More than half of America's 48 million people without health insurance are expected to get coverage as a result of the Affordable Care Act, most of them through the new health insurance exchanges that opened on Oct. 1. That will bring a significant increase in the demand for health care in a nation where 55 million people already live in areas that have a shortage of primary care providers.
Advanced practice registered nurses are an integral part of the solution. They provide all-inclusive, safe, patient-centered care and have completed additional graduate-level education. Nurse practitioners provide a broad range of primary care services, including prescribing medications. Unfortunately, Maryland, like many other states, does not allow them to practice without unnecessary restrictions.
For example, before a child is cleared to attend a child care center, Maryland requires a parent to have him or her undergo a complete medical evaluation. Advanced practice nurses are qualified and capable to perform that task, and it would lessen the burden on the individuals seeking these approvals. But state regulations require that the exam be administered and certified by a physician. Similarly, only a physician can authorize a student to be home or hospital schooled. Therefore, if a child has Crohn's disease (an inflammatory bowel disease), even if the child has been seen regularly by a pediatric nurse practitioner, the parent must find a physician to authorize this accommodation.
The National Governors Association published a position paper in December outlining the role of nurse practitioners in facing the increasing demand for primary care. The NGA encouraged states to consider changing scope of practice restrictions as well as assuring adequate reimbursement for services provided in order to incentivize nurse practitioner involvement in primary health care.
But Maryland law still enforces an arbitrary linkage between nurse practitioners and physicians that limits their ability to do the work they were trained for. Nurse practitioners in Maryland are required to list a physician "sponsor" on their licensure paperwork — supposedly so they can "collaborate and consult" on patient issues. But the attesting physician does not need to be within the nurse practitioner's specialty. For example, a trauma/critical care NP could name a pediatrician, with a vastly dissimilar specialty, to fulfill this excessive requirement.
The NP is then "bound" to this physician, which also causes unique problems. In one case, a psychiatric mental health NP who owns and runs a psychiatric practice in Cumberland has an attestation form listing a particular physician. This NP sees 1,500 patients. The named physician is retiring. This NP now has the unnecessary challenge of finding another physician and going through the entire attestation process before the doctor's retirement, or her patients are at risk of losing care. Of note, several insurance companies require the attesting physician be on the same plan as the NP, which is another bureaucratic obstacle. Sadly, this is not an isolated incident.
Allowing nurse practitioners to operate independently will increase access to health care providers and expedite diagnoses, treatment and referrals, significantly improving the health of Marylanders. Millions of newly insured consumers will need access to primary care, but "this will not happen if private insurers continue to exclude or restrict advanced practice registered nurses from their provider networks," Karen Daley, president of the American Nurses Association, said in a statement.
Maryland's nurse practitioners recognize that access to care is a complicated problem and there is no one simple solution. Increasing access to primary care and health services to all Marylanders is, nonetheless, a necessary part of the solution. Our Maryland nurse practitioners are ready. Let them do what they are both trained and educated to do without bureaucratic encumbrances.
Jane Kirschling is dean of the University of Maryland School of Nursing. Patricia Travis is a past president of the Maryland Nurses Association.Copyright © 2014, The Baltimore Sun