Category Archives: Nurses

Health system not doing enough to protect patients, experts

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Physician and Nurse Pushing Gurneyby Marshall Allen
ProPublica

WASHINGTON, D.C. — The health care community is not doing enough to track and prevent widespread harm to patients, and preventable deaths and injuries in hospitals and other settings will continue unless Congress takes action, medical experts said today on Capitol Hill.

“Our collective action in patient safety pales in comparison to the magnitude of the problem,” said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine. “We need to say that harm is preventable and not tolerable.” Continue reading

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Nurses delaying retirement – study

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Woman_doctor_surgeonBy Shefali Luthra
KHN / JULY 16TH, 2014

Despite predictions of an impending nurse shortage, the current number of working registered nurses has surpassed expectations in part due to the number of baby-boomer RNs delaying retirement, a study by the RAND Corp. found.

The study, published online Wednesday by Health Affairs, notes that the RN workforce, rather than peaking in 2012 at 2.2 million – as the researchers predicted a decade ago – reached 2.7 million that year and has continued growing.

The trend of nurses delaying retirement accounted for an extra 136,000 RNs in 2012, the study suggests. Continue reading

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State disciplines health care providers – July 15 update

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Seal_of_WashingtonPeriodically Washington State Department of Health issues an update on disciplinary actions taken against health care providers, including suspensions and revocations of licenses, certifications, or registrations of providers in the state.

The department also suspends the credentials of people who have been prohibited from practicing in other states.

Information about health care providers is also on the agency’s website.

To find this information click on “Provider Credential Search” on the left hand side of the Department of Health home page (www.doh.wa.gov).

The site includes information about a health care provider’s license status, the expiration and renewal date of their credential, disciplinary actions and copies of legal documents issued after July 1998.

This information is also available by calling 360-236-4700.

Consumers who think a health care provider acted unprofessionally are also encouraged to call and report their complaint.

Here is the July 16th update issued by the Washington State Department of Health: Continue reading

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New respect for primary care docs?

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Blue doctorBy Jay Hancock
KHN Staff Writer
This KHN story also ran in wapo.

BALTIMORE — A few years ago it struck the D.C. region’s biggest medical insurer that the doctors who saw its members most often and knew them best got the smallest piece of the healthcare dollar.

By paying primary care doctors to cut specialist and hospital revenue, CareFirst is helping to alter the medical spoils system.

CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients.

Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy.

The company’s move to shift that balance tells a lesser-known story of the Affordable Care Act and efforts to change the health system. Continue reading

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After court’s home health aide ruling, fewer state workers to organize

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U.S. Supreme CourtBy Jake Grovum
Stateline

The U.S. Supreme Court’s recent ruling in a case brought by home health care aides in Illinois casts doubt on labor agreements between such workers and state governments in nine other states.

It also closes off—or at least complicates—one of labor’s clearest paths to reversing a decades-long trend of declining ranks and shrinking clout.

The petitioners in Harris v. Quinn were home health care aides who did not want to join a union, though a majority of their co-workers had voted to join. Continue reading

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School nurses’ role expands with access to students’ online health records

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Although the school nurse is a familiar figure, school-based health care is unfamiliar territory to many medical professionals, operating in a largely separate health care universe from other community-based medical services.

Now, as both schools and health care systems seek to ensure that children coping with chronic conditions such as diabetes and asthma get the comprehensive, coordinated care the students need, the schools and health systems are forming partnerships to better integrate their services. Continue reading

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When doctors need advice, it might not come from a human

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This story was produced in collaboration with 

Long Island dermatologist Kavita Mariwalla knows well how to treat acne, burns and rashes. But when a patient came in with a potentially disfiguring case of bullous pemphigoid—a rare skin condition that causes large, watery blisters—she was stumped.

The medication doctors usually prescribe for the autoimmune disorder wasn’t available. So she logged in to Modernizing Medicine, a Web-based repository of medical information and insights, for help.

Within seconds, she had the name of another drug that had worked in comparable cases.

“It gives you access to data, and data is king,” she said of Modernizing Medicine. “It’s been very helpful especially in clinically challenging situations.” Continue reading

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Want to see a doctor? Get in line.

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Stethoscope DoctorBy Jenny Gold
KHN

Need to see a doctor? You may have to wait.

survey of physician practices in 15 metropolitan areas across the country found that the average wait time for a new patient to see a physician in five medical specialties was 18.5 days.

The longest waits were in Boston, where patients wait an average of 72 days to see a dermatologist and 66 days to see a family doctor.

The shortest were in Dallas, where the average wait time is 10.2 days for all specialties, and just 5 days to see a family doctor.

Seattle: 16.5 days for a specialist; 23 days for a family practice doctor.

Continue reading

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ER docs give Washington a D+

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The American College of Emergency Physicians has given Washington state a “near failing D+” in the its annual state-by-state report card assessing the nation’s emergency services.

Overall the state ranked 35th in the nation, down from its ranking of 19 in the College’s 2009 report, which that year gave Washington a C.

Screen Shot 2014-01-16 at 15.21.58 Continue reading

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Are there enough doctors for the newly insured?

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doctors-300By Michael Ollove
Stateline Staff Writer

Signing up for health insurance on the new state and federal exchanges was supposed to be the easy part of the Affordable Care Act. The really dicey part, lots of health policy experts have always feared, will come on Jan.1.

