The Nurse Practitioner Will See You Now

Laura A. Stokowski, RN, MS

Disclosures

June 29, 2010

In This Article

Medical Homes and NPs

The model most widely promoted for primary care in the United States right now is the patient-centered medical home, a system of care that embodies the full spectrum of primary care, from the preventive to the curative.[3] It is patient-centered, accessible, comprehensive, integrated, and interdisciplinary. The patient/provider relationship is clearly defined, as are the roles and responsibilities of provider team members.

With respect to NPs, one problem with the medical home model is that the National Committee for Quality Assurance (which certifies primary care settings as medical homes) recognizes only physicians as leaders of medical homes.[7] Thus, NPs are formally excluded from leading such care models, although in practice they have been doing so for years in nurse-managed health centers.

The Patient Protection and Affordable Care Act (popularly known as "the health reform bill"), signed into law in March 2010, takes an important step toward increasing primary care access to vulnerable populations by funding nurse-managed health centers. However, unless policy changes are made, these centers will not be designated medical homes.

Schram[8] suggests that NPs should participateinmedical home demonstration projects and publish their outcomes to increase the body of evidence to support the ability of NPs to lead medical homes. Getting payers to recognize NPs as primary care providers is another necessary step if NPs are to gain the right to coordinate care in the primary care setting.

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