Interesting commentary in a Fierce Practice Management editorial post on Sept. 19. Debra Beaulieu writes about the rise of nurse practitioners (NPs) and physicians assistants (PAs) practicing independently, and the pretty virulent reaction of primary care physicians to this trend.
We’ve devoted ourselves at Hello Health to promoting a vibrant future for primary care physicians. But, all of us involved in the primary care sector have to pay attention to the reasons for the rise of the independent NP and PA and the retail clinic. And all of us have to be doubly conscious of consumer, as opposed to legislation-driven shifts in the marketplace.
The debates around health care reform and technology adoptions have been extraordinarily insular. As Dave Chase (follow him on Twitter at @chasedave) pointedly noted in his Forbes health care blog,
“…in reality, the fundamental design point of the vast majority of EMR and HealthIT systems is the patient is merely a vessel for billing codes.”
It reminds me of the comment a bank president once made.
“One of our major challenges is that we tend to regard the customer as a necessary inconvenience.”
Yet, to the consternation of many on the provider side, consumerism is finally flexing its muscles in health care, and one aspect of this is the NP or PA providing primary care. Anyone who is a student of service, retail or consumer product businesses knows what the consumer wants – transparency, the ability to make intelligent choices, value for money, respect for their intelligence. A marvelous book titled “Demand: Creating What People Love Before They Know They Want It”, written by Adrian Slywotzky and Karl Weber in 2011, is worth reading by anyone looking to better engage the health care consumer. One of its key concepts is the “hassle map,” a construct an innovator will make of the hassles customers face in an existing market that can serve as a map for reinventing the experience and attracting those who felt they had no choice before. Think of Amazon or Zip Car.
Or Minute Clinic.
Almost half of all states allow retail clinics staffed by nurse practitioners, addressing common issues such as cuts, flu, blood or cholesterol tests, a child’s ear ache and more. According to a recent Harris Interactive poll, over half interviewed suggested they’d use (and by definition trust) a retail clinic staffed by an NP for such everyday health issues. They like the easy access, the reasonable price (whether cash or co-pay) and the customer-focused service experience, things they don’t see at their physician’s practice.
Legislating to prevent NPs and PAs from practicing independently is no strategy. Remember import quotas for automobiles? The Japanese responded by upping the value of their cars, and consumers voted with their feet. It ultimately forced all carmakers to increase the quality of products and service to thrive. Imagine the same evolution of retail clinics under similar constraints.
Another strategy for a primary care practice would be to co-opt retail clinics and NPs in their area, allowing the physician to address the more serious challenges while simply managing the simple day-to-day patient issues dealt with through the NP. An extension of this is the hiring of nurses as case managers in practices developing Accountable Care Organization (ACO) initiatives. That’s not a path for everyone. — in particular the smaller, independent practice — and as a doctor in Beaulieu’s article asked, “Is my future to be the overseer of midlevels and ultimately lose the opportunity to provide direct patient care? I did not go to medical school to be an administrator.”
We tend to agree. Physicians want the hands-on involvement and relationships. A third strategy is to adopt the enabling technologies and new revenue models that not only streamline a practice but also directly address the consumer’s hassle map of practice. The physician must use these tools to make the practice the easiest, most convenient and engaging option for consumers (formerly known as the patients) or they will go elsewhere. And that elsewhere includes nurse practitioners and physician assistants.