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Will ACOs accelerate acceptance of nurses as primary care practitioners?

By jeremy.engdahl-johnson

An editorial in The Atlantic recently argued strongly in favor of the expansion of the role of nurses in primary care:

Should the ACA pass muster with the Supreme Court next month, an additional 30 to 33 million previously uninsured Americans will be covered — and even if ACA is not implemented in full, and in the end merely expands Medicaid, it will add 17 million to the insured ranks by 2020.

One of the best ways to alleviate this shortage is to expand the scope of practice for advanced practice registered nurses (APRNs), well-trained registered nurses with specialized qualifications who can make diagnoses, order tests and referrals, and write prescriptions. APRNs could provide a variety of services that primary care physicians now provide.

This issue remains contentious, but one of the most interesting points the author made concerned a frequent topic of this blog—the growth of accountable care organizations (ACOs):

Employers and patients are beginning to clamor for progress in this area and the turf wars may lose steam as we move away from fee-for-service and toward accountable care organizations, in which a team of providers takes responsibility for the well-being of a population in return for global rather than provider-specific payments.

A 2011 article on Gannett’s Nurse.com on the role of nurses in federally sanctioned ACOs referenced Milliman’s own Patty Jones on the topic:

According to Patty Jones, RN, MBA, a healthcare management consultant with the Seattle office of Milliman, an actuarial consulting firm, nurses are the logical choice to help patients navigate barriers to care and to educate them about how to best care for themselves. They already serve as health coaches for patients with multiple chronic illnesses, and they perform discharge and transition planning for those who are hospitalized. Jones predicted these roles will expand in an ACO.

You can read Patty’s paper on the topic of nurses in accountable care here.

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  1. May 10th, 2012 at 13:57 | #1

    You clearly can see a value to the system to spin off some of these activities but it revives the arguments about the training differences between doctors and nurses or other healthcare professionals. A doctor who somehow had slept or been gone for the last five or ten years would not recognize his art upon his return. However, the increase in coverage will necessitate an expansion of care givers and this is one area that may work but it needs to be approached cautiously.

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