Nurse Practitioners in the New World of Health Care | Steve Adubato | Caucus NJ


HI, I’M TOM MARINO. AT COHN REZNICK WE BELIEVE THAT ALL CITIZENS NEED TO BE INFORMED ABOUT THE ISSUES THAT AFFECT THEIR DAILY LIVES. THAT’S WHY WE’RE PROUD TO SUPPORT THE PROGRAMMING PRODUCED BY CAUCUS EDUCATIONAL CORPORATION AND THEIR PARTNERS IN PUBLIC TELEVISION.>>NURSE PRACTITIONERS IN THE NEW WORLD OF HEALTH CARE NEXT ON CAUCUS NEW JERSEY.>>FUNDING FOR THIS EDITION OF CAUCUS NEW JERSEY HAS BEEN PROVIDED BY HOLY NAME MEDICAL CENTER IN TEANECK NEW JERSEY, HEALING BEGINS HERE NEW JERSEY MANUFACTURERS INSURANCE GROUP. AUTO INSURANCE, HOME OWNERS INSURANCE AND BANKING UNDER THE PRINCIPLE OF STEWARDSHIP WELLS FARGO THE LAW FIRM OF GIBBONS PC JOHNSON AND JOHNSON AND BY NEW JERSEY NATURAL GAS PROUD TO SUPPORT EDUCATION IN OUR COMMUNITIES PROMOTIONAL SUPPORT PROVIDED BY NJBIZ ALL BUSINESS ALL NEW JERSEY THE STAR LEDGER AND NJ.COM EVERYTHING JERSEY AND BY NEW JERSEY MONTHLY THE MAGAZINE OF THE GARDEN STATE. AVAILABLE AT NEWS STANDS. (MUSIC) WELCOME TO CAUCUS NEW JERSEY I’M STEVE ADUBATO. NOW THE AFFORDABLE CARE ACT WILL BE SET INTO MOTION IN JANUARY 2014. NURSE PRACTITIONERS ARE EXPECTED TO MAKE A HUGE IMPACT ON THIS NEW WORLD OF HEALTH CARE. HERE IN THE STUDIO TO DISCUSS THIS CHANGING LANDSCAPE WE HAVE DOCTOR KATHLEEN SCURA WHO IS ASSOCIATE PROFESSOR OF NURSING AT FAIRLEIGH DICKINSON UNIVERSITY DOCTOR JUDITH KUTZLEB WHO IS VICE PRESIDENT OF ADVANCED PRACTICE PROFESSIONALS AT HOLY NAME MEDICAL CENTER DOCTOR PATRICK BEATY CHIEF MEDICAL OFFICER OF THE METROPOLITAN FAMILY HEALTH NETWORK IN JERSEY CITY AND FINALLY DENIS TARRA CEO OF MANHATTAN HOUSE CALLS. THANK YOU ALL FOR JOINING US VERY MUCH. THE CHANGING FACE OF HEALTH CARE WE’RE DOING THIS PROGRAM IN THE FALL OF 2013 THE WORLDS GOING TO CHANGE IN 2014. NURSE PRACTITIONERS THEY’VE ALWAYS BEEN IMPORTANT ARE THEY GOING TO BECOME THAT MUCH MORE IMPORTANT WITH THIS NEW LAW?>>YES>>DESCRIBE IT BY THE WAY WHAT IS A NURSE PRACTITIONER?>>A NURSE PRACTITIONER IS AN ACADEMICALLY PREPARED WITH A MASTERS OF SCIENCE IN NURSING DEGREE WHO HAS ADVANCED SKILLS IN ASSESSMENT, ABLE TO DIAGNOSE, THEY HAVE THE UNDERLYING ADVANCED (UNINTEL) PHYSIOLOGY AND THEY KNOW THE DISEASE PROCESS MANAGEMENT SO THEY CAN TREAT THEY CAN MANAGE THEY CAN ASSESS THEY CAN DIAGNOSE. IT’S KIND OF VERY IT’S A BIG WORLD OF ACRONYMS NURSE PRACTITIONER, ADVANCED PRACTICE NURSE THEY’RE ONE IN THE SAME>>ARE THEY?>>PRETTY MUCH HERE IN NEW JERSEY THEY ARE>>BUT THEIR GOING TO BE MORE IMPORTANT AFTER THE NEW LAW IS PUT INTO AFFECT.>>BECAUSE WE’RE AUTONOMOUS. WE’RE AUTONOMOUS PRACTITIONERS WHO HAVE OUR OWN LICENSE OUR OWN D.E.A….>>D.E.A?>>YES FOR CONTROLLED DRUGS…>>WHAT ARE YOU JUST SPRINGING MORE ACRONYMS THAT WE DON’T UNDERSTAND?>>SORRY…D.E.A. WE HAVE OUR OWN LICENSES TO PRESCRIBE SO WE ARE AUTONOMOUS PRACTITIONERS ABLE TO PROVIDE PRIMARY CARE.>>GOT IT. TALK ABOUT THIS TALK ABOUT YOUR ORGANIZATION DOCTOR.>>WELL I WORK FOR A COMMUNITY HEALTH CENTER A FEDERALLY QUALIFIED HEALTH CENTER IN JERSEY CITY. WE TREAT VERY UNDER INSURED, VERY UNINSURED PATIENTS…>>SORRY FOR INTERRUPTING YOU. ARE NURSE PRACTITIONERS A KEY PART OF IT AN INTEGRAL PART OF YOUR OPERATION?