That is when Americans who have enrolled in health insurance for the first time under the ACA are likely to discover that having coverage doesn’t guarantee them easy access to a primary care doctor, dentist or mental health professional.

Some changes in the works, such as the use of new technologies and allowing mid-level medical providers to perform some functions usually reserved for doctors and dentists, should improve health care access in the long run.

“In the meantime,” said Linda Rosenberg, president of the National Council for Behavioral Health, “people are going to suffer.”

According to the Health Resources and Services Administration , the federal agency charged with improving access to health care, nearly 20 percent of Americans live in areas with an insufficient number of primary care doctors.

Sixteen percent live in areas with too few dentists and a whopping 30 percent are in areas that are short of mental health providers.

Under federal guidelines, there should be no more than 3,500 people for each primary care provider; no more than 5,000 people for each dental provider; and no more than 30,000 people for each mental health provider.

According to the Association of American Medical Colleges (AAMC), unless something changes rapidly, there will be a shortage of 45,000 primary care doctors in the United States (as well as a shortfall of 46,000 specialists) by 2020.

In some ways, the shortage of providers is worse than the numbers indicate. Many primary care doctors and dentists do not accept Medicaid patients because of low reimbursement rates, and many of the newly insured will be covered through Medicaid. Many psychiatrists refuse to accept insurance at all.

Christiane Mitchell, director of federal affairs for the AAMC, predicted that many of the estimated 36 million Americans expected to gain coverage under Obamacare will endure long waits to see medical providers in their communities or have to travel far from home for appointments elsewhere.

During the debate over the ACA, Mitchell said the AAMC pushed for the federal government to fund additional slots for the training of doctors, but that provision was trimmed to keep the ACA from costing more than a trillion dollars over 10 years.

Aging Boomers

There are various reasons for the shortages. Certainly a big contributor is the aging of the baby boomers, who may still love rock ‘n roll but increasingly need hearing aids to enjoy it. The growing medical needs of that large age group are creating a huge burden for the existing health care workforce. The retirement of many doctors in the boomer cohort is compounding the problem.

During the course of their careers, primary care physicians earn around $3 million less than their colleagues in specialty fields.

The federal government estimates the physician supply will increase by 7 percent in the next 10 years. But the number of Americans over 65 will grow by about 36 percent, according to the U.S. Census Bureau.

Money also is a factor in the shortages. During the course of their careers, primary care physicians earn around $3 million less than their colleagues in specialty fields, which makes primary care a less appealing path for many medical students.

In mental health, the problem is that much of the work is in the public sector, where the pay is far less than it is for providers in other medical specialties, who tend to work in the private sector. As an example, according to the National Council for Behavioral Health, a registered nurse working in mental health earns $42,987 as compared to the national average for nurses of $66,530.

Valuing Work-Life Balance

“Half of the physicians in training are women. You find more of them are looking for a career that might be compatible with part-time hours, that don’t involve being on call.”

But financial factors are not the leading reason that medical students are avoiding primary care, Mitchell said. In surveys of medical students conducted by AAMC, students valued “work-life balance” more than money when they were choosing their specialties. Because primary care often involves long hours and night and weekend calls, it is far less desirable to this generation of students.

“Half of the physicians in training are women,” Mitchell said. “You find more of them are looking for a career that might be compatible with part-time hours, that don’t involve being on call. Men are more engaged in child care today, and they have similar concerns as they consider their career choices.”

A steady stream of negative attention has made medicine in general a far less attractive career choice than it once was, according to Rosenberg of the National Council for Behavioral Health. Insurance headaches, pricey technologies, long hours and the risk of liability have convinced many talented students to eschew medicine as a career choice.

“Nowadays,” Rosenberg said, “the best and the brightest are talking about becoming investment bankers or going off to Silicon Valley.”

Dwindling Dentists

To some extent, dentistry created its own problem. Richard Valachovic, president of the American Dental Health Association, said today’s shortage of dentists can be traced to the closing of seven dental schools in the 1980s and 1990s. In 1980, he said, the United States produced 6,300 dentists. Ten years later, the number was down to 4,000.

Why did the schools close? “There was a perception that we had conquered dental disease,” Valachovic said. “Kids weren’t getting cavities anymore so we thought we wouldn’t need as many dentists.” Dental health did improve, he said, but not for the poor and those without insurance.

Twelve new dental schools — smaller than their predecessors — have opened since 1997, Valachovic said, so the U.S. is back to graduating 5,700 dentists a year. But the ACA has made pediatric dental care coverage a requirement for all insurance, which will extend benefits to as many as 8.7 million children by the year 2018. Demand will far exceed capacity to produce dentists for years to come.

Some Cause for Optimism

Despite the shortages, many believe that new technologies will extend the reach of medicine in ways that will ameliorate the problem.

For example, health care professionals can serve more people by using Skype or other telemedicine technologies to examine, treat and monitor patients.

Similarly, patients can be fitted with electronic devices that remind them to take their medications and provide other guidance about their conditions. These and other technologies are already keeping patients out of hospitals and doctors’ offices.

