Editor's Note: This is Part Two of two articles looking at the role of nurse practitioners in long-term care.Read Part One here.
Has your facility considered a third-party nurse practitioner?
NPs can take the load off of staff, as I discussed in Part One. Third-party nurse practitioners also can provide much needed support to physicians. While family practice physicians may only be able to visit once every 60 days, many patients' need for higher level care does not wait for a house call. By having a nurse practitioner overseeing long-term and skilled nursing residents, these physicians can concentrate on their practice, and avoid frequent and sometimes unnecessary calls and visits to the facilities.
Some argue that nurse practitioners will impede on the physicians revenue. Though this argument is relevant, it's also avoidable. As long as the practitioner and physician do not see the patient on the same day, the doctor can still evaluate and manage his or her patients whenever they deem necessary. Doctors follow strict guidelines concerning patient visits, they must see patients within certain time limits, order labs, and prescriptions daily. Nurse practitioners can help. A nurse practitioner working full time at a facility sees these patients weekly and can offer not only a seasoned perspective on the patient's condition, but the ability to carry out needed medical and laboratory orders.
The use of nurse practitioners would benefit LTC and SNF patients. A nurse practitioner would see high acuity patients at least four times a week. Certain issues, such as increased confusion, can only be addressed if a caregiver knows what is normal behavior in a particular patient. If a nurse practitioner can foresee and treat at the beginning stages of an illness, countless expensive and stressful emergency room/acute hospital visits can be avoided.
Last but not least, the utilization of third party nurse practitioners would save Medicare money. Third-party nurse practitioners avoid hospital transfers, which can cost upwards of $25,000 a week. A study done by the University of Minnesota states that nurse practitioners reduced hospitalizing in LTC facilities by 45% (Journal of the American Geriatric Society). By avoiding just one acute hospital transfer in a two-month period an NP has compensated Medicare for what they bill. It's time Medicare started working smarter, not harder.
In conclusion, Medicare would benefit from mandating nurse practitioners in LTC and SNF's. As the American population ages, a change is imperative to the survival of these facilities and their residents. Facilities would find comfort in the support of a higher level health care provider who serves as an extension not only to the staff, but the physician. Long-term care staff would see a needed reprieve from their workload, and have the added confidence of a seasoned mentor. Physicians who are overworked and drowning in red tape could breathe easy knowing there is a watchful eye collaborating in their patients' care, and supporting their managerial efforts. Residents of health care facilities would get the care they need and deserve, and their families could rest easy knowing serious issues are being avoided, not just tended to. Finally, Medicare would have a solution to the looming crisis nipping at its heels, without making incredible costly changes billions can be saved. As Leonardo De Vinci stated, “I have been impressed with the urgency of doing. Knowing is not enough; we must apply. Being willing is not enough; we must do.”
Knowing what to do does not solve the issues facing healthcare. In order to assure the survival of long-term care Medicare must be ready and willing to make a change.
Sarah Stephens is the Director of Operations at Mobile Medical Nursing Inc, which specializes in the management of long- term care patients by a professional staff of nurse practitioners.