>>YES. THE REASON BEING IS I THINK ONE OF THE THINGS THAT WE RECOGNIZED EARLY ON IS THERE IS A DECLINE IN THE NUMBER OF PRIMARY CARE PROVIDERS COMING OUT OF MEDICAL SCHOOL…>>WE DON’T HAVE ENOUGH PRIMARY CARE PHYSICIANS.>>ABSOLUTELY>>GOT IT>>AND THE NUMBER.. THE PROSPECTS OF MORE COMING OUT ARE…>>NOT GOING TO GET BETTER>>NO NOT BETTER>>SO AS WE CONTINUE TO STRUGGLE TO HAVE THE NUMBER OF PRIMARY CARE PHYSICIANS THAT WE NEED AND IT’S NOT GOING TO CHANGE ANYTIME SOON PROBABLY GET WORSE THE NEED FOR NURSE PRACTITIONERS WITH THE SKILL SET BECOMES GREATER.>>ABSOLUTELY. WHAT HAPPENS IS THE PRIMARY CARE PHYSICIANS THAT ARE IN PRACTICE RIGHT NOW ARE OVERWHELMED TO SAY THE LEAST. AND THIS NEW AFFORDABLE CARE ACT WILL OVERWHELM THEM EVEN FURTHER…>>BY THE WAY IT’S KNOWN AS OBAMA CARE JUMP IN AND JUMP IN GO… DESCRIBE YOUR ORGANIZATION BY THE WAY..>>SURE I RUN MANHATTAN HOUSE CALL ESSENTIALLY…>>YOU ACTUALLY MAKE HOUSE CALLS?>>I DO I DO>>COME ON>>WE MADE 30,000 OVER THE LAST 12 YEARS SINCE 2001 IT’S SOMETHING THAT I STARTED BACK IN 2001. WE STRIVE TO CREATE THE MEDICAL OFFICE IN THE HOUSE. YOU KNOW THE IDEA OF BRICKS AND MORTAR IS BECOMING MORE AND MORE HARD OR HARDER TO MAINTAIN. THE IDEA OF BEING ABLE TO PAY A MORTGAGE, A SECRETARY PAY THIS, PAY THAT BECOMES HARDER AND HARDER WHEREAS THE HIGHEST NEED PATIENTS ARE RIGHT THERE IN THEIR HOMES UNABLE TO ACCESS CARE. AND WE’VE MET THAT NEED SINCE 2002..>>(UNINTEL) US BACK TO NURSE PRACTITIONERS ARE A KEY PART OF THAT>>IT’S THE ONLY PART IN A SENSE. LET ME BACK UP THERE.>>GO AHEAD>>IT’S MY SELF (UNINTEL) HISTORY OF THE NURSE PRACTITIONER WE PROVIDE PRIMARY CARE IN THE HOUSE BUT WE DO HAVE HOME VISITING ORTHOPEDISTS, HOME VISITING DENTISTS, HOME VISITING PODIATRISTS, HOME VISITING GASTROENTEROLOGIST THE AMOUNT OF TECHNOLOGY IN THE HOME TODAY ALLOWS US TO DO X-RAYS, EKG’S, ULTRA SOUNDS ALL RIGHT AT THE BED SIDE. AND WHEN YOU LOOK IN THE EMERGENCY ROOM TODAY THE MODERN EMERGENCY ROOM 50 PERCENT OF THOSE PEOPLE DON’T NEED TO BE THERE HAD THEY BEEN SEEN A WEEK EARLIER. AND THE HIGHEST COST MEDICARE POPULATION WHICH IS WHO I TAKE CARE OF LARGELY ELDERLY PATIENTS WIND UP IN THE HOSPITAL MAINLY BECAUSE THEY HAD NO ACCESS TO CARE PRIOR TO WHEN IT HIT THE FAN.>>QUESTION IF SOMEONE IS SEEN BY A NURSE PRACTITIONER BECAUSE SAY THERE AREN’T ENOUGH PRIMARY CARE PHYSICIANS RIGHT, SOMEONE IS SEEN BY A NURSE PRACTITIONER AND THEY POTENTIALLY AVOID GOING TO THE EMERGENCY ROOM ARE WE SAVING MONEY AS A SOCIETY BECAUSE THE HEALTH CARE COSTS GO DOWN?>>THERE’S MORE TO TAKING CARE OF HEALTHCARE THAN JUST SICK PEOPLE. WE WANT TO PREVENT PEOPLE FROM GETTING SICK. WE WANT TO MAINTAIN THEM AT THEIR HIGHEST LEVEL AND THAT’S SOMETHING THAT WE THREAD THROUGH OUR ACADEMIC PROGRAM FOR NURSE PRACTITIONERS SO THAT THEY ARE VERY SKILLED AT TALKING ABOUT DIET WHICH IS VERY IMPORTANT IN MAINTAINING HEALTH. THEY’RE VERY SKILLFUL AT TALKING ABOUT HOW THEY FIT INTO THE PERSONS VALUE SYSTEM IF THEY HAVE A CULTURAL ISSUE THAT THEY’RE DEALING WITH THEY TRY TO WORK WITH THEM NOT JUST TO GIVE THEM A PRESCRIPTION AND SEND THEM OFF NOT KNOWING WHAT HAPPENS SO THAT THAT APPROACH TO DEALING WITH HEALTHCARE HELPS THE NURSE PRACTITIONER TO DO THINGS MORE THAN JUST DIAGNOSE A DISEASE AND TREAT A DISEASE THEY’RE LOOKING AT…>>IT’S MORE COMPLEX..