Changes in the way medicine is delivered, such as the use of “medical homes” and “accountable care organizations” to better coordinate patient care, are also expected to improve efficiency and keep patients out of the hospital.

These organizational changes will make primary care physicians more important than ever, which might make primary care a more appealing — and lucrative — career choice.

A more controversial idea is to allow nurse practitioners, physician assistants, pharmacists and dental aides to do some of the work usually reserved for doctors and dentists. Many states have passed such legislation while others are eyeing similar measures. The Pew Charitable Trusts, which funds Statelinehas supported such efforts.

The American Dental Association, however, opposes allowing mid-level dental workers to perform some of the functions of dentists, such as routine preventive and restorative work.

The organization, which represents 157,000 dentists, questions federal data on a dentist shortage, suggesting the problem is more of an uneven distribution of dentists.

Some groups representing doctors are resisting similar efforts to allow nurse practitioners to, for example, write prescriptions and admit patients to the hospital. But many believe the trend is unstoppable.

“Health care is not a zero-sum game where there’s a limited amount of care to be given,” said Polly Bednash, the head of the American Association of Colleges of Nursing. “If there’s more care needed than we can deliver in the world, we have to decide who else can provide quality care.”

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A Health Professional Shortage Area (HPSA) is a geographic area or population group with too few health care providers to serve people’s medical needs.  Under federal guidelines, there should be no more than 3,500 people for every one primary care provider; no more than 5,000 people for every one dental provider; and no more than 30,000 people for every one mental health care provider. The graphs below show the percentage of the population in each state that lives in an HPSA.

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Group Health and Bartell Drugs to open retail clinics

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Group Health IconGroup Health Cooperative and Bartell Drugs will open three retail clinics early next year in Ballard and University Village in Seattle and at Crossroads, Bellevue.

The “CareClinics” will be staffed by nurse practitioners from Group Health and provide walk-in service to the general public for common minor illnesses and procedures, such as cold and flu, sinus infections, allergies, minor injuries (burns, rashes, and cuts), pinkeye, sore throat, headaches, sprains and strains, bronchitis, ear infections, urinary tract infections, and diarrhea.

Care will be provided for adults and children over two years of age. Patients will not have to be Group Health members to receive care

The clinics are slated to open between mid-January and early March.

The initial locations will be:

  • Ballard – 1500 NW Market St, Suite 101, Seattle, WA  98107-5211
  • Crossroads – 653 156th Ave NE, Bellevue, WA 98007
  • University Village – 2700 NE University Village St., Seattle, WA 98105

 

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Why doctors stay mum about mistakes their colleagues make

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propublica thumbnailby Marshall Allen
ProPublica

Patients don’t always know when their doctor has made a medical error. But other doctors do.

A few years ago I called a Las Vegas surgeon because I had hospital data showing which of his peers had high rates of surgical injuries – things like removing a healthy kidney, accidentally puncturing a young girl’s aorta during an appendectomy and mistakenly removing part of a woman’s pancreas.

I wanted to see if he could help me investigate what happened. But the surgeon surprised me.

Before I could get a question out, he started rattling off the names of surgeons he considered the worst in town. He and his partners often had to correct their mistakes — “cleanup” surgeries, he said. He didn’t need a database to tell him which surgeons made the most mistakes.

By some estimates, medical errors are one of the leading causes of death in the United States. Physicians often see the mistakes made by their peers, which puts them in a sticky ethical situation: Should they tell the patient about a mistake made by a different doctor? Too often they do not.

A new report in The New England Journal of Medicine, “Talking With Patients About Other Clinicians’ Errors,” suggests it’s a common problem.

The report’s lead author, Dr. Thomas Gallagher, an internist and professor at the University of Washington School of Medicine, said he conducted a survey of doctors in which more than half said that, in the prior year, they identified at least one error by a colleague. (The survey, unrelated to the NEMJ report, did not ask what the doctors did about it, Gallagher said.)

There’s wide agreement in the medical community that doctors have an ethical duty to disclose their own errors to patients, Gallagher said. But there’s been less discussion about what physicians should do when they discover that someone else’s mistake.

For the NEJM report, Gallagher led a team of 15 experts who discussed the problem. They identified many reasons why doctors may want to stay silent about errors by their peers.

One is that doctors depend on each other for business. So a physician who breaks the code of silence may become known as a tattler and lose referrals, a financial penalty.

Or maybe they aren’t sure exactly what happened to the patient and don’t want to take the time to try and unravel it. In some cases, issues related to cultural differences, gender, race and seniority come into play.

The report notes that doctors also may be wary of becoming entangled in a medical malpractice case, or of causing a colleague to face legal consequences.

Dr. Brant Mittler, a cardiologist who now works as a medical malpractice attorney in Texas, told me that he frequently saw errors made by other physicians during almost four decades in medicine.

Mittler remembers a scan read by a radiologist that said a patient had an “ejection fraction” — the amount of blood pumped by the heart with each beat — of zero. But that would only be possible if the patient was dead, he said. He noted the error to the radiologist, who thanked him.

Many times Mittler stayed quiet, he said. He saw many errors reading electrocardiograms at a 500-bed hospital in San Antonio. He said he didn’t know the details of each case, so he couldn’t tell if the errors affected the outcome for the patient.

But he did not go to the other doctors to point out the errors — there would have been hostility if he had, he said.

