Growing demand for primary & speciality care…how about a nurse practitioner?

It is estimated that in about 2 years we will be short approximately 29,000 physicians in the United States. By 2020 that number is excepted to grow to somewhere near a deficit of 45,000 physicians. Whether the demand for primary and specialty care comes from the “baby boomers” or from the increase in access to care, now that many more people have access as a result of the Affordable Care Act. The demand for care is not going away and it it is only going to increase as time goes on. Many practices are faced with the challenge of determining how to keep their overhead as low as possible, while still maintaining their current patient panel & attracting future patients as well, and also providing all of their patients with high quality care.  Some experts believe that the deficit of physicians leaves a void that can be filled by medical professionals like nurse practitioners.  A new trend among the health care industry is looking towards nurse practitioners to provide primary care services in collaboration with a physician. This model of care seems to be working because the trend is growing across the U.S. and abroad & nurse practitioners are in very high demand.  http://www.chillicothegazette.com/article/20140208/NEWS01/302080029/Nurse-practitioners-physician-assistants-might-help-address-doctor-shortfall However there appears to be a gap in the current number of physicians and the number of active nurse practitioners and physician assistants. But data also shows that there have been an increase in enrollment in both career fields, which makes many experts hopeful about the future. Yet they are still cautious about what is to come in the next few year  to help with the growing number of people that will be seeking medical care immediately.

Instead of patients having to wait weeks to be seen at a practice that is understaffed or seeking another physician who can see them sooner.  By adding a nurse practitioner to one’s practice; patience are afforded a continuum of care by establishing & maintaining a relationship with a primary care physician and/or a medical home. The primary care physician becomes the nucleus of their health care. . The nurse practitioner typically works in collaboration with the physician to provide care for patients, and ultimately this will improve the patient’s health care, and improve upon overall clinical outcomes.  http://www.dispatch.com/content/stories/editorials/2014/02/04/1-health-care-needs-nurse-practitioners.html Nurse Practitioners can perform just about everything that physicians can do and they can work in a variety of settings pretty autonomously. They can work in inpatient or outpatient settings, diagnosis & treat medical conditions, prescribe medications (depending on the state), perform procedures, and admit patients to the hospital.

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In North Carolina in order for a nurse practitioner to practice they are required to have a collaborative agreement in place with a Primary Supervising Physician, according to the North Carolina Board of Nursing. http://www.ncbon.com/myfiles/downloads/np-rules.pdf Over the past few years here has been some push for states to eliminate the collaborative agreement after nurse practitioners have been practicing for a few years. In some cases the agreement becomes a barrier for those nurse practitioners who want to practice on their own and or who are not at the same practice as their Primary Supervising Physician. And in other cases  some nurse practitioners have been asked to pay high rates as somewhat of a “supervision fee” by their supervising physician.”

Over time it seems that more physicians will become more  open to the idea of working with nurse practitioners. Eventually they will see the value of what they can bring to their practice, while also providing a cost effective alternative to hiring another physician. There seems to be a growing demand in requests to recruit nurse practitioners from a staffing perspective as well. Perhaps with the growing demand for nurse practitioners we will see some changes in the way that they are governed & managed over the next few years- since they are reporting to the state nursing board and the DEA at the federal level.

It’s almost the weekend, hang in there!

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Today’s Blog is dedicated to 2 of our favorite nurse practitioners Mrs. T. Gibson & Ms. T. Starkes- two amazing, overachieving, talented, & intelligent, nurse practitioners that we would let treat us any day! We love you ladies! XOXO

Starving for Assistance Pt. 1

EBT CardOld school food stamps

The past few months have been pretty rough for the North Carolina Department of Health and Human Services. DHHS Secretary Dr. Alonda Wos has faced questioning multiple times regarding the ongoing issues that have plagued the department she oversees. Two major issues that have come to everyone’s attention lately are 1.) NC FAST, the system that processes requests for food stamps and other assistance programs and 2.) NCTracks the Medicaid payment system, which processes payments to healthcare providers who treat Medicaid patients. The food stamps have become a great concern for many around the state, especially because the United Stated Department of Agriculture has set a February 10th deadline for the state to make some significant progress towards resolving the backlogged food stamp and other nutrition assistance program initial & recertification applications. If the state fails to make enough progress to address the backlogged applications the USDA could potentially withhold approximately $88 million in funding; which essentially covers administrative costs associated with running the food stamp program annually. http://www.northcarolinahealthnews.org/2014/01/24/new-usda-letter-shows-food-stamp-program-federal-funds-in-jeopardy/ As DHHS Officials began to review the pending cases they, did report there were numerous cases of duplicate applications, especially for those who had been waiting longer periods of time.