>>THE PERSON AND THEY’RE LOOKING AT WHERE THEY COME FROM AND WHERE THEY’RE GOING TO GO TO AND HOW CAN WE BEST KEEP THEM HEALTHY.>>FOLLOW UP GO AHEAD>>I ALSO THINK THAT WE (UNINTEL) THE CARE. I MEAN WE’RE GREAT EDUCATORS WE’RE MENTORS. WE ENGAGE THE PATIENT IN SELF MANAGING DISEASE AND THAT IS AN IMPORTANT ASPECT IN HEALTH MAINTENANCE AND DISEASE PREVENTION OR PROGRESSION OF AN ALREADY ESTABLISHED DISEASE.>>STAY ON THIS FOR A SECOND. THE PATIENT EXPERIENCE, AND THIS IS IN NO WAY INTENDED TO BE CRITICAL OF PHYSICIANS AT ALL, BUT IS IT DIFFERENT IN ANY DISCERNIBLE WAY…THE QUALITY OF CARE AND THE INTERACTION….WELL THOSE ARE TWO DIFFERENT THINGS… IS THE INTERACTION SLASH THE TIME SPENT WITH A PATIENT ANY DIFFERENT WITH A NURSE PRACTITIONER VERSES A DOCTOR?>>YES WE SPEND MORE TIME WITH THE PATIENT. THAT’S A DOCUMENTED YOU KNOW RESEARCHED FACT.>>IS THERE ANY DIRECT CORRELATION BETWEEN THE AMOUNT OF TIME SPENT WITH A PATIENT AND PATIENT OUTCOMES?>>I CAN ANSWER THAT… THERE IS RESEARCH THAT SAYS THAT WHEN YOU DO HEAD TO HEAD RESEARCH OF PHYSICIANS TAKING CARE OF PATIENTS OR A NURSE PRACTITIONER THAT WE GET THE PATIENTS COMPLIANCE INCREASED BOTH ON THEIR MEDICATION…>>COMPLIANCE?>>WITH MEDICATIONS THAT YOU EXPECT THEM TO BE ON. THAT WE ARE ABLE TO GET THEM TO MANAGE THEIR DIET BETTER. IF THEIR DIABETIC WE CAN KEEP THEIR BLOOD SUGAR BETTER UNDER CONTROL. NOW THOSE ARE HEAD TO HEAD MEASUREMENTS WHERE THEY’VE LOOKED AT LARGE NUMBERS OF PATIENTS WHO ARE SEEN BY NURSE PRACTITIONERS AND PHYSICIANS AND THAT’S DOCUMENTED IN THE LITERATURE THAT HOWEVER YOU WANT TO SAY THE REASON THAT’S THE OUTCOME.>>BUT THERE ARE SO MANY COMPLEX REASONS FOR THAT.>>IT’S HARD TO QUANTIFY>>WHY IS IT HARD TO QUANTIFY?>>YOU CAN ONLY QUANTIFY EMOTION AND EXPERIENCE SO MUCH. YOU KNOW IT’S SORT OF LIKE TRYING TO DIAGNOSE DEPRESSION. IF YOU HAVE BLOOD PRESSURE HERE’S THE NUMBER, HERE’S THE PILL IT COMES DOWN. BLOOD SUGAR, HERE’S THE BLOOD SUGAR, HERE’S THE PILL IT COMES DOWN. I’M DEPRESSED…WELL HOW DO WE QUANTIFY THAT AND THERE ARE MEASUREMENT TOOLS. THE SAME THING WITH THE PATIENT EXPERIENCE. IT’S VERY VERY HARD TO QUANTIFY. WE DO GO BY OUTCOMES DATA, WE DO USE DIFFERENT SCALES, DIFFERENT QUANTIFIABLE SCALES FOR PATIENT COMPLIANCE, FOR PATIENT HAPPINESS WITH THEIR PROVIDER BUT IT’S VERY DIFFICULT TO QUANTIFY THOSE NUMBERS IN A SENSE.>>BUT A NURSE PRACTITIONER DOES OR DOES NOT…THIS IS A QUESTION THAT KEEPS FLOATING AROUND IN MY HEAD AS WE PREPARED FOR THIS SHOW… DOES A NURSE PRACTITIONER I’M GOING TO USE THE WORD REPLACE A PHYSICIAN OR NOT… DOES HE OR SHE REPLACE THE PHYSICIAN OR COMPLEMENT THE PHYSICIAN GO AHEAD…>>I THINK THE WORD COMPLEMENT IS A BETTER WORD. I MEAN ONE OF THE BIG CONCEPTS CURRENTLY GOING ON RIGHT NOW SOMETHING CALLED PATIENT CENTERED MEDICAL HOME..