“There’s not a culture where people care about feedback,” Mittler said. “You figure that if you make them mad they’ll come after you in peer review and quality assurance. They’ll figure out a way to get back at you.”

Gallagher said physicians experience the normal range of human emotions when they find a colleague’s error. They wonder if they can keep it to themselves or whether they’re compelled to tell someone. Or they consider what they would want to happen if they had made the error.

That results in too much leniency toward mistakes, he said.

The bottom line: Too often doctors aren’t learning from errors, Gallagher said. Nor are patients getting the information they need to receive proper treatment or compensation when the outcome is harmful, he said.

Even after patients do learn about an error, the lack of communication by doctors often continues.

Almost 400 people who have completed the ProPublica Patient Harm Questionnaire, and more than 1,800 are members of ProPublica’s Patient Harm Facebook Community. Many reported that they experienced the silent treatment from doctors after experiencing harm during medical care.

The NEJM report stresses that patients come first and recommends that doctors should explore, not ignore, a colleague’s error. They should start by collecting the facts, starting with a one-on-one conversation with the physician who made the error so they can decide how to inform the patient.

Hospitals and other health-care institutions must lead by supporting such conversations, the NEJM group reported.

Dr. David Mayer is vice president of quality and safety at Medstar Health, which runs 10 hospitals in Maryland and Washington, D.C. Mayer said reporting of medical errors is a top priority at the organization so everyone can learn from mistakes.

When doctors identify an error, made by themselves or a colleague, they’re required to tell their supervisor, whether the error resulted in harm to the patient or not, he said.

Each month there are about 1,400 reported safety events, Mayer said. Most are “near misses,” though some involve actual harm to a patient (Medstar declined to disclose how many).

The safety events are analyzed for trends that need to be corrected or that need immediate attention to protect patients, Mayer said. Cases in which a patient was harmed are investigated so that the cause can be disclosed to the patient and family, an apology can be made, and compensation can be offered, he said.

Mayer and Larry Smith, Medstar’s vice president of risk management, said their organization is unusual for its proactive approach to reporting medical errors. Smith said most institutions seem to only report them when it’s obvious the harm will be discovered by some other means.

“Far fewer are doing this kind of work when the information would never surface,” Smith said.

Dr. Humayun Chaudhry, president and CEO of the Federation of State Medical Boards, which provides guidance for how state boards regulate doctors, said that physicians and health-care organizations need to be more assertive about reporting errors.

Failing to divulge another doctor’s mistake undermines the doctor-patient relationship, Chaudhry said. “It makes patients wonder if they can trust their own physicians,” he said, “and the profession of medicine.”

DISCUSS: Join us for a discussion on why doctors stay silent on Monday, November 11th at 4 PM ET, on Google+. Reporter Marshall Allen will lead the discussion. Dr. Thomas Gallagher, the study’s lead author, and Brant Mittler, a cardiologist and medical malpractice attorney.

Have you worked in the health-care industry? Please help ProPublica’s reporting on patient safety by completing the ProPublica Provider Questionnaire.

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Nurse practitioners try new tack to expand primary care role

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By Julie Appleby
KHN Staff Writer

This story was produced in partnership with 

inky nurses 300

Jerry Driscoll, a nurse practitioner, visits Gwendolyn Slaughter, 85, in Mount Airy. Because he is not directly credentialed, “people can’t find my name or the name of my company” in insurers’ providers lists, he said. (David Swanson/the Philadelphia Inquirer).

Nurse practitioners say efforts to expand primary care to millions of Americans under the health law are hampered by insurance industry practices that limit or exclude their participation.

Despite laws in 17 states and the District of Columbia allowing them to practice independently, nurses with advanced degrees say some insurers still don’t accept them into their credentialed networks as primary care providers, while others restrict them mainly to rural areas.

After years of fighting doctors in state legislative battles to expand their authority, nurse practitioners are taking a new tack: asking the Obama administration to require insurers to include them in the plans offered to consumers in new online marketplaces, which open for enrollment Oct. 1.

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,” said Karen Daley, president of the American Nurses Association (ANA), in a prepared statement.

Nurse advocates want to be able to bill insurers directly for services, which would require them to be credentialed in insurers’ networks. But insurers say a mix of state laws governing nurses’ ability to practice independently complicates such efforts.

They say they have taken other steps to expand primary care services, often using nurse practitioners in “medical homes,” where doctors, nurses and other professionals work together to provide care.

“We think the future is in the coordination of team-based care,” said Alissa Fox, senior vice president of the Blue Cross Blue Shield Association. “And nurses are a key part of the team.”

Physician groups, which have often opposed nurse practitioners’ efforts to operate independently, question whether allowing nurses to bill insurers directly would increase access to primary care.

The ANA argues that insurers selling plans in the new marketplaces should be required to credential a minimum number of advanced practice nurses. Under its recommendation, insurers would need to include as few as 20 nurse practitioners in some states and more than 600 in others.

The group submitted its recommendation in July as part of formal comments on proposed health law rules that the Obama administration is expected to finalize later this year. An administration official declined to comment.

Clare Krusing, a spokeswoman for America’s Health Insurance Plans, wouldn’t comment directly on the recommendation, but noted the percentage of HMOs that credential nurses is rising, “a reflection that new models of care are being implemented.”

