NPs at SNFs as a huge element of health reform

[3rdcareerRN]

I just ran across a concept that I'd never considered (I'm an RN, not an NP, but interested in health reform):

UnitedHealth has proposed: "onsite nurse practitioners at skilled nursing facilities to manage illnesses and prevent avoidable hospitalizations." with projected U.S. savings of ~$166 billion [2010-2019 period]"

http://www.unitedhealthgroup.com/hrm/UNH_WorkingPaper1.pdf

This seems like such a good concept at first glance. Obviously the reimbursement elements must be addressed, and some coordination established between the NP and the patients' PMP. But avoiding unnecessary hospitalizations and providing care-in-place seems to make so much sense...and it could be a HUGE opportunity for NPs.

Your thoughts?

(cross posted to LTC forum)

[mwboswell]

I don't think this is a "novel" idea.

There are already NP's and MD's taking "call" for nursing home (NH) "issues".

I think the system improvement as it stands would be just to actually go in and see the patient when the nursing staff calls with an issue or problem....

[traumaRUs, MSN, APRN]

When I was doing clinicals for the geriatric portion of my CNS, I did a week with an FNP at a large (300 bed) county-owned NH. She was excellent: worked full time and just trouble-shooted issues which kept pts out of the ER.

[BarbaraNP]

NPs have been doing this for years. I became a GNP in 1988 (and later FNP) and that was my job for many years. I was hired by facilities to be onsite. The problem was...I could not bill for my services as I was employeed by the facility.

Years later, I was hired into a private LLC group that was owned and operated by a hospital. We...2-3 GNP's and one MD covered 4-5 LTC facilities for most of the providers in the county. We had written agreements with all of them. The MD of our group was the Medical Director in almost all the buildings, and we, the GNP's were in various buildings on a daily basis.

We were able to keep people out of the ER and out of the hospital. And because we were right there (and covered call 24/7) we developed great relationships with the nursing staff, did lots of teach, and helped the facilities increase their quality of care.

What is really needed now, is to allow NPs to be the attendings in these facilities.

BarbaraNP