...This is not the first time that organized medicine has taken a stand against NPs taking the helm of the medical home. In March 2011, the AAFP, the AOA, the AAP, and the American College of Physicians released model guidelines
for accrediting medical homes that would prohibit NPs from being in charge. Of 4 organizations that accredit medical homes, only the Accreditation Association for Ambulatory Health Care limits the top spot to physicians.
The controversy over medical home leadership dovetails with the controversy over independent practice for NPs. According to the AAFP report, 22 states and Washington, DC, allow NPs to diagnose and treat disease on their own, although roughly half of them require that a physician supervise prescriptions. The AAFP opposes widening scope-of-practice regulations on NPs, arguing that these clinicians must not work apart from physician oversight.. NP Leader Says Profession Can Coordinate Care
NPs who favor independent practice for their profession have heard all these arguments before, said Marsha Siegel, EdD, an NP in Cheyenne, Wyoming, and a past president of the American College of Nurse Practitioners.
Dr. Siegel told Medscape Medical News
that a primary care NP is not a "full substitute" for a primary care physician, but nevertheless is qualified to direct a medical home. That role emphasizes coordinating care, which an NP can do, whether the patient needs a hand-off to a primary care physician or a specialist. That is already happening in NP-owned practices that employ physicians, she said.
She contested the argument that patient care slips when an NP supplies it. Studies going back to 1996, she said, document that "we have been providing quality of care equal to or better than that of primary care physicians."