Credentialing Is New Strategy

The focus on credentialing is the latest strategy in a long running battle by nurse practitioners, marked mainly by efforts to expand their authority under state law to provide care without direct physician oversight.

In 2010, the Institute of Medicine endorsed such efforts, urging state and federal regulators to remove barriers so nurse practitioners can make full use of their training, which includes instruction on examining, diagnosing and treating patients.

A National Governors Association report in 2012 made similar suggestions and noted that studies showed nurse practitioners provided care comparable to physicians.

Controversy has continued, however. While proponents say nurse practitioners can perform many of the primary care services that physicians do — and at lower cost — doctor groups say they should do so only as part of doctor-led teams. They also question whether the approach would increase access to primary care.

“Absent that team approach, patients will be at serious risk,” Paul R. Phinney, president of the California Medical Association, said in a statement opposing a bill that would expand nurse autonomy. “In California, where we already have integrated medical teams in many areas, removing nurse practitioners to set up shop elsewhere will only create a new access problem where one does not currently exist.”

Nevada was the latest state to allow nurse practitioners to hang out their own shingles, with Gov. Brian Sandoval signing a bill in June.

Still, in most states, nurse practitioners require collaborative arrangements with physicians for oversight of their diagnoses and treatment, according to a report by researchers at the Center for Studying Health System Change, a nonpartisan research group in Washington.

While each state has its own licensing and certification criteria, advanced practice nurses generally can diagnose and manage common illnesses such as strep throat, order tests and give patients prescriptions for medications. Those specially certified can administer anesthesia.

Such laws generally do not specify exactly what tasks nurse practitioners can perform, but “authorize a broad range of practice and spell out whether or not physician supervision is required to carry out tasks,” the report says.

Shortage of Primary Care Docs

With up to 30 million Americans expected to gain coverage through private insurance and Medicaid in the next decade, a projected shortage of primary care physicians is leading to questions about who will care for all the new patients.

Because nurse practitioners undergo a shorter training time — a master’s degree program after becoming an RN, plus up to 700 hours of supervised clinical experience – their numbers can be increased more quickly than physicians.

Currently, about 250,000 advanced practice nurses, including nurse practitioners, midwives and anesthetists, are licensed nationwide, according to the ANA. About 6,000 nurse practitioners run their own offices, according to the American Association of Nurse Practitioners (AANP). The U.S. Department of Labor says about half of the nation’s nurse practitioners work in physician practices.

More nurse practitioners would go into business for themselves if insurers included them in their networks and they could bill directly, said Deanna Tolman, an advanced practice nurse who opened her own office several years ago in Aurora, a suburb of Denver.

“We’re in this gray area: Insurers are fine with us providing care as long as we’re working for physicians. But some of us don’t want to work for physicians,” said Tolman.

Jerry Driscoll, a Philadelphia-area nurse practitioner, for instance, runs an agency that delivers primary care to 1,000 patients in their homes.

But since he is not credentialed by several of the state’s major insurers, his company must bill through physicians with whom he has collaborative agreements. In addition, “people can’t find my name or the name of my company” in insurers’ providers’ lists, he said.

Opposition From Doctors’ Groups

Credentialing policies vary. While nurse practitioners may be included in an insurer’s network — allowing patients access — they might not be credentialed.

Researchers said that insurers may be hesitant to credential more nurse practitioners because of the paperwork burden or because of the mix of state rules governing nurse autonomy.

Physician concerns are also part of the mix.

“There are longstanding debates between physicians and nurse practitioners about the clinical roles of each,” said Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change. “Aside from those clinical issues, there isn’t any denying there are economic issues on the table as well that revolve around nurse practitioners being able to bill independently of physicians.”

Nurse practitioners say some insurers sign them up no matter where their offices are located, while others do so only in rural areas and places where primary care physicians are in short supply.

In Massachusetts, which in 2006 became the first state to require residents to have insurance, demand for medical care rose after the law’s passage. Responding to that, Massachusetts lawmakers required insurers to recognize nurse practitioners as primary care providers, among other changes.

But insurers “can still write a policy that makes it difficult,” said Nancy O’Rourke, a regional director for the American Association of Nurse Practitioners.

Even though the number of nurse practitioners in the state has grown by a few hundred to about 6,000 since the law’s passage, the state’s major insurers have  credentialed very few, she said.

Blue Cross Blue Shield of Massachusetts said it has about 3,200 nurse practitioners in its network, but fewer than 100 are credentialed as primary care providers.

About 74 percent of 258 large HMOs nationwide said they credential nurse practitioners as primary care providers, according to a 2012 study by the national Nursing Centers Consortium, which advocates for independent practice nursing.

That was an increase from 53 percent of those surveyed in 2007. While the sample included HMOS with the largest enrollment in each state, it didn’t include all HMOs or other forms of insurance policies, such as preferred provider organizations (PPOs).

Nurse advocates are encouraged, but not satisfied.

“We’ve made progress, but we’re not there,” said Tay Kopanos, vice president for state policy at the American Association of Nurse Practitioners.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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State revokes, suspends licenses of health care providers

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Periodically Washington State Department of Health issues an update on disciplinary actions taken against health care providers, including suspensions and revocations of licenses, certifications, or registrations of providers in the state.