>>PATIENT CENTERED MEDICAL HOME..GO AHEAD>>WHERE A PATIENT COMES INTO A PRACTICE THEY HAVE A PROVIDER AND THEY HAVE ALL THIS OTHER SUPPORTING PEOPLE. A LOT OF TIMES WHAT HAPPENS IS THE OTHER SUPPORTING PERSON TO THE DOCTOR IS THE NURSE PRACTITIONER. THE NURSE PRACTITIONER SOMETIMES CAN BE THE LEADER OF THAT PARTICULAR TEAM. WHAT HAPPENS IS THE PATIENT EXPERIENCE IMPROVES AND YOU HAVE MORE THAN ONE SET OF HANDS ON THE PATIENT. THE NURSE PRACTITIONER WILL PROVIDE MORE EDUCATION YOU KNOW BECOME MORE RESPONSIVE TO THE PATIENTS NEEDS WHERE AS THE DOCTOR WILL SPEND MORE TIME PROBABLY WITH THE MORE DIFFICULT PATIENTS, PATIENTS WHO REQUIRE A LOT OF YOU KNOW HANDS ON…I CALL IT SPEND A LOT OF TIME WITH TYPES OF THINGS. THERE’S CERTAIN THINGS THAT DOCTORS I BELIEVE IN THE SYSTEM PROBABLY ARE MORE OF AN EXPERT…PROBABLY SHOULD BE THE PERSON DISCUSSING THESE THINGS LIKE END OF CARE DECISIONS SHOULD…>>END OF CARE YOU MEAN END OF LIFE…>>END OF LIFE NOT END OF CARE…>>GO AHEAD>>BUT END OF LIFE DECISIONS A LOT OF TIMES I THINK DOCTORS BY THEIR EXPERIENCE YOU KNOW THE NUMBER OF PATIENTS YOU KNOW KNOWING FOR EXAMPLE I’VE TAKEN CARE OF A PATIENT FOR 13 YEARS AND I KNOW SOMETIME IN THE NEAR FUTURE THEY’RE NO LONGER GOING TO BE AROUND. YOU NEED TO HAVE THIS DISCUSSION WITH THE FAMILY, YOU NEED TO HAVE THIS DISCUSSION WITH THE PATIENT WHAT TYPES OF THINGS DO YOU WANT TO DO. RECENTLY THE STATE OF NEW JERSEY HAVE THIS FORM THAT PATIENTS HAVE TO COMPLETE…FOR YOUR DOCTOR CAN COMPLETE… TO WHAT DO YOU WANT DONE. YOU KNOW, DO YOU WANT TO BE RESUSCITATED. DO YOU….>>SORRY TO INTERRUPT YOU BUT I WANT TO BE CLEAR. ONLY THE PHYSICIAN CAN DO THAT, NOT THE NURSE PRACTITIONER?>>I THINK THE NURSE PRACTITIONER CAN START THE DISCUSSION BUT I THINK ULTIMATELY THE PHYSICIAN IS THE PERSON THAT HAS TO ANSWER A LOT OF THE QUESTIONS.>>WELL HERE’S WHAT I’M GETTING TO AND YOU RAISED A VERY GOOD POINT DOCTOR, I WANT TO UNDERSTAND RIGHT NOW AS WE DO THIS PROGRAM AS WE APPROACH AS WE’RE DOING THIS IN THE BEGINNING OF LATE SEPTEMBER EARLY OCTOBER 2013 IT WILL BE SEEN AFTER THAT AND PROBABLY REPEAT AFTER THAT. AS WE DO THE PROGRAM RIGHT NOW WHAT ARE NURSE PRACTITIONERS LEGALLY ABLE TO DO IN THE STATE OF NEW JERSEY AND WHAT WILL THEY BE LEGALLY ABLE TO DO AFTER THE AFFORDABLE CARE ACT IS IMPLEMENTED AND IS THAT DIFFERENT?>>WE CAN PRESCRIBE…>>NOW>>WE CAN PRESCRIBE…>>PRESCRIBE MEDICATION..>>PRESCRIBE MEDICATION AND NARCOTICS. CONTROLLED DRUGS…>>AND NARCOTICS…>>YES>>GO AHEAD>>WE CAN ORDER…>>TRANSLATE>>WE CAN ORDER TESTING, WE CAN ORDER LAB WORK, WE CAN ORDER CONSULTATIONS, WE CAN DO REFERRALS, WE CAN ORDER AND REVIEW DIAGNOSTIC TESTING, WE CAN ADMIT, WE CAN DISCHARGE, WE CAN DO THE ENTIRE ADMISSION PROCESS…>>LET’S GO THE OTHER WAY WHAT CAN’T YOU DO?>>WHAT WE CAN NOT DO…>>CAUSE THAT’S A LONG LIST>>WE CAN NOT DO IN THE STATE OF NEW JERSEY…>>YOU CAN’T OPERATE…>>OH WE CAN ASSIST. WE CAN GET A LICENSE TO DO A FIRST ASSIST, BUT THE THING IS WE CAN NOT ORDER HOME CARE FOR HOME CARE NURSING SERVICES FOR A PATIENT THAT WE’VE BEEN FOLLOWING WHO WE KNOW NOW WOULD BENEFIT FROM HOME CARE VISITS. WE CAN NOT DO THAT, WE CAN NOT ORDER DURABLE MEDICAL EQUIPMENT SO I COULD NOT ORDER YOU KNOW PULMONARY EQUIPMENT, OXYGEN, OXYGEN TANKS, WHEEL CHAIRS AND CANES…>>WHY NOT?