Factors Associated With Seeking Physician Care by Medicare Beneficiaries Who Receive All Their Primary Care From Nurse Practitioners

Abstract Rising care complexity in skilled nursing facilities (SNFs), coupled with growing shortages of geriatricians and other primary care physicians able to see SNF patients, have increased demand for nurse practitioners and physician assistants (NP/PAs). We used 2008-2016 Medicare Part A and B claims and nursing home assessment data to describe longitudinal trends in NP/PA practice in SNFs. We identified 8,877,094 SNF post-acute primary care visits for 1,494,113 Medicare beneficiaries. The total number of visits increased from 850,285 in 2008 to 1,189,553 in 2016. The share of visits by NP/PAs rose significantly over time, from 24% of visits in 2008 to 43% in 2016. 71% of SNFs (n=10,139) used NP/PAs in 2016, up from 46% (n=6,696) in 2008. The number of NP/PAs practicing in SNFs more than doubled, from 4,472 clinicians in 2008 to 10,000 in 2016. The number of physicians practicing in SNFs declined from 26,297 in 2008 to 19,745 in 2016. NP/PAs represented 14% of all SNF medical providers in 2008 and 34% of providers in 2016. In 2016, 48% of NP/PAs were SNFists (i.e. >90% of visits billed in SNF), vs. only 11% of physicians. SNFs with NP/PAs are on average larger, more likely urban, for profit, and care for larger populations of racial minorities, than SNFs without NP/PAs. SNFs with NP/PAs also have more short-stay Medicare residents, more admissions, higher nurse and rehab staffing levels, and higher case mix. These findings show that NP/PAs are taking on increasingly prominent roles as medical providers in SNFs.

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Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

American Journal of Law & Medicine ◽

10.1017/s0098858800002586 ◽

2003 ◽

Vol 29 (4) ◽

pp. 489-524

Author(s):

Brent Pollitt

Keyword(s):

Primary Care ◽

Mental Illness ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

American Psychological Association ◽

The United States ◽

Psychotropic Medications ◽

American Psychological ◽

Training Requirements ◽

Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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Analysis of Annual Costs of Mobile Clinics in the Southern United States

Journal of Primary Care & Community Health ◽

10.1177/2150132720980623 ◽

2020 ◽

Vol 11 ◽

pp. 215013272098062

Author(s):

Sharon Attipoe-Dorcoo ◽

Rigoberto Delgado ◽

Dejian Lai ◽

Aditi Gupta ◽

Stephen Linder

Keyword(s):

Primary Care ◽

Healthcare Services ◽

Medicare Beneficiaries ◽

Mobile Clinic ◽

Efficient Manner ◽

Healthcare Facilities ◽

Capital Costs ◽

At Risk Populations ◽

Mobile Clinics ◽

The Cost

Introduction Mobile clinics provide an efficient manner for delivering healthcare services to at-risk populations, and there is a need to understand their economics. This study analyzes the costs of operating selected mobile clinic programs representing service categories in dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive. Methods The methodology included a self-reported survey of 96 mobile clinic programs operating in Texas, North Carolina, Georgia, and Florida; these states did not expand Medicaid and have a large proportion of uninsured individuals. Data were collected over an 8-month period from November 2016 to July 2017. The cost analyses were conducted in 2018, and were analyzed from the provider perspective. The average annual estimated costs; as well the costs per patient in each mobile clinic program within different service delivery types were assessed. Costs reported in the study survey were classified into recurrent direct costs and capital costs. Results Results indicate that mean operating costs range from about $300 000 to $2.5 million with costs increasing from mammography/primary care/preventive delivery to dental/preventive. The majority of mobile clinics provided dental care followed by dental/preventive. The cost per patient visit for all mobile clinic service types ranged from $65 to $529, and appears to be considerably less than those reported in the literature for fixed clinic services. Conclusion The overall costs of all delivery types in mobile clinics were lower than the costs of providing care to Medicare beneficiaries in federally funded health centers, making mobile clinics a sound economic complement to stationary healthcare facilities.

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