Archive for June, 2015

The Last Mile in Healthcare Delivery

Lately, I’ve been thinking about the impact of the changing healthcare landscape on the people who actually deliver the healthcare – the healthcare professionals -  as millions and millions of more Americans now have health insurance coverage.

There’s been much written about how there won’t be enough primary care physicians available to handle the increase in patients. Some primary care physicians are overloaded, and in some cases are not taking on new patients because their capacity is maxed out, but so far most practices are handling the increase in insured patients.

Nevertheless, the predictions are that the US will have a shortfall of 50,000 primary care physicians in the next decade.

I’ve already written about the primary care physician as an “endangered species.”

This emerging situation highlights the important role of Nurse Practioners (NPs) and Physician Assistants (PAs), those professions that are often lumped under a category called “Healthcare Extenders” or HCEs. Sometimes they’re known as the “Allied Professionals” within healthcare. There are currently 150,000 nurse practitioners in the US.

city on hill 2The Last Mile in Healthcare Delivery
I often consider these HCEs or allied professionals as providing the “last mile” in healthcare delivery.

Physicians have traditionally done the tasks of diagnosing the illness, writing the prescriptions and monitoring the patients, but as primary care physicians are called on to see more patients, they are able to spend less and less time in the exam room. And that’s where the “last mile” comes into play.

For example, some patients may ask, “Now that I have this disease, how do I manage it?” For them, the last mile is patient education. Others may be encountering drug side effects. For them, the last mile is patient support or discussion about an alternate therapy.

Lifestyle changes? Coaching is the last mile.

All of these support requirements will fall more and more squarely on the shoulders of the allied professionals.

What’s more, the HCEs and allied professionals aren’t just doctors’ helpers – they have the education and authority to prescribe medicine and educate patients.

-       79% of NPs and 69% of PAs provide or recommend patient support resources for patients

-       NPs are able to legally prescribe medications in all 50 states

-       PAs can prescribe in 48 of the 50 states

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Is Your Doctor an Endangered Species?

I recently attended the American College of Physicians’ (ACP) Internal Medicine Meeting, the annual national conference for internists and primary care physicians. It was well attended and offered a mix of clinical presentations on new advances in medicine, seminars about the practical side of running a primary care practice, and policy updates on the Affordable Care Act.

Quarterback InternistThe Internist as your Healthcare Quarterback
This group of physicians is arguably the most important in the field. Primary care physician keep our health history, coach us on healthier lifestyle choices, and they are often the first to diagnosis a life-threatening problem.

These are also the clinicians who have to triage the millions of newly insured patients while at the same time dealing with declining reimbursement rates. There is a reason why internists are considered an endangered species.

Yet there was no hand wringing or complaining at the ACP conference.

Given the challenges for this group of doctors, I expected to hear a lot of moaning and complaining, but the reality is that physicians are already moving forward with the new ground rules to build and maintain their practice. They’re embracing the changes despite more complex and tedious record keeping. Ultimately, physicians want to get everything settled so they can get back to their patients.

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