>>BECAUSE THAT WILL… MEDICARE, MEDICAID WILL NOT ACCEPT THAT ORDER…>>LOGICALLY WHY CAN’T YOU?>>THERE IS NO LOGICAL REASON WHY WE CAN’T.>>TO GIVE YOU AN EXAMPLE…>>IT’S LEGAL…>>I UNDERSTAND, MY QUESTION IS SHOULD YOU BE ABLE TO?>>YES BECAUSE…>>SHOULD THEY BE ABLE TO?>>YES SHOULD THEY BE ABLE TO?>>OF COURSE>>OF COURSE SHOULD THEY BE ABLE TO?>>I THINK SO… IT DEPENDS ON THE EQUIPMENT. LIKE I SAID FOR EXAMPLE IF SOMEONE HAS A BI-PACK(SP) MACHINE THERE THAT’S SLEEP APNEA I THINK IT PROBABLE IS THE DOCTOR…>>LET ME ASK YOU THIS IF WE HAD THE PRESIDENT OF THE MEDICAL SOCIETY RIGHT HERE RIGHT NOW WOULD THAT REPRESENTATIVE SAY “ABSOLUTELY”?>>NO>>NO>>NO>>WOULD NOT?>>THEY WOULD NOT SAY ABSOLUTELY…>>BECAUSE?>>I BELIEVE BECAUSE OF THE FACT OF THEIR FEAR OF A PIECE BEING USURPED FROM THEIR CONTROL AND THEIR ABILITY TO OVER SEE AND MANAGE THE PATIENT, AND I DO RESPECT THAT.>>WHAT ABOUT IF THEY JUST HAVE A DIFFERENCE OF OPINION THAT THEY TRULY BELIEVE THAT THE PHYSICIAN MUST BE …I USE THIS WORD A LOT THE QUARTER BACK OF THAT SITUATION THE LEADER WHO MAKES THAT DECISION AND THEN THAT DECISION CAN NOT BE RELEGATED TO A NURSE PRACTITIONER.>>WELL FIRST OF ALL YOU’RE TALKING ABOUT A TEAM.>>GOT IT.>>THE PATIENT SHOULD BE THE HEAD OF THE TEAM..>>THE QUARTERBACK..THE PATIENT CAN’T MAKE THOSE DECISIONS…I’M WRONG?>>WELL THE PATIENT ULTIMATELY HAS TO LIVE WITH WHAT HAPPENS SO THE PATIENT NEEDS WHOEVER THE HEALTH CARE PROVIDER IS WHETHER IT’S PHYSICIANS, NURSE PRACTITIONER..THEY NEED TO MAKE THE PATIENT UNDERSTAND WHAT THE CHOICES ARE AND WHAT THE CONSEQUENCES ARE. AND THE PERSON WHO CAN BEST DO THAT SHOULD BE THE PATIENTS WHO DOES….>>IF THE PATIENT SAYS “I REALLY LIKE THIS NURSE PRACTITIONER AND I WAN’T HIM OR HER TO ORDER THIS TEST FOR ME” THE LAW DOESN’T ALLOW IT OR CERTAIN THINGS YOU JUST SAID…I DON’T WANT TO GET INTO THE WEEDS HERE BUT MY POINT IS THIS. I AM CURIOUS NOW YOU BROUGHT NURSE PRACTITIONERS IN A LONG TIME AGO, YOU BROUGHT NURSE PRACTITIONERS A LONG TIME AGO.>>RIGHT RIGHT>>ARE MOST PHYSICIANS… HERE’S WHAT I’M TRYING TO GET AT, ARE MOST PHYSICIANS YOUR COLLEAGUES ARE THEY SUPPORTIVE OF THE IDEA OF HAVING MORE NURSE PRACTITIONERS DO MORE THAT RIGHT NOW THEY CAN’T DO?>>I WILL SAY ORGANIZED MEDICINE SAYS NO.>>DISORGANIZED MEDICINE SAYS YES? WHAT DOES THAT MEAN?>>ORGANIZED MEDICINE HAS BEEN…>>THE OFFICIAL WORD…>>THE OFFICIAL WORD A.M.A, ESSENTIALLY THE LARGE ORGANIZATIONS THAT HAVE A STAKE OR STAKE HOLDERS IN TRENTON, IN WASHINGTON HAVE BEEN VERY VERBOSE, HAVE WRITTEN PAPERS..>>THEY SAID NO>>THEY SAID NO>>AND THE REASONING IS?