3Qs: Expanded health care creates need for empowered professionals

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July 03, 2012

What is the most important outcome of the Supreme Court's ruling that the Affordable Care Act is constitutional?

Cov­erage for health care is the most impor­tant out­come because the ACA is about access to quality health care for every Amer­ican. At Bouvé, we believe this is a basic human right.

Increasing access to health care is also a way to pro­mote cost sav­ings. It has been esti­mated that for every dollar spent in pre­ven­tion, you save $10 in care. If you keep people healthy by, for example, con­trol­ling blood pres­sure and weight, there will be lower expen­di­tures for car­dio­vas­cular dis­ease man­age­ment. In Mass­a­chu­setts, there are now fewer indi­vid­uals going to emer­gency rooms with, for example, with acute chest pain — that has to do with people get­ting pre­ven­tive care before the devel­op­ment of far more serious con­di­tions. We expect to see that trend con­tinue as access to health care expands nationally.

What are some of the big challenges part and parcel of increased access to health care?

A major chal­lenge will be an ade­quate work­force for access. The need for addi­tional primary-​​care providers will come with uni­versal cov­erage: there will not be enough primary-​​care physi­cians to deliver care for the needs of those with new cov­erage. Nurse prac­ti­tioners and physi­cian assis­tants will be an impor­tant work­force devel­op­ment area. At Bouvé, our nurse prac­ti­tioner and our physi­cian assis­tant pro­grams grad­uate excep­tional stu­dents who are ded­i­cated to pri­mary care. There are more than 160,000 NPs and 60,000 PAs in the United States and employ­ment of both groups is expected to increase 30 per­cent from 2010 to 2020, much faster than the average for all occu­pa­tions. As more physi­cians enter spe­cialty areas of med­i­cine, there will be a greater need for gen­er­alist pri­mary health-​​care providers. Other health care pro­fes­sionals — like our phar­ma­cists, phys­ical ther­a­pists, and audi­ol­o­gists, for example — will also need to be empow­ered to improve access to care.

Today, 11 states permit nurse prac­ti­tioners to prac­tice inde­pen­dently, without physi­cian involve­ment, while 27 states require NPs to prac­tice in col­lab­o­ra­tion with an MD. Col­lab­o­ra­tion def­i­n­i­tions vary, but written prac­tice pro­to­cols are often required; 10 states require MD super­vi­sion of NPs. Mass­a­chu­setts is among the states that require col­lab­o­ra­tive agree­ments — if this restric­tion can be lifted (as it was in states such as New Hamp­shire and Maine), there will be more access to pri­mary care. These highly-​​trained pro­fes­sionals should be able to pro­vide key ser­vices, including immu­niza­tions, blood pres­sure mon­i­toring, and pre­scrip­tion mod­i­fi­ca­tion, which might oth­er­wise require a full visit to a pri­mary care doctor. All of these changes save money and, more impor­tantly, are inter­ven­tions that can pre­vent a con­di­tion from becoming much more severe down the road.

How are colleges and universities positioned to help train the next generation of health-care providers and leaders?

Careers in health care are a major growth area for col­leges and uni­ver­si­ties. The Bureau of Labor Sta­tis­tics doc­u­ments the extra­or­di­nary growth antic­i­pated in the health fields. North­eastern has a robust and growing health-​​professions pro­gram; we will con­tinue to pro­vide excel­lent con­tem­po­rary health-​​care edu­ca­tion as well as expand pro­grams of research that can help guide the future. The demo­graphics of the aging Baby Boomer gen­er­a­tion under­score the need for health-​​care reform that ensures access and afford­ability to meet the growing needs of an aging America.

Most impor­tantly, we need to ensure pro­fes­sionals work at the top of their license. With the accel­er­a­tion of sci­en­tific research and knowl­edge gen­er­a­tion, every pro­fes­sional needs to be able to do every­thing he or she was trained for, without unnec­es­sary reg­u­la­tions lim­iting care pro­vi­sion. Accred­iting bodies and state