The department also suspends the credentials of people who have been prohibited from practicing in other states.

Information about health care providers is also on the agency’s website.

To find this information click on “Provider Credential Search” on the left hand side of the Department of Health home page (www.doh.wa.gov).

The site includes information about a health care provider’s license status, the expiration and renewal date of their credential, disciplinary actions and copies of legal documents issued after July 1998.

This information is also available by calling 360-236-4700.

Consumers who think a health care provider acted unprofessionally are also encouraged to call and report their complaint.

Here is the Jan 18th update issued by the Washington State Department of Health:

Note: Health care providers charged with unprofessional conduct have 20 days to respond to the Department of Health in writing. The case then enters the settlement process. If no disciplinary agreement can be reached, the case will go to a hearing.

State revokes, suspends licenses, certifications, registrations of health care providers

OLYMPIA - The Washington State Department of Health has revoked or suspended the licenses, certifications, or registrations of health care providers in our state.

The department has also immediately suspended the credentials of people who have been prohibited from practicing in other states.

The department’s Health Systems Quality Assurance Division works with boards, commissions and advisory committees to set licensing standards for more than 80 health care professions (e.g., medical doctors, nurses, counselors).

Information about health care providers is on the agency’s website. Click on “Look up a healthcare provider license” in the “How Do I?” section of theDepartment of Health home page (doh.wa.gov).

The site includes information about a health care provider’s license status, the expiration and renewal date of their credential, disciplinary actions and copies of legal documents issued after July 1998.

This information is also available by calling 360-236-4700. Consumers who think a health care provider acted unprofessionally are also encouraged to call and report their complaint.

Benton County

In June 2013 the secretary of health accepted the surrendered credential of radiologic technologist Gary Wayne Owens (RT60068503) after he was convicted of third degree child molestation. Owens took a 13-year-old girl to his home and groped her while she slept.

In July 2013 the Chiropractic Quality Assurance Commission dismissed charges against chiropractor Gabriel Anguiano (CH00002745).

Clark County

In July 2013 the Nursing Commission suspended the license of registered nurse Marcy C. Harris (RN00154541) until her Oregon credential is reinstated. She voluntarily surrendered her license to the Oregon State Board of Nursing after calling in unauthorized prescriptions for Vicodin and testing positive for hydrocodone and morphine in 2011.

King County

In June 2013 the secretary of health modified a cease and desist order to Ruilian Yang by reducing the amount of the fine. The cease and desist order was issued for giving a massage to a client even though Yang didn’t have a credential to practice as a massage therapist.

In June 2013 the secretary of health issued a permanent cease and desist order to Wenjing Feng for giving a massage to a client though Feng has no credential to practice as a massage therapist.

In June 2013 the secretary of health withdrew the statement of charges against certified nursing assistant Fantanesh H. Terara (NC10087040).

In July 2013 the secretary of health suspended the credential of registered nursing assistant Mary Anna Vanwieringen (NA00126440) for at least two years. While working for an assisted living services company, Vanwieringen yelled at, threatened, and teased vulnerable adults.

Lewis County

In July 2013 the secretary of health suspended the credential of certified nursing assistant Rhonda Jo Baxter (NC10093371) for at least two years. She didn’t comply with a substance abuse monitoring contract.

Pierce County

In July 2013 the Nursing Care Quality Assurance Commission suspended the credentials of pharmacy assistant Christa Nelson (VB60153239 and VA60245078) for at least three years. Nelson went inside an elderly neighbor’s home and stole blank checks after the neighbor was taken to the hospital in an ambulance.

In July 2013 the secretary of health ended the probation order against registered nursing assistant Brent M. Pritchard (NA60182909, NC60182962 and CO60327796).

In July 2013 the secretary of health suspended the credential of registered nursing assistant Sharon Louise Pouncy (NA60103488) for at least three years. Pouncy stole at least $80 from a patient while working at an assisted living facility.

In July 2013 the secretary of health indefinitely suspended the credential of agency affiliated counselor Teresa Lorraine Holloway (CG60300038). She didn’t participate in a required substance abuse monitoring program.

In July 2013 the secretary of health suspended the credentials of chemical dependency professional Bonnie Rebecca Russell (CO60150321 and CP60249085) for at least three years. Russell had an intimate relationship with one of her clients, and they moved in together.

In July 2013 the Nursing Care Quality Assurance Commission indefinitely suspended the credential of registered nurse Sarah M. Bain (RN00161217). She didn’t comply with the terms of her contract after entering a substance abuse monitoring program.

In July 2013 the Chiropractic Quality Assurance Commission permanently revoked the credential of chiropractor Danny D. Baldwin (CH00003681). Baldwin continued to provide chiropractic treatment to patients while his license was suspended. The commission found that Baldwin has had multiple prior disciplinary issues and has a pattern of ignoring the laws and rules that govern the practice of chiropractic.

Skagit County

In July 2013 the secretary of health suspended the credential of certified nursing assistant Tammy Kim Vega (NC10076977) for at least three years. Vega was convicted of unlawful possession of a firearm.

Snohomish County

In June 2013 the secretary of health suspended the credential of registered nursing assistant Ebrima Dibba (NA00173030) for at least two years. Dibba yelled and cursed at a resident while working at an assisted living facility.