>>BECAUSE THAT WE DON’T HAVE ENOUGH TRAINING>>THAT’S THE BIGGEST>>WE ARE NOT SAFE. THAT WE NEED TO HAVE ADDITIONAL TRAINING TO DO XYZ. NOW EVEN THOUGH I UNDERSTAND PEOPLE HAVE DIFFERENT OPINIONS AND THAT’S FINE IF YOUR OPINION IS YOUR OPINION WITHOUT BEING BASED ON QUANTIFIABLE DATA. WHEN WE AS A NURSE PRACTITIONER SOCIETY WE HAVE 40-50-60-7- STUDIES SHOWING THAT WE PROVIDE HIGH QUALITY, COST EFFECTIVE CARE THROUGHOUT THE CONTINUUM OF A PATIENTS LIFE ON MULTIPLE, MULTIPLE LEVELS AND SOMETHING AS THE INSTITUTE OF MEDICINE WHICH SORT OF SETS THE GOLD STANDARD FOR MEDICAL CARE HAS WRITTEN A PAPER TO SAY THAT NURSE PRACTITIONERS PROVIDE THIS TYPE OF CARE. I WANT TO KNOW A GOOD SOLID REASON WHY WE SHOULDN’T BE ALLOWED TO PRACTICE TO THAT HIGHEST EXTENT OF OUR LICENSE.>>WELL HERE’S MY QUESTION AND BY THE WAY PAULA WHAT IS THAT NAME OF THAT AGREEMENT AGAIN I WANT TO GET A CLARIFICATION ON? WHAT IS IT CALLED AGAIN? THE “COLLABORATIVE PRACTICE AGREEMENT” WHAT IS THAT AND WHY IS IT SIGNIFICANT TO THE PEOPLE WATCHING ON PUBLIC TELEVISION?>>IN NEW JERSEY THE LAW IS THAT YOU HAVE TO HAVE A PHYSICIAN IF YOU’RE GOING TO PRESCRIBE MEDICATIONS WHATEVER ON YOUR PRESCRIPTION PAD THEIR NAME.>>I THOUGHT YOU SAID THAT…>>BUT THEIR NOT IN YOUR PRACTICE…>>THEIR NOT IN THE PRACTICE THEIR COLLABORATIVE AGREEMENT IS FOR PRESCRIPTIVE AUTHORITY ONLY NOT FOR DIAGNOSING, NOT FOR ASSESSING, NOT FOR MANAGING AND NOT FOR TREATING.>>AND IT’S NOT UNDER THEIR LICENSE.>>IT’S NOT UNDER THE LICENSE>>IT’S UNDER THE NURSE PRACTITIONERS LICENSE>>SO HE OR SHE IS ULTIMATELY RESPONSIBLE THERE>>THE NURSE PRACTITIONER NOT THE PHYSICIAN>>I WANT TO BE CLEAR>>YES>>WELL THAT DEPENDS. THAT DEPENDS ON THE PRACTICE. IT DEPENDS ON WHERE YOU ARE.>>I DON’T WANT TO CONFUSE PEOPLE..I’M NOT SAYING YOU ARE.>>WELL IT DEPENDS ON THE PRACTICE. FOR EXAMPLE THE COLLABORATIVE AGREEMENT THAT I HAVE WITH 2 NURSE PRACTITIONERS GOES A LITTLE BIT BEYOND THAT. I MEAN IT ALSO GIVES THEM THE ABILITY TO CONSULT ME ON DIFFICULT ISSUES.>>IS THAT BECAUSE YOU CHOSE TO DO IT THAT WAY?>>THAT’S THE WAY IT’S WRITTEN…(UNINTEL) TEMPLATE THAT WAS WRITTEN THAT YOU KNOW IN THEIR PRACTICE…>>IN YOUR PRACTICE YOU CHOSE TO DO IT THAT WAY BECAUSE YOU FELT IT WAS THE BEST THING FOR YOUR PATIENTS.>>I’M CURIOUS ABOUT SOMETHING. I ASKED THE QUESTION OF YOU BEFORE WHAT WILL CHANGE WITH RESPECT TO THE POWER AND AUTHORITY OF NURSE PRACTITIONERS AFTER THE AFFORDABLE CARE ACT “OBAMA CARE” IS IMPLEMENTED? WHAT WILL CHANGE?>>HOPING SOME OF THE LAWS WILL CHANGE AND GIVE US MORE ADVANTAGE TO PRACTICE TO THE FULL EXTENT IN THE SCOPE OF OUR LICENSE.>>BUT THE LAW ITSELF DOES NOT SAY, I JUST WANT TO BE CLEAR..>>THERE’S NO CHANGE IN THE LAW.>>THE LAW DOES NOT SAY YOU KNOW WHAT AFTER THE AFFORDABLE CARE ACT IS IMPLEMENTED NOT ONLY WILL MORE AMERICANS HAVE ACCESS TO HEALTHCARE THAT PREVIOUSLY DIDN’T HAVE IT BUT NURSE PRACTITIONERS WILL NOW BE ABLE TO DO CERTAIN THINGS THAT HERE TO FOR THEY WEREN’T ABLE TO DO BECAUSE WE REALIZE WE NEED THEM. IT DOESN’T SAY THAT. I BELIEVE WHAT IS BEING IMPLIED HERE IS THAT NURSE PRACTITIONERS WILL BE NEEDED MORE THAN EVER BEFORE TO PROVIDE THAT QUALITY HEALTHCARE FOR THESE GREATER NUMBER OF AMERICANS WHO HERE TO FORE NEVER HAD HEALTHCARE. SO THEREFORE DE-FACTO THEY’LL BE…>>YOU WOULD ASSUME>>BUT NOT IN THE LAW ITSELF>>THE IDEA THAT YOU BRING UP IS ACTUALLY A VERY LARGE PROBLEM THAT IN NEW JERSEY THE STATE LAWS THAT ARE REQUIRED IN NEW JERSEY ARE DIFFERENT THAN NEW YORK, ARE DIFFERENT THAN MONTANA DIFFERENT THAN FLORIDA…>>HOW CAN THAT BE? IT’S A FEDERAL LAW THAT CHANGES HEALTHCARE AND ACCESS TO HEALTHCARE FOR EVERYONE IN THE COUNTRY BUT THE ROLL OF NURSE PRACTITIONERS IS…>>MANAGED ON THE STATE LEVEL>>ISN’T THERE A DISCONNECT?