How will Health care reform affect me as nurse practitioner?

mammac5 · Mar 24, 2010

I'm with you! I am currently an MSN student working toward Adult NP certification and getting nervous. Part of the problem seems to be that the bill was never posted (as President Obama promised when campaigning to post all bills that came across his desk for 5 days on the internet so they American people could view them prior to his signing) and none of us really knows what's in there. I'll wager that many who voted on the bill do not know what's in it!

Unbelievable.

I can only imagine, after years of working in physician practice mgmt, that once the Federal Gov't gets involved there will be LOADS of government jobs created (paid for with our tax dollars) to administer and police the program(s). If the reimbursement follows Medicare (which I heard from a more-or-less reliable source that it will) there will be massive cuts to both outpatient and inpatient reimbursements. I also heard that cuts are coming to home health care reimbursements for nursing supplies and services.

It remains to be seen how this will affect us all. Sounds like the tax increases will begin in the next year and "benefits" will be phased in over the next three years. I'm wondering if school right now was a wise choice...

elkpark · Mar 24, 2010

Part of the problem seems to be that the bill was never posted (as President Obama promised when campaigning to post all bills that came across his desk for 5 days on the internet so they American people could view them prior to his signing) and none of us really knows what's in there.

If people don't know what's in the bill, it's because they didn't want to find out. The various proposed bills were posted on the House and Senate websites for a long time, and the final bill that the House just voted on (the final version that the Senate passed) was posted on the House website for 72 hours before the House voted -- that's why the actually vote didn't take place until Sunday evening (to wait the 72 hours from when the bill was posted so anyone interested could read it).

cruisin_woodward · Mar 24, 2010

Thank you for that information. Honestly, this has been a very confusing subject to me. This has nothing to do with Dem vs Rep...not to me any way! I think I have avoided educating myself on the subject bc of sheer frustration of feeling stupid. Now however, I am tired of being told one thing, then the next minute being told that it is not true... I think I understand the whole what it will do for/to the consumer, but I am wondering how it will affect the health care PROVIDER I guess maybe Canadian nurses could help me understand what it means from where they are?

elkpark · Mar 24, 2010

I think I understand the whole what it will do for/to the consumer, but I am wondering how it will affect the health care PROVIDER I guess maybe Canadian nurses could help me understand what it means from where they are?

I don't think anyone really knows yet how it will affect providers. I don't see how Canadian nurses would have much to offer, since the bill just signed into law bears no resemblance whatsoever to the Canadian healthcare system (we should be so lucky ...)

wowza · Mar 24, 2010

Unless the medicare fix gets passed anytime soon, expect salaries for all health care workers to decrease.

Even then, the bill is unsustainable, despite what congress says. Eventually they will cave and drop reimbursement because of political pressure. In this bill they have made no important steps to curb costs and have created things that will actually increase costs for the federal gov't.

middleageNP · Mar 24, 2010

The country needed serious health care reform. Though I'm not sure this bill will solve anything other than allow health care to an additional 32 millions (necessary IMO), but at what cost? Biggest beneficiaries to this bill are insurance & pharmaceuticals companies, whom I'm sure assisted in writing the bill. Frankly, I'm disgusted that there is no mention of insurance premiums cap. This bill clearly does not improve our tremendous problem in health care cost. Though I think it will benefit primary care practitioners initiall (increased demands) , the long term financial benefits for this area of practice is not certain.

Trauma Columnist · Mar 24, 2010

I take care of nephrology pts who have end stage renal disease on dialysis. As this is one of the DRGs that doesn't have the age requirement on it, all my pts are on medicare.

The one thing that I know is supposed to happen is that all medicare recipients will receive a $250 credit per year for the "doughnut hole" - that time when the pts have no medication coverage. Well, since the doughnut hole out of pocket expenses are approx $2500, this is only a drop in the bucket.

