APRN Practice Expansion and Healthcare Gap Analysis - Delaware 14% Growth Newsletter

Delaware State Board of Nursin - Advanced Practice Nursin Committee

June 2013 - Newsletter

practice that prohibit them from fully using Increasing APRN Practice to their demonstrated ability to provide a wide Bridge Gaps in Healthcare range of primary and specialized healthcare services for patients. According to the Institute of Medicine (IOM), States with By: Beatrice Gaynor, MSN, CFNP, and greater restrictions on NP practice did not Allen V. Prettyman, PhD, CFNP demonstrate improved quality of healthcare services (Institute of Medicine, 2012). Advanced Practice Registered Nurses (APRNs) have expanded in numbers and In Delaware, the number of APRNs grew by capabilities over the past several decades 14% from May 2011 to May 2013. Nationally, and are highly valued as an integral part of between the mid-1990s and the mid-2000s, the health care system. Currently, 20 States the number have independent practice authority for of APRNs per APRNs, and 15 others are moving forward capita grew with introduction of legislation over the next an average few months. Adoption of the Consensus of more than Model is a key component of this and is an 9% annually exciting opportunity for APRNs in Delaware. compared with just 1% The goal of the Consensus Model is to for the primary care physicians. It is standardize licensure, accreditation, estimated that by 2020 there will be credentialing, and education of the APRN shortage of 45,000 primary care physicians. nationwide, thereby protecting public safety APRNs will play an important role in filling the and improving access to healthcare for gap between supply and demand for primary patients (NCSBN, 2012). Delaware law healthcare providers for patients in Delaware requires an APRN to have a collaborative (USDHSS, 2008). practice agreement to practice as an APRN. However, this requirement negatively More APRNs practice in States that allow impacts APRNs' scope of practice and thus independent practice than in States with limits access to healthcare providers for restrictive practice laws. Reports suggest individuals in need of healthcare in Delaware. APRNs tend to move from more restrictive States to less restrictive States. This In one-third of the United States, Nurse tendency results in loss of access to care for Practitioners (NPs) are licensed to practice to patients in restrictive States (Fairman et al, the full extent of their education, skills and 2011). With predicted future physician training. Evidence confirms that NPs in these shortages, elimination of restrictions to States do so safely and effectively (Fairman APRNs' scope of practice in Delaware will et al, 2011). The other two-thirds of the encourage APRNs to remain in Delaware. This states impose legal restrictions on NPs' can help improve the number of APRNs who

are working in Delaware and provide an participation in state Medicaid programs. APRN workforce to help meet the healthcare Since APRNs are more likely to practice in needs of people in areas where there are rural, underserved areas and to care for shortages of health professionals. Medicaid beneficiaries, APRNs will play an important role in balancing the supply and There are approximately 5,900 designated demand for health care services for Medicaid health professional shortage areas (HPSAs) populations (Kaiser Commission, 2011). in the United States. The HPSA designations are based on a physician to population ratio The APRN Consensus Model provides a of 1:3,500. Applying this formula, it would mechanism for protecting public safety and take approximately 7,550 additional primary improving access to quality healthcare for care physicians to eliminate the current patients is all geographic locations in primary care HPSA designations. Delaware. The adoption of the APRN Furthermore, primary care needs of an Consensus model allows the growing number individual community will vary by a number of APRNs in Delaware to practice to their full of factors such as the age of the community's potential as APRNs and thus provide needed population. The formula for HPSAs also does healthcare for people throughout Delaware. not take into account the availability of additional primary care services provided by APRNs in a geographic area. Other sources The APN committee can be reached by that describe primary care supply use other contacting the Delaware State Board of ratios; for example, a ratio of 1 physician to Nursing at: 2,000 population (HRSA, 2013). To meet this  Phone: (302) 744-4500 ratio, approximately 16,000 more primary  Fax: (302) 739-2711 care physicians would need to be added to  Email: customerservice.dpr@state.de.us the current supply in HPSAs. Delaware has a critical shortage of physicians in two of its three counties: Sussex and Kent APN Committee Meetings Counties are designated as rural HPSAs. In Join the Dialog! addition, a significant portion of New Castle Dates locations and times for APN Committee County is also designated as a HPSA (HRSA, meetings are posted on the following website: 2013). As one-quarter of primary care http://egov.delaware.gov/pmc/#agency45physicians in Delaware are 55 years or older and nearing retirement, this shortage of physicians working in rural and underserved areas is unlikely to improve in the near future. New replacement physicians are not the answer; nationally, only 3% of medical school students indicated that they plan to practice in a rural area or small town (Thomas Jefferson University, 2013). The shortage of physician services is most likely to have a greater impact on Medicaid recipients due to limited physician practice locations in rural, low socioeconomic communities, as well as low physician

References:

Fairman, J. A., Rowe, J. W., Hassmiller, S., & Shalala, D. E. (2011). Broadening the scope of nursing practice. N Engl J Med, 364(3), 193-196. doi:10.1056/NEJMp1012121. HRSA - Health Resources and Services Administration (2013), Find shortage areas by state and county http://www.hrsa.gov/shortage/ . Health Resources and Services Administration (HRSA). (2013), Find Shortage Areas: HPSA by State & County, http://hpsafind.hrsa.gov/ . Institute of Medicine, The Impact of Medicare Payment Policy on Workforce Supply, Distribution, and Access to Care. Educational Webinar: IOM Committee on Geographic Adjustment in Medicare Payment (2012). http://www.iom.edu/Activities/HealthServices/GeographicAdjustments/~/media/Files/Activity%2 0Files/HealthServices/GeographicAdjustment/2012-OCT- 10/IOMWorkforceWebinarOct102012final.pdf Kaiser Commission on Medicaid and the Uninsured, Improving Access to Adult Primary Care in

Medicaid: Exploring the potential Role of Nurse Practitioners and Physician Assistants (March

. 2011). http://www.kff.org/medicaid/upload/8167.pdf National Council of State Boards of Nursing (2012), Campaign for the APRN Consensus Model and Toolkit, https://www.ncsbn.org/aprn.htm. Thomas Jefferson University (2013), Physician Shortage Area Program . http://www.jefferson.edu/jmc/psap.html U.S. Department of Health and Human Services, Health Resources and Service Administration Bureau of Health Professions (2008), The Physician workforce: Projections and Research into current issues affecting supply and demand, 70-72, exhibits 51-52 http://bhpr.hrsa.gov/healthworkforce/reports/physwfissues.pdf .