>>IF I WERE TO GO TO MONTANA I WOULD HAVE FULL PRACTICE AUTHORITY, HANG MY SHINGLE AND I PRACTICE.>>EXPLAIN THAT TO PEOPLE IN THE TRI-STATE AREA WATCHING RIGHT NOW. WHAT WOULD HAPPEN IN MONTANA?>>FOR EXAMPLE IN MONTANA WHICH IS A FULL PRACTICE AUTHORITY STATE, THAT I BELIEVE THERE IS A REQUIREMENT OF MAYBE ONE OR 2 YEARS OF COLLABORATIVE AGREEMENT BUT IN THE BIG PICTURE THAT YOU ARE FULLY AUTONOMOUS TO PRACTICE WITHOUT A WRITTEN PRACTICE AGREEMENT. THAT YOU DON’T NEED TO HAVE A WRITTEN PRACTICE AGREEMENT WITH A PHYSICIAN IN ORDER TO PRACTICE. TO GIVE YOU AN EXAMPLE…>>TRANSLATION YOU CAN GO OUT ON YOUR OWN AT SOME POINT?>>YOU CAN GO OUT ON YOUR OWN AFTER 2 YEARS… ON YOUR OWN.>>YOU CAN NOT DO THAT IN NEW JERSEY?>>NO. FOR EXAMPLE I WOULD LOVE TO START A HOUSE CALL PRACTICE IN NEW JERSEY.>>YOU’RE IN NEW YORK THOUGH.>>I’M IN NEW YORK AND I STARTED THIS IN NEW YORK WITH IT’S OWN BARRIERS AND I WOULD LOVE TO MOVE MY HOUSE CALL PRACTICE INTO NEW JERSEY..>>BUT YOU DON’T BECAUSE..>>BECAUSE OF THE REGULATORY BARRIERS THAT I HAVE TO PAY MY COLLABORATING PHYSICIAN A MONTHLY FEE. THIS IS NOT DONE FOR FREE SO WHEN…>>YOU DON’T WANT TO SHARE YOUR FEES?>>NO>>PROPRIETARY INFORMATION>>BUT THE IDEA IS YOU KNOW WE’VE MADE OVER 30,000 HOUSE CALLS IN 12 YEARS A PHYSICIAN HASN’T MADE ONE.>>I DON’T WANT TO BE TRASHING PHYSICIANS HERE.>>NOW WHAT I MEAN BY THAT AND BY NO MEANS DOES THE PHYSICIAN I WORK WITH IS FANTASTIC AND WE WORK WITH COLLABORATIVE DOCTORS ALL THE TIME. WE WORK WITH PODIATRISTS…>>BUT WHAT?>>BUT IN ORDER FOR ME TO PRACTICE I NEED A WRITTEN PRACTICE AGREEMENT THAT IF THIS PHYSICIAN GOES INTO A MULTI SPECIALTY PRACTICE AND WHICH HAS HAPPENED TO ME AND IT’S THE PHYSICIAN IS NOT ALLOWED TO BE IN OTHER AGREEMENTS OR ARRANGEMENTS MY PRACTICE ENDS TOMORROW.>>DOCTOR LET ME BRING YOU BACK IN HERE. DENIS IS SAYING LOOK, THERE’S A DISCONNECT WITH THE FEDERAL LAW BEING IMPLEMENTED THE AFFORDABLE CARE ACT. WHAT’S GOING TO BE EXPECTED OF NURSE PRACTITIONERS AND WHAT THE LAW ALLOWS PRACTITIONERS TO DO RIGHT NOW. DO YOU AGREE?>>YES>>DO YOU SEE ANY SENSE DO YOU FEEL ANY MOVEMENT IN THE STATE IN TERMS OF…. WE’RE ACTUALLY GOING TO DO THIS SOME OF THIS PROGRAMMING ON CAPITAL REPORT OUR PROGRAM THAT LOOKS AT PUBLIC POLICY ISSUES IN THE STATE BECAUSE IN SOME WAYS REALLY APPROPRIATE THERE BUT I WANT TO TOUCH ON IT HERE AS WELL. DO YOU FEEL ANY MOVEMENT IN THE CAPITAL IN THE PUBLIC THAT SAYS HEY WE NEED THIS LET’S MOVE IN THIS DIRECTION?