In July 2013 the Department of Health dismissed charges against chemical dependency professional Lelan C. Jamison (CP00003694).

In July 2013 the Department of Health suspended the credential of certified nursing assistant Jongkunda Ad Ceesay (NC10075035) for at least five years. Ceesay mentally and physically abused a vulnerable adult while working for an assisted living service. He yelled and swore at a disabled adult, straddled the client on a couch, and choked him.

Spokane County

In July 2013 the secretary of health ended the probation order against certified nursing assistant Jennifer E. Martin (NC10057361).

In July 2013 the Nursing Commission suspended the credentials of registered nurse John V. Billings (RN00127908 and AP30004240) for at least four years. Billings overprescribed multiple patients and routinely practiced outside the scope of his credentials.

In July 2013 the Department of Health indefinitely suspended the credential of home care aide Douglas Eugene Campbell (HM60294171). He didn’t enroll in a substance abuse monitoring program as required by a February 2013 agreed order.

Thurston County

In July 2013 the secretary of health suspended the credential of registered nursing assistant Kathleen Laporta (NA60330472) for at least two years. Laporta tried to get Vicodin by fraudulently calling in a prescription to a Safeway pharmacy.

In July 2013 the secretary of health indefinitely suspended the credential of registered nursing assistant Tracy Marie Hill (NA60252834). Her health care assistant credential was suspended in February 2013 for practicing with an expired credential.

Walla Walla County

In July 2013 the Nursing Care Quality Assurance Commission indefinitely suspended the license of registered nurse Melissa R. Metcalf (RN00146003). Metcalf surrendered her license to practice as a registered nurse in Oregon.

Yakima County

In June 2013 the secretary of health suspended the credential of registered nursing assistant Mayra C. Sanchez (NA00183257) for at least five years. Sanchez was convicted of first degree criminal trespass and making false or misleading statements to a public servant. The Department of Social and Health Services found that she stole $50 from a resident while working at an assisted living facility.

In July 2013 the Nursing Care Quality Assurance Commission indefinitely suspended the credential of registered nurse Alicia E. Eirich (RN00159917). She didn’t comply with a substance abuse monitoring program.

In July 2013 the Nursing Commission indefinitely suspended the credential of licensed practical nurse Regina J. Mercer (LP60013043). Mercer diverted controlled substances for her use.

Out of State

Arizona: In June 2013 the Nursing Care Quality Assurance Commission indefinitely suspended the credential of registered nurse Pamela M. Kause(RN00166827). She sent bizarre and rambling e-mails to various Arizona government agencies. The Arizona State Board of Nursing immediately suspended Kause after determining that Kause’s e-mails exhibited paranoia and delusional thought processes related to a psychiatric disorder.

Florida: In July 2013 the Department of Health suspended the credential of certified nursing assistant Shamrul Neshaw Hossain (NC10049391) until her Florida credential is reinstated. Florida placed her on probation for using her position to steal money and property from a resident while working at an assisted living facility.

Idaho: In July 2013 the Nursing Care Quality Assurance Commission suspended the credential of licensed practical nurse Cynthia Lynn Van Holland(LP00035653) for at least five years. She pled guilty to 21 counts of bank robbery.

Oregon: In July 2013 the Nursing Care Quality Assurance Commission indefinitely suspended the credential of registered nurse Shannon L. Bradley(RN00151984). Bradley surrendered her nursing credential in Oregon after failing to comply with the terms of a substance abuse monitoring program.

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Nurse practitioners slowly gain autonomy

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Doctor at deskBy Christine Vestal, Staff Writer
Stateline

When the federal health law takes effect in January, some 30 million more Americans are expected to have health insurance, many for the first time.

An already critical shortage of primary care providers may make a doctor’s appointment hard to come by. Increasingly, you might hear, “The nurse will see you now.”

Some states are trying to fill the primary care physician shortage with nurses who have advanced degrees in family medicine. That requires relaxing decades-old medical licensing restrictions, known as “scope of practice” laws that prevent these nurse practitioners from playing the lead role in providing basic health services.

At least 17 states now allow them to work without a supervising physician, and lawmakers in five big states are considering similar measures.

Advocates for patients, hospitals and insurers agree that allowing nurse practitioners (NPs) to fill in for doctors makes sense when it comes to basic services. But physician groups vigorously oppose the changes, arguing that nurses lack the training to safely diagnose, treat, refer to specialists, admit to hospitals and prescribe medications for patients, without a doctor’s oversight.

After six years of legislative debate, Nevada became the most recent state to allow NPs to practice independently. Signed by Republican Gov. Brian Sandoval in June, the new law allows nurse practitioners with at least two years of experience to set up practice. They can open their own autonomous health clinics and provide the same range of primary care services as physicians do.

The hope is that the state, which ranks fifth from the bottom in doctors per capita, will prompt more nurse practitioners to offer primary care services to more patients, particularly in remote areas.

The need for the law, advocates say, was urgent, particularly because Sandoval welcomed the Affordable Care Act’s Medicaid expansion in his state, one of only six Republican governors to do so. Starting Jan. 1, an estimated 300,000 currently uninsured adults will get a new Medicaid card in Nevada, and many will want to see a primary care provider.

