re just asking to be able to do what they are trained to do.”

In states where nurse-midwives can practice independently, there is more access to care, he said, citing a recent report published by the George Washington University’s Jacobs Institute of Women’s Health.

There are more than 11,200 nurse-midwives around the nation, including about 1,200 in California. They provide maternity care, family planning services and other primary care for women.

 

C-suite feels ripple effect from Medicaid expansion, study says

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http://www.healthcarefinancenews.com/news/c-suite-feels-ripple-effect-medicaid-expansion-study-says

Arkansas is one of the four Medicaid expansion states who participated in the study.

Arkansas is one of the four Medicaid expansion states who participated in the study.

Medicaid expansion is making a difference as to whether hospitals are investing in clinics, new equipment and hiring new staff, or looking at the status quo and layoffs, according to a recent report by Georgetown University Health Policy Institute.

Hospitals in Medicaid expansion states have realized a drop in uncompensated care; an increase in institutional financial security; new community efforts to integrate and improve care; and innovative programs to expand access to specialists, according to the study.

CEOs who head hospitals in both expansion and non-expansion states said they saw a drop in uninsured rates in expansion states that was not as dramatic in non-expansion states.

This has translated to a decline in uninsured patient stays by close to 40 percent. Non expansion states reported a decline of 2.9 percent.

Sanders convention speech cites Clinton health care concessions

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Sanders convention speech cites Clinton health care concessions

In a Democratic convention speech that revisited the agenda of his surprisingly competitive campaign for the nomination, Sanders reminded the audience that while he may have lost the race, he did succeed in convincing Clinton to support three important proposals: a “public option” for Obamacare, letting people join Medicare early, and a big funding increase for community health centers.

“This campaign is about moving the United States toward universal health care and reducing the number of people who are uninsured or underinsured,” Sanders said. “Hillary Clinton wants to see that all Americans to have right to choose public option in their health care exchange.”

California Nurse Practitioners Lose Battle For Independent Practice, Again

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California Nurse Practitioners Lose Battle For Independent Practice, Again

Neonatal-Nurse-Practitioner

Expanding the medical role of nurse practitioners has long been opposed by doctors – some say for economic reasons. Proponents of the idea say it can help address the shortage of primary care doctors in the state by making treatment more accessible — and more affordable.

Under current state law, nurse practitioners can independently provide basic primary care, such as assessing a patient’s health status or diagnosing ailments. But they must follow physician-approved guidelines to prescribe medication, order tests or otherwise manage patients.

Nurse practitioners are among the most highly trained nursing professionals and must have at least a master’s degree. Registered nurses, are only required to hold an associate’s degree at minimum, and they don’t diagnose or prescribe on their own. Nurse practitioners say they provide quality care that’s comparable to that provided by physicians. They want California lawmakers to allow them to practice without the supervision of a doctor.