>>I THINK I THINK IT’S GETTING THERE. SLOWLY BUT SURELY IT WILL GET THERE AND I THINK AN ADVANTAGE THAT A NURSE PRACTITIONER DOES HAVE TO OFFER IS THROUGHOUT OUR TRAINING WE LOOK HOLISTICALLY AT PATIENTS AND FAMILIES. AND I THINK THAT HOLISTIC APPROACH ALLOWS US TO HAVE THAT COMMUNICATION AND THAT RELATIONSHIP WITH PATIENTS AND WE ALSO ENABLE THE PATIENT TO GET ENGAGED. I THINK FOR ME I’M IN MULTIPLE DIFFERENT SETTINGS AND I VIEW A COLLABORATIVE AGREEMENT NOT AS A RESTRICTIVE ASPECT TO MY PRACTICE AT ALL. I REALLY TRULY LOOK AT IT AS A PARTNERSHIP. AND I AM A PARTNER WITH MY COLLABORATING PHYSICIAN. I CAN REFER, I CAN CONSULT I AM COMFORTABLE KNOWING THAT THERE IS A LIFELINE AT THE OTHER END OF MY TELEPHONE.>>WOULD YOU BE BETTER OFF WITHOUT IT SO THAT YOU COULD QUOTE HANG OUT PUT OUT YOUR SHINGLE AND YOU’RE ON YOUR OWN? WOULD YOU BE BETTER OFF?>>YES AND NO BECAUSE BEING IN PRIVATE PRACTICE, I’LL TELL YOU ONE THING THERE IS A DYER NEED TO HAVE A PHYSICIAN BECAUSE OF THAT MULTI-COMPLEX PATIENT THAT THEIR TRAINING ALLOWS THEM TO BE ABLE TO MANAGE…>>YOU LIKE THE WAY IT IS THAT PART OF IT?>>THAT PART OF IT. DO I LIKE MY INDEPENDENCE? ABSOLUTELY. AM I GOOD AS AN AUTONOMOUS PRACTITIONER? YES.>>YOU JUST HIRED AN ADDITIONAL NURSE PRACTITIONER WHY?>>BECAUSE ONE OF THE ISSUES THAT OCCUR WITH OUR VOLUME IT GOES UP AND YOU IT BETTER SERVES US TO HAVE A NURSE PRACTITIONER FOR WHAT WE CALL LOW ACUITY TYPE OF VISITS. BASICALLY SOMEONE COMES IN WITH AN EAR PROBLEM SORE THROAT SOMETHING LIKE THAT. THAT WOULD BE SOMETHING YOU KNOW THAT WOULD TAKE UP SOME TIME FOR ME BUT I COULD PROBABLY DEDICATE THAT TIME TO SOMEONE THE DIABETIC WHO’S HAVING PROBLEMS WITH THEIR DIABETES, PEOPLE WHO’VE HAD STROKES, THINGS OF THAT NATURE WHERE THE EXPERTISE OF THE PHYSICIAN PROBABLY WILL BE MORE BENEFICIAL TO THE PATIENT. SO I’M FREED UP THE NURSE PRACTITIONER TAKES CARE OF WHAT I CALL LOW ACUITY VISITS. EVERYDAY WITH MY NURSE PRACTITIONER SHE CONSULTS WITH ME WITH MAYBE 1 TO 2 PATIENTS THAT SHE’S NOT SHE’S SURE BUT SHE REALLY WANTS TO HEAR FROM THIS IS THE RIGHT THING TO DO.>>GOT IT. FIRST OF ALL I PROMISE YOU WE’RE GOING TO BRING YOU BACK ON THE CAPITAL REPORT PROGRAM, THIS IS AN IMPORTANT TOPIC WE JUST SCRATCHED THE SURFACE, THANK YOU VERY MUCH.>>THE PRECEDING PROGRAM HAS BEEN A PRODUCTION OF THE CAUCUS EDUCATIONAL CORPORATION. CELEBRATING 25 YEARS OF BROADCAST EXCELLENCE. AND 13 FOR WNET NJTV AND WHYY FUNDING FOR THIS EDITION OF CAUCUS NEW JERSEY HAS BEEN PROVIDED BY HOLY NAME MEDICAL CENTER IN TEANECK NEW JERSEY NEW JERSEY MANUFACTURERS INSURANCE GROUP WELLS FARGO THE LAW FIRM OF GIBBONS PC JOHNSON AND JOHNSON AND BY NEW JERSEY NATURAL GAS TRANSPORTATION PROVIDED BY AIR BROOK LIMOUSINE SERVING THE METROPOLITAN NEW YORK NEW JERSEY AREA CAUCUS NEW JERSEY HAS BEEN PRODUCED IN PARTNERSHIP WITH TRISTAR STUDIOS THIS PROGRAM HAS BEEN MADE POSSIBLE IN PART BY NEW JERSEY STATE NURSES ASSOCIATION>>HI I’M DANIEL MISA AND I’M A STAFF NURSE WHO WORKS IN A HOSPITAL. NURSES ARE EDUCATED AND PREPARED TO WORK IN MANY PLACES AND AREAS LIKE HOSPITALS, CLINICS IN RESEARCH AND IN THE MILITARY. AS MEMBERS OF THE NEW JERSEY NURSES ASSOCIATION WE THANK YOU FOR THE TRUST YOU’VE GIVEN US. SINCE BEING INCLUDED IN THE GALLOP POLL IN 1999 NURSES HAVE BEEN RANKED AS THE MOST TRUSTED PROFESSION EVERY YEAR EXCEPT IN 2001 WHEN FIRE FIGHTERS RECIEVED TOP

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