Secretary Wos faced questioning by the NC Legislature regarding the continued delays with the food assistance program, After hearing the new numbers and finding out the true status of things at DHHS, some of the leadership felt they had been mislead about the state of affairs at the department and the food assistance program.  The Secretary was not unable to provide concrete answers that seemed to satisfy anyone, nor did it appear that she was able to boost the morale about the ability to resolve the ongoing issues. Secretary Wos was questioned about everything from personnel decisions to whether or not the new system was actually going to work for the state or not. http://www.wfmynews2.com/news/article/301675/0/Lawmakers-Intervene-In-Statewide-Food-Stamp-Delays

Legally applications should be processed within 30 days. However based on the USDA letter to NC DHHS date January 23, 2014; NC had approximately 19, 974 untimely applications, and another 11,482 recertification applications. Secretary Wos has stated that changes in Medicaid eligibility have effected the department, as well as the implementation of the Affordable Care Act. So to address the backlog of pending applications the State sent about 200 employees to various counties around the state to assist them with things like processing applications, technical, and policy support. Some counties like Cumberland County allowed certain employees to work from home when some county social agencies were shutdown due to inclement weather. Enabling employees to work from home allowed them to continue to chip away at the pending applications. Cumberland County had the second highest number of overdue food stamp applications. The state sent four staff members to help process applications, and two others to assist with policy or technical support. http://www.fayobserver.com/news/local/article_4bf898b5-5e78-533e-bc27-0fc79fce4319.htm Other counties like Wake County; have their staff working overtime, which includes late evenings and some Saturdays. Wake County had the highest number of overdue food stamp applications for the entire state. However it appears that the county has made major progress with processing the applications. They too received assistance from several staff members of the state that were sent to help out with the backlog. http://abclocal.go.com/wtvd/storysection=news/local&id=9416016&rss=rss-wtvd-article-9416016

In the Triad & Northwestern NC Counties local agencies have been very hard at work to resolve pending applications, like other agencies all over the state. The most significant area of improvement for Triad & Northwestern NC Counties is resolving applications that were 120 days overdue- combined the local agencies reduced the number of applications from 204 to nine in the normal processing cycle and also reduced the number from 126 applications to nine in the expedited processing cycle. http://www.journalnow.com/news/local/article_d5735aac-8a9f-11e3-824e-0017a43b2370.html It is clear that the counties are stepping up and doing everything that the possibly can to help resolve the pending applications. When asked individually each county seems confident that they are capable of meeting the USDA deadline.

As of Monday February 3rd there were approximately 7,000 applications that were still pending. It’s not so much that the applications can’t be processed by the 10th. It’s more about can DHHS prevent this from happening again? Should the state be considering other options for a computer system to manage things like the food stamp program? Will there even be funding for a food stamp program after Monday? http://www.wncn.com/story/24623742/dhhs-makes-progress-in-nc-fast-backlog

In an update reported today by WFAE 90.7 in Charlotte, it is reported that unfortunately NC just barely missed the USDA February 10th deadline to clear the entire backlog of food stamp applications by approximately 25. However, the state has until the absolute and final deadline the USDA has imposed to completely resolve the backlog which is March 31, 2014. Secretary Wos stated that counties will continue to maintain the same work schedules that they have been working until the state has satisfied the demands of the USDA. Some county employees have been working long work schedules requiring their day to begin at 5 a.m. and ending at 9 p.m. and almost all counties have their staff working overtime to resolve the backlogged applications. http://wfae.org/post/nc-barely-misses-federal-deadline-resolve-food-stamp-delays

Much gratitude and respect to those who are working diligently around the state to process the backlogged food stamp and nutrition assistance applications.  Hopefully our Secretary of DHHS will find a more concrete solution to resolve the issues with the system that the state has decided it will use to process applications for assistance programs such as food stamps and nutrition assistantce. So that nothing like this happens to the residents of NC again in the future.

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Even in this Economy there is still bad Business

note_desk_paper_237717_l  In the staffing business there really is very little time to get to know your staff or even your clients. I am a firm believer in doing the most thorough background & referece checks on potential staff as possible. And it also seems approrpriate that you would want to do some type of background check with regards to a potential client and/or the facility that you may be providing staffing to. While the prospect of income and building your client base may seem very enticing, every offer to provide your services may not be in the best interest of your business or even your staff. Your business is your brand and the clients and standards that you maintain speak for you, without you having to say a word. Although something may seem like a great idea when you initially hear about it, you always have to consider the long-term impact that working with a particular client could have on your business, your staff, & your brand. (Please don’t misunderstand me, I am not advocating that you use/abuse your clients because of what you think that they can do for you in the long-term.) However, I am advocating for keeping the lines of communications open at all times between your agency & your clients, as well as your agency & your staff.

There is a fine line to walk at all times for the agency. The agency is constantly attempting to keep the clients satisfied, as well as doing the same for the sfaff, & also ensuring that the staff are not being placed in jeopardy, & neither are their professional license.  As the agency you are the biggest advocate that your staff have. There may be times when you have to respectfully decline to provide services to a client, even after you have signed on to provide them services. There are going to be occassions where things are not always the way they seemed. The best thing you can do is try to end the business relationship respectfully within the guidelines of your contract and on “good terms.” (Good terms= no outstanding invoices, no bounced checks, no yelling matching, or name calling,…)

Despite the desre to always want to please your client, there are some situations where you have no choice and you are unable to do that. When it comes down to questionable judgement or lack of policies/protocols that could potentially lead to staff jeopardizing their professional license or certification- there is no choice, you defend your staff. It would be irriesponsible for an agency to not take some type of action to at least investigate the concerns of their staff and/or remove their staff from that type of environment. Some people say that is the beauty of staffing agencies, clients (in some cases agencies) don’t really have to worry about long-term committments.

Ultimately it is easier to get out of a poor environment before it becomes a serious problem that really can’t be resolved or fixed with a 30 day notice to discontinue providing services

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