Incremental Change

Alaska, New Hampshire, Oregon and Washington were the first states to adopt broader licensing authority for nurses in the 1980s to increase the supply of primary care providers, especially in remote areas. A handful of other largely rural states, many with severe doctor shortages, followed in the 1990s.

A few more states joined them after passage of the Affordable Care Act in 2010, but this year, five big states — California, Massachusetts, Michigan, Pennsylvania and New Jersey — are considering laws giving NPs total independence. If they are successful, the number of patients in the U.S. with greater access to primary care will increase substantially.

The National Conference of State Legislatures reports that state legislatures considered 349 measures aimed at loosening NP licensing restrictions in 2011 and 2012. So far this year, 178 proposals have been considered.

Several states that require physician supervision expanded the types of services that NPs can offer, such as prescribing certain drugs and signing death certificates and other official health records.

But for the nursing profession, the gold standard is full independence. That is the only way, advocates argue, that NPs will be able to make a dent in patients’ access to care.

According to the American Association of Nurse Practitioners, 17 states allow NPs full autonomy (see list). Other organizations, including the national Institute of Medicine, include two other states in that category: Maryland and Utah. (The discrepancy hinges on the precise language in the laws describing an NP’s ties to a doctor.)

States (and D.C.)Allowing Nurse Practitioners Full Autonomy

  • Alaska
  • Arizona
  • Colorado
  • Hawaii
  • Idaho
  • Iowa
  • Maine
  • Montana
  • Nevada
  • New Hamphire
  • New Mexico
  • North Dakota
  • Oregon
  • Rhode Island
  • Vermont
  • Washington
  • Wyoming
  • District of Columbia

Source: American Association of Nurse Practitioners

Bills in Connecticut and Kentucky failed to pass this year after fierce opposition from state medical organizations. Lawmakers in both states vow to offer similar measures next year.

New York lawmakers proposed a bill granting full independence to NPs this year, but it was never scheduled for a hearing.

Democratic Assemblywoman Maggie Carlton, the lead sponsor of Nevada’s scope of practice law, said it took three legislative sessions and six year before “we could get the right people to talk about the right topics at the right time.”

Carlton said she has “faith in nurse practitioners that they will practice up to the top of their license, and when they get there, they will refer to the next level of care just like a general practitioner refers to a specialist.”

Filling a Void

According to the federal Health Resources and Services Administration, or HRSA, at least 55 million Americans live in areas with an inadequate supply of primary care doctors. Massachusetts has the most primary care doctors per capita; Mississippi has the fewest.

The nation would need more than 15,000 additional providers to meet the target ratio of one primary care practitioner for every 3,500 residents, according to HRSA, a gap that cannot be filled with physicians.

The Association of American Medical Colleges predicts a worsening shortage ahead. In the next 10 years, as one-third of all doctors retire, there will be 90,000 fewer doctors than needed to serve the nation’s aging population. Half of the shortage will be in primary care.

Nationwide, 117,000 physicians practiced family medicine in 2012, according to the Kaiser Family Foundation; 134,000 nurse practitioners practiced primary care, according to the American Association of Nurse Practitioners.

Last year, only 1,916 U.S. medical school graduates, or about 12 percent of the total, went into primary care residency programs, according to the nonprofit research group National Resident Matching Program. Nursing school graduates who went into primary care totaled 11,764 in 2012, about 84 percent of all NP graduates.

But will relaxing state NP licensing laws improve patient access to care? A study reported this month in the journalHealth Affairs says yes. The authors found that between 1998 and 2010, as more states relaxed licensing laws, the number of patients receiving care from NPs increased by a factor of 15.

Physician Objections

The American Medical Association and other physician groups argue that NPs lack the same level of medical training — four years of medical school plus three years of residency compared to four years of nursing school plus two years of graduate schools for NPs. The gap in training, the doctors insist, means that NPs cannot safely provide the same services as doctors.

Research tells a different story. Studies have shown that primary care provided by nurse practitioners has been as safe and effective as care provided by doctors.  A 2010 report from the Institute of Medicine points to 50 years of evidence confirming that conclusion.

Supporters point out that doctors, particularly those in private practice, have a financial incentive to limit nurses’ independence. Often carrying heavy medical school loan debt, doctors are loath to see money diverted to competing health care services.

The Federal Trade Commission has weighed in on several state battles over scope of practice, arguing that physician groups have no valid reason for blocking such laws other than to thwart competition.

Supporters also argue that the practice of family medicine has changed in the past 20 years, making the training and skills of NPs even more appropriate for the job. In the earlier days of family medicine, doctors treated a wide variety of illnesses, set bones and performed minor surgery.

Today, most spend their days treating common colds, managing diabetes, hypertension and other chronic diseases, and diagnosing and referring patients to specialists.

Another change is the way primary care doctors are paid. As an increasing number of physicians join large practices or work for hospitals, some predict that they will be less concerned about whether they are losing business to nurse practitioners.

A recent study from The Physicians Foundation, a nonprofit advocate for practicing doctors, reported that one state medical society director said that 60 percent of his members were now employed by large institutions or practices, and they did not oppose expanding nurse practitioners’ scope of practice. “The independents are still very vocal,” he said.

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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