The short answer is Time! The long answer highlights all of the actual work involved to go from the concept of a good clinical topic to a polished presentation. Excellent original content takes a deep commitment to create, and identifying the literature, research, and data behind a clinical topic can be very time consuming. Once found, tying the clinical pieces and information together into a cohesive and interesting presentation begins.
And so the rest of this blog post comes to you – the biggest investment in healthcare.
Physicians, Physician Assistants, Nurse Practitioners – anyone who is considered a provider in healthcare, is now having their own quality measures applied to their care delivery. As part of the permanent “Doc Fix” the Medicare Access and CHIP Reauthorization Act (MACRA) was passed in 2015. CHIP is the Children’s Health Insurance Plan that provides matching federal payments to state-funded children’s insurance programs. MACRA is designed to shift the healthcare fee-for-service model of payments to the value-based payment (quality) payment model through Merit-based Incentive Programs (MIPs), which are designed to focus on quality measures at the provider level. Each specialty will have different requirements. The intent of these quality measures is aimed at reducing cost, but their application to current medical standards is debatable.
In the previous blog we went over how medicare, RVU’s and SGR have led us to where we are headed as you will read below.
Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), also known as “Obamacare” was passed in 2010 and was the first major overhaul to our nation’s reimbursement system since the introduction of Medicare in 1966. The intentions of the ACA were to create a system that would insure healthcare for everyone in the United States, and to reduce the cost of that insurance. The challenge with this law was to find a way to provide reduced cost coverage for patients, while providing expanded coverage at the same time.
What is a value-based payment system, and how do I fit in the equation?
This post will open your eyes to the government regulation coming our way, and show you how Nurse Practitioner and Physician Assistant skills and procedures courses and their continuing education will be invaluable to your success as a provider.
This blog post is important. Not because it is filled with clinical pearls, or focused on clinical decision-making. This post is focused on the delivery of healthcare, and how your career will be shaped by what you do – on a scale never before imagined. Please take a few moments and read below, to get a general sense for what is coming our way, and how to best prepare for the change in tides. Given the length of this post, it will be best to start with a little bit of history. Trust me – you will want to read this one through to the end, as it will define the rest of your career.
The Definition of an APP
Advanced Practice Providers (APP) include Nurse Practitioners (NP), Physician Assistants (PA), Clinical Nurse Specialists (CNS), Certified Registered Nurse Anesthetists (CRNA), and Certified Nurse Midwives (CNM). These practitioners have Master’s degree level of education. They also have been board certified by their own accreditation boards. Their level of expertise allows them to practice to the highest level of autonomy within their individual state practice acts.
The Growth of APPs
According to the American Academy of Nurse Practitioners, there are more than 248,000 licensed NP’s nationwide. In addition, there are over 115,500 practicing PA’s nationwide. There has been a recent increase in demand for APP’s to help assist with the strain on our healthcare system due to physician shortages, increased numbers of Medicare-Eligible patients, and the influence of change from the Affordable Care Act (ACA). Advanced Practice Providers are the future of the healthcare system. The demand for APPs is only going to increase.
By virtue of their training, APP’s can be exposed to the full complement of clinical skills and expected performance of the specialties in which they choose to practice. State medical boards have varying levels of oversight and delineation of privileges. These should be looked at closely when APP’s enter the clinical world. Ultimately, the ability of APPs to utilize their full skill set and training abilities will be dependent on the people who hire them, the comfort level of their supervising physician(s), and the hospital credentialing committee, in cases where hospital procedures are being considered. Breaking into the clinical procedure component of practice may be challenging in some places, while expected in others. Finally, depending on the state, some APP’s may have the ability to practice completely unrestricted and without supervision, within the state’s privilege guidelines.
Exposure to procedures and documented reliability and safety when performing these procedures are often reasons that APP’s may not be granted full reign to practice the procedures they request. Inevitably, as the healthcare shortage increases and needs become more paramount, these restrictions will become less encompassing in APP practice. Regardless of procedural exposure or expectations, all APP’s provide a critical niche in the healthcare landscape and will greatly reduce the burden of healthcare delivery as their numbers grow.
Advanced Practice Provider Education with PPE Medical
At Provider Practice Essentials, we want to help advanced practice providers become stronger through hands-on training with other APPs. Our workshop participants leave with not only knowledge but a practice suturing kit and access to our online portal filled with educational material including reference sheets and videos. Check out our 2018 courses and register today!
Here is a great summary table from The Physician Assistant Life of what it takes to be an advanced practice provider in today’s environment. While we have come a long way to narrow the gap in medical education, there is still a shortage of hands-on experience and clinical correlation to practice for those who have not attended a focused residency. That being said, clinical experience speaks for itself and with the right start to know where to focus during your career, it’s easy to learn how to put it all together and build on your own practice knowledge base.
Let Provider Practice Essentials give you the tools to know what you need to learn, help you apply how you learn it best, and broaden your knowledge base to accelerate your clinical learning pace throughout your career. They say practice makes perfect. Let’s get there by learning the essentials and building on them together.
|Category||Medical Assistant||Nurse (RN, BSN)||Nurse Practitioner||Physician Assistant||Physician (Family Practice)|
|Prerequisite Education||None||None||Bachelor Degree in Nursing and Clinical Hours||Bachelor Degree and Clinical Hours||Bachelor Degree|
|Time in Classroom||134 hours||Varies greatly by program||500 hours||1000 hours||2 years|
|Time in Clinic||160 hours||Varies by program||500-700 hours||2000 hours||2 years|
|Total Post High School Education||1-2 years||2-4 years||6-8 years||6-7 years||8 years|
|Residency||None||None||None||Optional 1-2 years||3-8 years|
|Degree or Certificate Awarded||Certificate or associate Degree||Associate or Bachelor Degree||Master’s Degree; Planned Transition to Doctorate||Master’s Degree PA-C||Doctor of Medicine (M.D.) or Osteopathy (D.O.)|
|Recertification||60 education points or exam every 5 years||1000 hours practicing in area of certification or exam every 5 years||1000 professional practice hours and 12 CE credits per year or exam every 5 years||100 education hours every 2 years and exam every 10 years||MD: 50 education hours/year and ABMS recommended|
|Base Salary U.S.||$29,708||$66,220 (varies greatly by state)||$97,990||$97,820||$185,151|
|Independented Practitioner||–||–||18 states allow NPs to practice independently||–||Yes|
|Complicated or High Risk Cases||–||–||Varies||Varies||Yes|
|Deliver Babies||–||–||Yes||Varies by State||Yes|
|Perscribe Controlled Substances||–||–||Varies by State||Varies by State||Yes|
|Conduct Physical Exams||–||Assist||Yes||Yes||Yes|
|Order and Interpret Tests||–||Assist||Yes||Yes||Yes|