Patients Flock To Nurse Practitioners


 
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By Tamela Baker

When legislation granting nurse practitioners independence to practice without an agreement with physicians went into effect Oct. 1, Christa Martin was ready.

Having worked as a nurse practitioner for local pediatricians, she opened her clinic, South Side Pediatrics, that day.

Within two months, she developed a patient base of "a couple hundred," she said. Many of them knew her from her work with local pediatricians before the law changed.

"Parents like to keep the same provider," she said. "They tend to follow you."

Similarly, on Nov. 7, Hub City Family Practice, staffed by nurse practitioners, opened on Leitersburg Pike, north of Hagerstown.

"We're doing really, really well," said Jeana Moats, one of the partners at Hub City. In only seven weeks, the practice has developed a patient base of 100.

"We've been busier than expected in our first two months," said Karen Dillard, another partner at Hub City.

Use of nurse practitioners and physicians' assistants for primary care is a growing trend. When the bill to release nurse practitioners from the requirement to work with physicians was called for a vote in the General Assembly last spring, only one legislator voted against it.

Perhaps as a sign of the occupation's popularity, Mark Halsey, executive director of the University System of Maryland at Hagerstown, told local lawmakers in December that the center is exploring offering graduate programs for nurse practitioners and physicians' assistants by 2017.

Holistic care at lower costs

Why are patients flocking to these nurse practitioners rather than traditional physicians?

Lower rates and more holistic care, the practitioners said.

"I do pretty much the same thing" as the pediatricians for whom she used to work, said Martin, "only cheaper."

Results for patients treated by nurse practitioners "are the same or better," she added. "We bring nursing to the table. … We've known from the beginning how to treat the whole family."

Moats agreed.

"We look at the whole person," she said. "We're not going to just look at the illness. We're going to look at everything."

Dillard noted that there's a lot of research showing patients treated by nurse practitioners have lower health care costs and fewer visits to emergency rooms. Nurse practitioners usually can spend more time with patients, as well, she said.

Nurse practitioners administer many of the same tests and can prescribe many of the same medicines as physicians. But they refer patients to physicians when patients have an issue outside their scope of practice, Martin said.

"It's very important to know what you don't know," Moats said, and to know when to refer a patient to a physician. But, "we can do over 90 percent of what people go to a primary provider for."

Most nurse practitioners have been nurses for at least 10 years, Martin said. They must complete at least a master's degree and be certified.

While physicians have a higher level of education, Martin said the question is whether having a doctorate is going to add to a patient's care. Martin said doctors haven't said a lot about the new role of nurse practitioners, but "I think there is resentment."

"I didn't leave my last job because I didn't like physicians," Moats said, adding that she maintains relationships with the doctors she worked with before. "It's the process health care has become. It's getting further away from the patient, not closer."

Rates and availability

"We're here to fill a huge gap," Martin said. "There's just not enough providers — especially since the Affordable Care Act."

Doctors are frequently double and triple scheduling because there aren't enough physicians, she said.

And the cost of health care prevents some people from seeing a doctor, Dillard said.

"We're giving people care that really need it," she said. "We reach people that can't afford it. We've helped a lot of people that way."

Martin said insurance companies credential nurse practitioners, although some companies reimburse them at a lower rate. They do get full reimbursement from Medicaid, she said.

Hub City has a different model. It doesn't accept insurance; it's a pay-as-you-go system.

"Our visits are super reasonable," she said, usually costing about $40 to $65. A physical costs about $80.

"We cut out the middle man," she said, making their fees "much more affordable. We found many people couldn't even afford their insurance deductibles or even the co-pays. It's the changing insurance climate."

A telling factor is that more than half of the patients they've seen so far actually have insurance.

But for these practitioners, cutting health care costs isn't the only objective.

"We hope that we can be an asset to the community and find a niche here," Moats said. "Our goal is to maximize the health of our patients."

Martin agreed.

"My goal is to bring back that small-town medicine feel," Martin said. "Everybody knew everybody. I miss that in health care."



 
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