By Daniel Menefee
Maryland must rely more on nurses and non-physician health care providers when the federal Affordable Care Act is fully adopted in 2014, said American Public Health Association President Dr. Melvin Shipp.
Shipp said increasing the reach of non-physician providers will ease the burden of a severe physician shortage when 32 million Americans are added to the health care rolls, 600,000 in Maryland.
“There is going to be a large surge of patients coming through the pipeline,” Shipp told the Senate Education, Health, and Environmental Affairs Committee on Tuesday. Shipp said the states must permit nurses and other “non-physician” health professionals to treat patients in anticipation of a nationwide physician shortage, expected to reach 70,000 by 2015.
Non-physician providers must be allowed to practice “to the level of their education so they can deliver the fullest possible array of services to these new patients,” Shipp said. “If you allow nurses or PAs [physician’s assistants] to practice at the level of their training, you really will improve access.” He said allowing non-physician providers to treat patients will expand the level of preventive care.
Maryland will add 600,000 new patients under the new federal law in 2014, according to the American Public Health Association.
Shipp said expanding the role of non-physician providers will help a sicker Maryland. He said Maryland recently dropped another notch in “America’s Health Rankings,” an annual report by the United Health Foundation, from 21 to 22. He said that obesity in the state has increased 57% during the last decade and has affected 1.2 million Marylanders. Diabetes cases have climbed 45% in the last decade, affecting 411,000 residents.
Sen. Karen Montgomery,D-Montgomery, asked Shipp if lower reimbursement rates contribute to the growing physician shortage.
“We are increasing the number of people covered by insurance under the [Affordable Care] Act and decreasing the number of doctors who are available,” Montgomery said. “Do you have suggestions to deal with the issue?”
Shipp responded that cutting waste and unnecessary costs would be a good first step.
“One of the places you would look is administrative costs. If you can take out some of the bureaucracy and become more efficient within the system, then there would be more resources to compensate the providers,” Shipp said.
Pat Roddy, an attorney who represents non-physician care providers in Maryland, said the state has been one of the most restrictive in permitting providers like podiatrists and optometrists to write prescriptions.
“This often requires unnecessary referrals to physicians who are already over-burdened,” Roddy said.
It would be well to refer to the work conducted by the Hilltop Institute under the direction of the Govenor’s Workforce Investment Board to place this and related workforce issues in the proper context. Maryland’s Ten Year plan, geared especially to the state’s primary care workforce needs was presented and discussed by the major providers, educators and payers at a Statewide meeting in September. Several key points were made, not the least of which is that the state does not have, nor expected to have an overall workforce shortage; it does have and will continue to face a significant shortfall in the distribution of primary care providers including PAs and NPs unless corrective policy and programmatic changes are made.
Health Care Consultant
Past President – Institute for Community Health