Consumers and Nurse Practitioners: Access and Barriers to Care

Consumer perspective on access and barriers to nurse practitioner care will be explored. Unless consumers have personal experience with nurse practitioners (NPs), the general public is unaware of their value in primary care, acute care, and long term care settings. Usefulness of partnering with consumer groups in addressing access and barriers to nurse practitioner care will be described. Federal barriers include laws that do not allow nurse practitioners to certify home health and hospice services, or to perform the admission physical in skilled nursing facilities, as well as regulations that exclude NPs from hospital privileges, plus current federal policy that pays a higher rate when NP provided services are billed under the physician’s provider number. For consumers, these barriers result in delayed care, and may engender unnecessary or duplicative service with increased costs. Consumer stories about these barriers will be told and more examples will be elicited from the audience. State barriers to accessing nurse practitioner care include restrictive collaboration requirements, duplicative regulation by boards of medicine and nursing, and prohibitions on prescribing controlled substances. Requiring physician supervision of NPs, preventing NPs from practicing to the full extent of their training and certification, and imposing redundant oversight actually diminishes public safety because it decreases the availability of primary care to those in need. Without such access, health outcomes diminish and costs rise. Policy of national consumer groups which promote access to advanced practice registered nurse care and removal of federal and state barriers will be described. Examples of advocacy by state consumer groups to promote expanded scope of practice laws and regulations will be described and more examples will be elicited from the audience. Framing access to health care as a consumer issue will be promoted. This session will also discuss implementation of the recommendations of the Institute of Medicine’s Initiative on the Future of Nursing on access and barriers to NP practice from the consumers’ perspective.