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The healthcare debate and advance practice professionals

Credentialing Resource Center Connection , September 17, 2009

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Anne R. Buss, CPMSM, CPCS, is a medical staff consultant based in Fayetteville, AR.

Dear readers,

The number one topic in the news today is healthcare reform. The nation’s uninsured and how to care for them is part of the reform debate. I don’t have any answers to this large question, but as things stand today, there are fewer doctors practicing, making it more difficult for all patients, including the uninsured, to receive care. However, much more of the nation’s primary healthcare is being provided by advance practice professionals (APPs) (i.e., physician assistants, advance practice registered nurses (APRN), certified nurse midwives, and certified registered nurse anesthetists). It certainly seems like these providers will fill the gap left by doctors. 

For many of us credentialing in mid-size hospitals and medical centers it is going to mean changes in how these APPs function. Specifically, it means that as hospitals begin to allow them to expand their scope of practice and work to their full potential to fulfill patient need, medical staffs will have more credentialing and privileging work to do around these practitioners. 

In some organizations, APPs are already working to their full potential. According to recent figures from Vantage Clinical Solutions, at least 42% practice in specialty fields. They have Medicare and Medicaid provider numbers and have access to patients as managed care providers. 

In hospitals where the APRN has not been able to fully utilize their advanced education, they are now, or soon will be doing more procedures and prescribing. According to the American Academy of Nurse Practitioners, “Restrictions on prescriptive authority limit the ability of nurse practitioners to provide comprehensive healthcare services.”

Credentialing and supervision will be more involved. Nurse practitioners are licensed in all states and the District of Columbia. They practice under the rules and regulations of the state in which they are licensed. Most of them are nationally certified in their specialty area and are recognized as expert healthcare providers. Collaborative practice agreements and/or plans will become a part of these APPs’ credentialing files as appropriate; however a growing number of states have removed supervision requirements. 

Sound policies and procedures regarding mid-level providers—what role they will play in your healthcare facility and community—could allow provisions for the urgent care needs of the insured, as well as the under and uninsured. 

Remember, those who are afraid to ask are afraid to learn. 

All the best,
Anne R. Buss, CPMSM, CPCS

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