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April 28, 2008

An Aging Population -- Why Can't NPs Provide Needed Care?

The Washington Post reported last week that by 2030, the number of adults 65 years and older will make up almost 20% of the population. Currently, this age group makes up 12% of the U.S. population and accounts for:

* 26% of all physician office visits
* 35% of all hospital stays
* 34% of all prescriptions
* 38% of all emergency-medical-service responses
* 90% of all nursing-home use

John Rowe, professor of health policy and management at Columbia University headed an Institute of Medicine panel that released a report on the healthcare outlook for the 78 million baby boomers about to begin turning 65. The report from the arm of the National Academy of Sciences reiterated:

*  There aren't enough specialists. It found there are about 7100 US physicians  certified in geriatrics, one per every 2500 older Americans.
*  Insufficient training is available.
*  Specialists are underpaid.
* Medicare fails to provide for team care that many seniors need.

The report said Medicare may hinder seniors from getting the best care because of its low reimbursement rates, a focus on treating short-term health problems rather than managing chronic conditions, and lack of coverage for preventive services.

Magnifyingglass72x571 Aren’t these aspects of care that nurse practitioners are so well trained in? We may be able to solve the impending looming healthcare crisis.

NPs – what do you think?

April 28, 2008 in Beka | Permalink


Readers -

Check out this Video created by NPs in Colorado State :


Posted by: beka | May 20, 2008 12:01:55 PM

This is just the sort of thing that our state and national NP organizations are working on. Here in MA, our bill to acknowledge NPs as primary care providers is looking good to pass. The goal is to make all health insurance companies list NPs on their panels. We are also working on including NPs in quality measures and using inclusive "provider" language rather than "physician" in all new legislation. We all need to join our organizations and help fight for increased recognition and the ability to do what we are trained to do!

On a personal note, I am a GNP who visits nursing facilities and long for the day when I am allowed to do 100% of the tasks. Medicare insists that a MD complete the history and physical, and sign the initial plan of care. NPs are certainly able to do that, and in many cases, superiorly.

Posted by: Susan Frazier | May 11, 2008 8:00:27 AM

The most recent article I read about the geriatrician shortage mentioned that at $120,000 per year geriatrics is the lowest paid medical specialty yet has the greatest job satisfaction in medicine. Holy Cow! Most NP's make under 100,000 per year, way under. Some physicians in elder care know how to work the system. They use NP's like pack mules to shoulder an unwieldy patient load while the physician pockets the difference between what Medicare pays for billing "incident to" and what the MD's pay the practitioners. The NP's become "Cash cows" for the doctors and the patients love them, but the NP's are frequently overworked and sometimes disrespected by doctors who are threatened by their skills. NP's can and should solve the elder care problem but this system needs to change.

Posted by: Ellen | May 9, 2008 6:13:02 PM

Medicare has failed to teach appropriate documentation for reimbursement. Nurses completing MDSs need to round up rather than down to determine acuity level. The joke is on the facility getting reimbursed and the care providers are getting ripped off in the long term! I somehow think that the baby boomers are better educated. (obviously d/t advanced technology) They have a better understanding of their own health. Regarding beka, I have to say that the wise man built his house upon the rock, the foolish man built his house upon the sand. I understand that the city has been there for a long time, but if one wants to go to the beach put up a cabana for a day, don't build a bizzilion dollar house next to the ocean- like it won't ever storm!

Posted by: T Anderson | May 9, 2008 10:11:15 AM

Thanks for sharing your story - Anna -

It may be possible that there remains a shortage of viable nursing homes in the Louisiana area ever since Katrina? After all, there are still hospitals that have not reopened in New Orleans and people are still living in lead infested FEMA trailers.

3 years out...Post -Hurricane status.


Posted by: beka | May 8, 2008 1:59:06 PM

I work for a large geriatric company and the wonderful thing is that I can follow the patient to the hospital, in the skilled nursing home and back to their private residence. I feel the problem is within the political system, to many ifs, ands, or buts...With the evergrowing healthcare shortage, we the people, need to stand up and shout that NP's, PA's and MD's need more compensation for what we do for the elderly population. That is why there is a world shortage of Geriatricians. Most office visits receive approx 250.00 for a 30-40 minute appointment. We, in long-term care or a clinic setting for elderly receive about 90.00 and because I am a NP I make 80% of that profit for the company that I receive a salary for.


Posted by: Kimberly Farber | May 7, 2008 10:21:34 PM

I am wondering why the patient in Anna's story did not go into a skilled nursing facility as he had a 3 day hospital stay and would have qualified more than likely for Medicare?
These are the times when we need to be the patient advocates and assist the families into the appropriate medical system. As a Geriatric Nurse Practitioner I see these types of families fall through the proverbial cracks in the system. As providers we need to look for the opportunity to gently lead families into the places where they will receive the best care possible for their loved one.

Posted by: Elizabeth Smith | May 6, 2008 9:09:06 PM

Because I have devoted the great majority of my nursing career to the care of the elderly, I can certainly identify with the post.

However, after moving back to Louisiana to help care for my ailing father, I have discovered something more sinister is going on in healthcare, at least in Louisiana.

I call it America's hidden holocaust and it involves the systematic elimination of elderly poor who have life threatening conditions and are simply sent home to die.

I have been working weekends for a home health agency and every weekend another incident like this pops up. It is disturbing to me as a nurse to see the elderly cast aside like this.

This particular gentleman is 70 years old, has abused alcohol and benzodiazepines and tobacco. He was diagnosed with an AAA which is nearly 4 inches across (9 cms). The did a temporary bypass but told his family that his aorta could still rupture at any time and that he would not survive an open surgical repair in his current condition. They also reduced his dose of Xanax, and sent him home with no nicotine patch to deal with nicotine withdrawal.

His family is afraid to leave him alone at home because he shakes and leans so badly when he attempts to walk to the bathroom and Medicare has never paid for 24 hour help at home.

The doctors discharged him to home care. When his family said his abdominal pain was increasing, I called the on-call physician and he said in no uncertain terms that this man was inappropriate for home care. He needed 24 hour skilled nursing care.

His family took him to the ER per the physician's instructions. He was kept in the hospital for three more days and discharged, again to home care.

If these incidents are any indication, what is going to happen to us when we reach our "golden years"?

We treat each other like animals in healthcare today which is why I will only work part-time in Louisiana. Full-time is just too depressing.

Posted by: Anna | May 2, 2008 9:53:16 AM

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