Comments on: Ian Furst: The looking glass http://www.kevinmd.com/blog/2008/07/ian-furst-looking-glass.html medical blog Sun, 14 Mar 2010 22:53:08 -0400 http://wordpress.org/?v=2.8.4 hourly 1 By: friendly neighbor! :) http://www.kevinmd.com/blog/2008/07/ian-furst-looking-glass.html/comment-page-1#comment-86728 friendly neighbor! :) Tue, 22 Jul 2008 15:27:00 +0000 http://clients.emmense.com/kevinmd/2008/07/ian-furst-the-looking-glass.html#comment-86728 A Texas study compared patient satisfaction with care provided by three different provider types: Nurse Practitioners, Physician Assistants and Physicians. Patients were most satisfied with care provided by NPs. [Source: Taylor, LG (2007). A study of patient satisfaction in rural Texas. Advance for Nurse Practitioners, 15 (1), 53-60.]<br/><br/>In Tennessee’s state-managed MCO, TennCare, NPs delivered health care at 23% below the average cost of other primary care providers with a 21% reduction in hospital inpatient rates and 24% lower lab utilization rate than physicians. They wrote 42% less prescriptions than other providers. The data suggests that the NP providers demonstrated above-average performance in cost efficiency while delivering top quality health care. [Source: Spitzer R (1997). The Vanderbilt University Experience. Nursing Management, 28 (3), 38-40.]<br/>In an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients' outcomes were comparable. [Source: Mundinger MO, Kane RL, Lenz ER, Totten AM, Tsai WY, & Cleary PD (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized clinical trial. Journal of the American Medical Association, 283, 59-68.]<br/>Research found performing all currently recommended preventive services for patients would consume 7.4 hours of a physician’s time each day. Authors suggest using nurse practitioners more extensively as one alternative to improve delivery of preventive services. [Source: Yarnall, K.S.H., Pollak, K.I., Ostbye, T., Krause, K.M., Michener, J.L. (2003). Pimary care: Is there enough time for prevention? American Journal of Public Health, 93, 635-641.]<br/>Simonson, Daniel C, Ahern, Melissa M, Hendryx, Micheal S.<br/>Anesthetia Staffing and Anesthetic Complications During Cesarean Delivery. Nursing Research, 2007, 56, 9-17.<br/><br/>I have more if you are interested. My point being. It is time stop our petty turf wars and acknowledge what APNs bring to the table. Additionally, if were could present a united front (APNs and MDs) to influence health care reform that is beneficial to providers instead of insurance companies, we would all be better served. A Texas study compared patient satisfaction with care provided by three different provider types: Nurse Practitioners, Physician Assistants and Physicians. Patients were most satisfied with care provided by NPs. [Source: Taylor, LG (2007). A study of patient satisfaction in rural Texas. Advance for Nurse Practitioners, 15 (1), 53-60.]

In Tennessee’s state-managed MCO, TennCare, NPs delivered health care at 23% below the average cost of other primary care providers with a 21% reduction in hospital inpatient rates and 24% lower lab utilization rate than physicians. They wrote 42% less prescriptions than other providers. The data suggests that the NP providers demonstrated above-average performance in cost efficiency while delivering top quality health care. [Source: Spitzer R (1997). The Vanderbilt University Experience. Nursing Management, 28 (3), 38-40.]
In an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients' outcomes were comparable. [Source: Mundinger MO, Kane RL, Lenz ER, Totten AM, Tsai WY, & Cleary PD (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized clinical trial. Journal of the American Medical Association, 283, 59-68.]
Research found performing all currently recommended preventive services for patients would consume 7.4 hours of a physician’s time each day. Authors suggest using nurse practitioners more extensively as one alternative to improve delivery of preventive services. [Source: Yarnall, K.S.H., Pollak, K.I., Ostbye, T., Krause, K.M., Michener, J.L. (2003). Pimary care: Is there enough time for prevention? American Journal of Public Health, 93, 635-641.]
Simonson, Daniel C, Ahern, Melissa M, Hendryx, Micheal S.
Anesthetia Staffing and Anesthetic Complications During Cesarean Delivery. Nursing Research, 2007, 56, 9-17.

