A Sure Way of Saving Health Care $$$ in Florida

Advanced Registered Nurse Practitioners (ARNPs) have been providing health care to patients since the 1960s. Florida ARNPs, usually abbreviated nurse practitioner (NP), are licensed and nationally certified health care providers who practice in ambulatory, acute, and long term care as primary and/or specialty care providers. In addition to diagnosing and managing acute episodic and chronic illnesses, nurse practitioners emphasize health promotion and disease prevention.

Even with our wide scope of practice capability and many published reports on our potential cost savings to Florida, nurse practitioners have met many legislative barriers to practice.   For over three decades NPs have been working to maximize health care access to Floridians with stagnant progression due to physician and legislative opposition.

Nurse practitioner scope of practice varies state to state. Florida, when compared to other states, is severely limited in areas that directly impact patient care. Florida and Alabama are the only two states in the nation that restrict prescribing authority for nurse practitioners.

Several studies have demonstrated that NPs, when compared to physicians, provide equivalent or superior care to patients. In addition, these documents show that NPs could save the state of Florida millions of dollars if allowed to practice to their full scope of education and certification.

In November 2008, a white paper was published by the Florida Coalition of Advanced Practice Nurses. It outlined an action plan for the state of Florida to address improving access to health care and containing cost by allowing NPs to practice as their education prepared them. Also in 2008, the Florida Senate published the “Interim Report” 2009-117. This report recommended, as 48 other states have, that the Legislature extend authority to NPs to prescribe controlled substances under protocols and within the scope of practice for their specialty.

In 2010, the Office of Program Policy Analysis and Government Accountability (OPPAGA) examined the implications of expanding scope of practice for NPs. OPPAGA’s estimates of potential cost savings from expanding NPs scope of practice in primary care range from $7 million to $44 million annually for Medicaid; $744,000 to $2.2 million for state employee health insurance and $339 million across Florida’s entire health care system. Reports of the Florida Tax Watch Government Cost Savings Task Force for fiscal year 2011 -2012 and 2012-2013 published the same $339 million annual savings and recommended the legislature grant NPs full scope of practice to utilize these cost savings.

The Institute of Medicine (IOM) is an organization comprised of experts to discuss, debate, and examine possible solutions for the multitude of complex health concerns that face the United States and the world. In 2011, the IOM published a report evaluating what roles nurses can assume to address the increasing demand for safe, high quality, and effective health care services. The two year initiative concluded that “nursing brings to the future a steadfast commitment to patient care, improved safety and quality, and better outcomes.” Nurses should practice to the full extent of their education and training, and nurses should be full partners with physicians and other health care professionals, in redesigning health care in the United States.  

The White Paper, published by Florida Coalition of Advanced Practice Nurses, summarizes the facts facing Florida’s health policy makers and residents and includes the following statistics:

• Florida ranks 49th in the nation for practice environment and consumer health care choice.                                                                                                                                    
• All counties in Florida have medically underserved areas.
• Florida exceeds the national average for avoidable hospitalizations for diabetes, asthma, pediatric gastroenteritis, and congestive heart failure.
• Florida has relatively high numbers of low income residents and high numbers of uninsured and underinsured families.
• There are decreasing numbers of family and general medical practitioners, decreasing reimbursement for providers, and cost-prohibitive malpractice insurance.
• There are insufficient numbers of practitioners willing to serve in rural and underserved areas and this shortage results in poor health outcomes.
• Six counties in Florida have extreme levels of poverty and very limited access to health care. These counties are Escambia, Glades, Marion, Okaloosa, Santa Rosa, and Suwannee.
• Almost half (46%) of low-income women are uninsured, which is significantly more than the national average.
• One in four (24%) of all women are uninsured.
• Many Floridians are hospitalized as a consequence of inadequate preventive care. The sequelae of this void in health care include increased costs to state funded and private insurance programs.
• The lack of access to preventive care results in increased costs to all Floridians.

Why is the state of Florida not utilizing its available resources to improve access to care and to provide better overall healthcare to its residents? Why is the State of Florida not utilizing Nurse Practitioners to their full scope of practice which could save the state $339 million dollars annually?

I’M NOT SURE EITHER, ASK YOUR STATE LEGISLATOR. 

Debra A. Friedrich, DNP, ARNP, CLS
FNPN Legislative Vice President