Reforming Delivery
Doc Groups Fight Losing Battle Against Cheaper Health Care

A big health care win: the NYT profiles the push to give nurse practitioners more power to care for patients without direct doctor oversight. As the story tells it, Nebraska has recently become the 20th state to giving nurse practitioners more autonomy. Previously, Nebraskan nurse practitioners had to get signed permission from doctors to perform certain health care services, even when they were already licensed by the state to offer those very services. Overturning that requirement, as the state has down, has the potential to unlock large health care savings—nurse practitioners can provide care cheaper than doctors. It also could help ease the doctor shortage that is poised to sweep the nation’s health care system. Research suggests that the doc shortage is more a problem of distribution than raw numbers; dense cities have enough providers but more rural areas, where docs can’t make a good of a living, don’t. Nurse practitioners could help plug that provider hole.

It’s no wonder, then, that more and more states are easing restrictions on nurse practitioner autonomy. But there’s one kind of group that’s not happy:

Groups representing doctors, including the American Medical Association, are fighting the laws. They say nurses lack the knowledge and skills to diagnose complex illnesses by themselves. Dr. Robert M. Wah, the president of the A.M.A., said nurses practicing independently would “further compartmentalize and fragment health care,” which he argued should be collaborative, with “the physician at the head of the team.”

Dr. Richard Blatny, the president of the Nebraska Medical Association, which opposed the state legislation, said nurse practitioners have just 4 percent of the total clinical hours that doctors do when they start out. They are more likely than doctors, he said, to refer patients to specialists and to order diagnostic imaging like X-rays, a pattern that could increase costs.

Doctors’ groups appear willing to fight this change to the bitter end. Luckily, the trends aren’t going in their favor, and the U.S. could wind up with a cheaper, better health care system as a result.

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