Scope of Practice: Colorado and the Current Debate
- 1. Scope of Practice:Colorado and the Current DebateImpact Conversation SeriesOctober 5, 2011
- 2. Today’s DiscussionPrimary Care: A booming marketThe National ConversationState of the Debate in ColoradoAPN & PA Survey FindingsPlanning now for new solutions2
- 3. Primary Care: A booming market
- 4. On the Horizon: Primary Care NeedIn Colorado 500k more “newly insured”How much care will they seek?Where will they seek care?4214,000153,000175,000
- 5. Gaps in Primary Care5
- 6. Who Can Practice Primary Care?6
- 7. Scope of Practice7Training & complexity of careCost-effective care & providers, access
- 8. Progression of the Debate8Cultural
- 10. The Importance of Frame of ReferenceNursing PerspectivePhysician PerspectiveIOM PerspectiveGrowing literature: plenty for everyone10
- 11. National-level reform11Mid-to-long range changeFederal roleImmediate term changeState role
- 12. The Promise of Medical HomesReduced costsImproved care qualityReduced medical errorsHigher patient satisfactionFewer health disparities12
- 13. The Promise DeferredNot today or tomorrow Require transformationWorkforce as members of “care teams”Technology is not “plug and play”Health care neighborhoodsPayment reform13
- 14. Accountable Care OrganizationsA model for reforming health care delivery and paymentIntegrated care deliveryPayments linked to cost-reducing quality benchmarksPerformance measurement14
- 15. Scope of Practice: Market Dynamics15
- 16. State of The Debate in Colorado
- 17. Our Primary Care Workforce17NOTES: Estimates do not include non-primary care practitioners.*Colorado providers include practicing/working providers only.SOURCES: GAO, Peregrine, DORA, Colorado Office of Demography, CHI)
- 18. State Role: Leverage PointsPractice Acts (legislative decisions)Medicaid payment structureInsurance regulation18
- 19. 19CO
- 20. Scope of Practice: APNs20Pre-20082008200920102011
- 21. APN & PA Workforce Surveys
- 22. Colorado NPsNOTE: The total of all specialties sums to more than 100% because each respondent could select more than one specialty.SOURCE: 2010 Colorado Advanced Practice Nurse Workforce Survey, Colorado Health Institute, Q14, Q15, Q24
- 23. NPs: Many recent graduates23
- 24. NPs: A homogenous professionNOTE: The total of all specialties sums to more than 100% because each respondent could select more than one specialty.SOURCE: 2010 Colorado Advanced Practice Nurse Workforce Survey, Colorado Health Institute, Q14, Q15, Q2424
- 25. NPs: Age and career cycle25
- 27. Colorado PAs2743% of PAs57% of PAs*PAs were classified as primary care if they practiced family/general medicine, general internal medicine, general pediatrics or prevention/wellness at least 50% of their practice time during a typical work week. SOURCE: CHI: 2011 Physician Assistant Workforce Survey, Q24, Q17, Q1.
- 28. PAs: Increasingly educated28SOURCE: CHI: 2011 Physician Assistant Workforce Survey, Q24, Q2, Q13
- 29. PAs: Policy opinions29SOURCE: CHI: 2011 Physician Assistant Workforce Survey, Q8
- 30. What the surveys tell us:Important primary care providersMeeting higher education standardsSome of the same issues as physiciansNP issues: Reimbursement, institutional policies, physician conveningsPA issues: Reimbursement and Medicare scope30
- 31. Planning now for new solutions
- 32. The late stages of the debate32
- 33. Are the Changes Enough?Calls for Disruptive InnovationClinician-led teams, practicesTelehealthLeveraging new practitioners: Community health workers/patient navigators/care managers?33Innovation
- 34. Options Moving ForwardAligning financial structures & institutional policiesPaying for valueBuilding consensus: NPATCHSupport for loan forgivenessEvaluate Community health worker models34
Editor's Notes
- #15: A model for reforming health care delivery and paymentIntegrated care deliveryFocus on primary care, prevention, chronic disease mgt.Payments linked to cost-reducing quality benchmarks(shared risk/reward)Performance measurementMedicareShared Savings Program (FFS)Pioneer (capitated)TransitionsCommercial Insurance PilotsColorado RCCOsEveryone knows what one looks like, but no one has actually seen one…