Sensipar - approx $400/month cash price

Rocaltrol - approx $150/month cash price

Renvela - approx $700/month cash price

These are all common meds for dialysis pts.

prairienp · Mar 24, 2010

unless the medicare fix gets passed anytime soon, expect salaries for all health care workers to decrease.
even then, the bill is unsustainable, despite what congress says. eventually they will cave and drop reimbursement because of political pressure. in this bill they have made no important steps to curb costs and have created things that will actually increase costs for the federal gov't.

i am quite optimistic for nps and np practice. i see a significant increase in the need for nps in primary care. a welcome change in the approach to prevention and wellness exams versus the "sick" model we currently practice under. with the increase demand for nps in primary care i anticipate a salary increase, nothing dramatic, but an increase. i also agree costs will go up for the federal government in some areas, but decrease in other areas. most importantly to me as a np is that all children will be covered, maybe not on a premium plan, but at least some coverage. my rural patients at least have a reasonable choice now for health insurance.

middleageNP · Mar 24, 2010

Isn't the "donut hole" an effect by Bush's medical drug coverage plan?

And $250 may be a drop in a bucket, but it is still better than 0. Think positive.:)

The bill is not a perfect bill, but it addressed many needed reforms.

I have a son who suffers from a chronic illness through no fault of his. He would never be covered under pre-existing conditions. I am ecstatic that the profiteering clause has been removed by law... Let's focus on what the main objective of health care is... preventive care & heal the sick.

wowza · Mar 24, 2010

i am quite optimistic for nps and np practice. i see a significant increase in the need for nps in primary care. a welcome change in the approach to prevention and wellness exams versus the "sick" model we currently practice under. with the increase demand for nps in primary care i anticipate a salary increase, nothing dramatic, but an increase. i also agree costs will go up for the federal government in some areas, but decrease in other areas. most importantly to me as a np is that all children will be covered, maybe not on a premium plan, but at least some coverage. my rural patients at least have a reasonable choice now for health insurance.

while i completely agree that we will need many more nps in primary care (as well as doctors, rns etc), i fail to see how this bill does anything to shift the paradigm from a "sick" approach to a "prevention approach." it made literally no new steps in this direction, it just gave 30 million more access.

in terms of salary increases, i doubt it. as it stands now the medical model is not lead by market forces, but rather by the whims of the politicians as they set medicare rates (and insurance follows suit). as nps get more independence, they too will feel the yolk of the gov't and the control of their salaries.

don't believe me? well, there is a tremendous demand for primary care physicians yet their salaries continue to plummet despite working longer hours and having more hastles to deal with along the way. expect the same trend to continue for them and also for nps.

prairienp · Mar 24, 2010

while i completely agree that we will need many more nps in primary care (as well as doctors, rns etc), i fail to see how this bill does anything to shift the paradigm from a "sick" approach to a "prevention approach." it made literally no new steps in this direction, it just gave 30 million more access.
in terms of salary increases, i doubt it. as it stands now the medical model is not lead by market forces, but rather by the whims of the politicians as they set medicare rates (and insurance follows suit). as nps get more independence, they too will feel the yolk of the gov't and the control of their salaries.
don't believe me? well, there is a tremendous demand for primary care physicians yet their salaries continue to plummet despite working longer hours and having more hastles to deal with along the way. expect the same trend to continue for them and also for nps.

simply having insurance will allow access, at least for many of my patients. i have a large cohort who typically are seen when they are so ill i need to send to the hospital. call me optimistic, i hope i see them for a well check and catch them before they need acute care. maybe i catch a few hypertensive patients before they have a stroke/ami. i fully believe my costs are a whole lot lower than the visit to the ed under our current system.

in fact, i agree, the medical model (sick) may not change. i am hoping the healthcare model, using health promotion (and those theories) will result in a healthier population, thus decreased costs and increased rewards for those who preach health promotion. maybe primary care providers will see an increased salary for contributing to a healthier population.