ReimbursementIssues for Nurse Practitioners: Independent verses CollaborativePractice in Retail Clinics
Thenurse practice has received attention in the recent years asdifferent states debate whether to encourage independent practice ordiscourage it (NationalGovernors Association, 2012).To add to this discourse, a summary of a recent publication thatfocuses on how the laws in different states have affected cost savingefforts in retail clinics is undertaken (Spetz,Parente, Town, & Bazarko, 2013).In the U.S.A, some states allow nurses to set up and run care clinicson their own while others make it mandatory for them to work underthe supervision or partnership of physicians. What is at stakeaccording to the author is the impending closure or limitation ofservices nurses in more than 5,000 clinics could offer across theUnited States. The consequences will be increased healthcare costsresulting from patients who will be forced to seek for referrals athigher level facilities for conditions nurses are capable ofhandling.
TheEfficacy of Retail Clinics
Retailclinics are a recent phenomenon with the first clinic having been setup in 2000 in a ‘grocery store in the Minneapolis. Care clinics arepopular due to their location and transparency with pricing. Theclinics are opened both during the weekend and late hours during theweek when physician offices would normally be closed. They contributeto reducing the burden of primary care on emergency departments, andthey can do that at a reduced cost.
Theclinics are not without criticism. To begin with they are marketdriven and offer only a narrow range of services that are common withmost patients. In the end, they may increase rather than reduce thetotal cost of health care because they ‘complement rather thanreplace the physician’ (NationalGovernors Association, 2012 Spetz et al., 2013 Yee, Boukus, Cross,& Samuel, 2013).Poor quality care, hidden costs in advertised prices, and the dangerof colluding with dispensing outlets are the other criticisms thatboarder on unethical behavior.
Thestudy drew a sample of 9,503 individuals who had visited a retailclinic from 2004 – 2007 available from a database of a largeinsurance provider. The study limited the services sought to a rangeof ten clinical conditions most popular with retail clinics. Thehealth care costs were measured for a period of fourteen days. Costsincluded both insurance payments and out of pocket expenditures bypatients. The client expenditure health and demographic data werecross-tabulated with nurse scope of practice measures in each stateat a given time. The analysis was descriptive.
Findingsindicate that in 2007 thirteen of the sampled states allowed nursesto practice independently (six states even allowed prescribing), theother fourteen sampled states required physician collaboration orsupervision. The results found that retail clinics were associatedwith lower total costs consistent with previous findings. Contrary tocriticism, the clinics did not increase subsequent hospitalization.However, prescription costs were higher for retail compared tonon-retail outlets. Another finding was that legal restrictions onnurse practice and the requiring them to collaborate with physicianswould escalate 14-day episode costs from $543 and $484 betweenrestrictive and liberal states respectively. The findings summarizethat allowing NPs to be independent and offer all primary careservices they can do so at adequate standards and a reduced cost.
Thenurse practitioners are the answer to the challenges in thehealthcare sector, and the legal environment should enable ratherthan hinder its development. There are quality concerns that havebeen raised by a potential conflict of interest. This could happenany other field, but there are checks and balances to reduce chancesof abuse to the system.
NationalGovernors Association. (2012). Therole of nurse practitioners in meeting increasing demand for primarycare.NGAPaper.Washington DC. Retrieved fromhttp://www.nga.org/cms/home/nga-center-for-best-practices/center-publications/page-health-publications/col2-content/main-content-list/the-role-of-nurse-practitioners.html
Spetz,J., Parente, S. T., Town, R. J., & Bazarko, D. (2013).Scope-of-practice laws for nurse practitioners limit cost savingsthat can be achieved in retail clinics. HealthAffairs,32(11),1977–1984. http://doi.org/10.1377/hlthaff.2013.0544
Yee,T., Boukus, E., Cross, D., & Samuel, D. (2013). PrimaryCare Workforce Shortages: Nurse Practitioner Scope-of-Practice Lawsand Payment(No. 13). Washington DC. Retrieved fromhttp://www.floridanurse.org/arnpcorner/ARNPDocs/NIHCR_Research_Brief_No._13.pdf