I have more if you are interested. My point being. It is time stop our petty turf wars and acknowledge what APNs bring to the table. Additionally, if were could present a united front (APNs and MDs) to influence health care reform that is beneficial to providers instead of insurance companies, we would all be better served.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/07/ian-furst-looking-glass.html/comment-page-1#comment-86722 Anonymous Mon, 21 Jul 2008 19:53:00 +0000 http://clients.emmense.com/kevinmd/2008/07/ian-furst-the-looking-glass.html#comment-86722 WHICH studies exactly are you referring to which purport to show that NP's get the same "outcomes" as physicians??<br/><br/>How do your define outcomes?<br/><br/>What disease states are you referring to? WHICH studies exactly are you referring to which purport to show that NP’s get the same “outcomes” as physicians??

How do your define outcomes?

What disease states are you referring to?

]]> By: Anonymous http://www.kevinmd.com/blog/2008/07/ian-furst-looking-glass.html/comment-page-1#comment-86721 Anonymous Mon, 21 Jul 2008 19:17:00 +0000 http://clients.emmense.com/kevinmd/2008/07/ian-furst-the-looking-glass.html#comment-86721 The numbers do not compute. 82 primary care doctors per 100,000 people in Massachusetts would mean an average patient panel size of 100,000/82 = 1219 patients per primary care doctor. In my experience you cannot sustain a viable family practice with only 1219 patients per doctor. So it looks to me like the problem should actaully be too many rather than too few primary care doctors. The other possibility is that the numbers are incorrect. The numbers do not compute. 82 primary care doctors per 100,000 people in Massachusetts would mean an average patient panel size of 100,000/82 = 1219 patients per primary care doctor. In my experience you cannot sustain a viable family practice with only 1219 patients per doctor. So it looks to me like the problem should actaully be too many rather than too few primary care doctors. The other possibility is that the numbers are incorrect.

]]> By: friendly neighbor! :) http://www.kevinmd.com/blog/2008/07/ian-furst-looking-glass.html/comment-page-1#comment-86719 friendly neighbor! :) Mon, 21 Jul 2008 13:21:00 +0000 http://clients.emmense.com/kevinmd/2008/07/ian-furst-the-looking-glass.html#comment-86719 The value of Advanced Practice Nurses has never been more evident. Numerous studies have shown patient outcomes for MD and APNs to be equal and the APN workforce is already in place. However, laws tying them to physicians are impedeing their usefulness. Grant APNs autonomous practice. The additional providers will not solve the problem completely, but can atleast help to alleviate the problem. Adjusting reimbursement to draw providers into primary care is the long term answer. The value of Advanced Practice Nurses has never been more evident. Numerous studies have shown patient outcomes for MD and APNs to be equal and the APN workforce is already in place. However, laws tying them to physicians are impedeing their usefulness. Grant APNs autonomous practice. The additional providers will not solve the problem completely, but can atleast help to alleviate the problem. Adjusting reimbursement to draw providers into primary care is the long term answer.

]]> By: Chuck Brooks http://www.kevinmd.com/blog/2008/07/ian-furst-looking-glass.html/comment-page-1#comment-86711 Chuck Brooks Sun, 20 Jul 2008 17:33:00 +0000 http://clients.emmense.com/kevinmd/2008/07/ian-furst-the-looking-glass.html#comment-86711 The camel's behind is definately in the tent now. How its nose got in initially is immaterial. This is now a purely political matter, with insurance construed as an entitlement, and doctors no longer relevant beyond being billing conduits. No wonder that the talented are going where they are more rewarded. An excellent example of Gresham's Law in action. The camel’s behind is definately in the tent now. How its nose got in initially is immaterial. This is now a purely political matter, with insurance construed as an entitlement, and doctors no longer relevant beyond being billing conduits. No wonder that the talented are going where they are more rewarded. An excellent example of Gresham’s Law in action.

]]>