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January 1, 2007
Note: New CE Credit Calculation Rules
Effective January 1, 2007, the American Nurses Credentialing Center (ANCC) has directed continuing nursing education providers to change the way that continuing education credit is calculated. 1.0 Continuing Education Credit will now be issued for activities that are 60 minutes in length, rather than the previous ratio of 1.0 credit for a 50-minute activity. All certificates issued prior to January 2007 that were awarded based on the old calculation WILL be accepted by ANCC.
February 1, 2006
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The National Provider Identifier (NPI)
Final Rule requires health care providers who are organizations and who
are covered entities under HIPAA to determine if they have "subparts"
that should be assigned NPIs. The NPI Final Rule provides guidance to
those health care providers in making those determinations.
The Centers for Medicare and Medicaid Services (CMS) has communicated to the Provider Enrollment staff at the carriers and fiscal intermediaries the Medicare program's expectations concerning the determination of subparts for NPI assignment purposes. CMS has posted a document describing the subpart concept and its relationship to the way in which Medicare enrolls its organization providers at? http://www.cms.hhs.gov/NationalProvIdentStand/06_implementation.asp#TopOfPage. This document will be helpful to providers in understanding the issue of subparts and how subpart determination could be done in a way that helps to promote smoother and more efficient Medicare claims processing during the implementation of the NPI in the Medicare program. The health care industry in general has expressed an interest in being informed of this type of information. CMS is making this information available on the CMS website so that it is easily available to interested parties. With best regards ~ Valerie Valerie A. Hart, Director
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November, 2005
Quality of HIV Care Provided by Nurse Practitioners, Physician Assistants, and Physicians
15
November
2005 |
Volume 143 Issue 10 | Pages 729-736
Background: Nurse practitioners (NPs) and physician assistants (PAs) are primary care providers for patients with HIV in some clinics, but little is known about the quality of care that they provide.
Objective: To compare the quality of care provided by NPs and PAs with that provided by physicians.
Design: Cross-sectional analysis.
Setting: 68 HIV care sites, funded by Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Title III, in 30 different states.
Participants: The authors surveyed 243 clinicians (177 physicians and 66 NPs and PAs) and reviewed medical records of 6651 persons with HIV or AIDS.
Measurements: 8 quality-of-care measures assessed by medical record review.
Results: After adjustments for patient characteristics, 6 of the 8 quality measures did not statistically significantly differ between NPs and PAs and either infectious disease specialists or generalist HIV experts. Adjusted rates of purified protein derivative testing and Papanicolaou smears were statistically significantly higher for NPs and PAs (0.63 and 0.71, respectively) than for infectious disease specialists (0.53 [P = 0.007] and 0.56 [P = 0.001], respectively) or generalist HIV experts (0.47 [P < 0.001] and 0.62 [P = 0.025], respectively). Nurse practitioners and PAs had statistically significantly higher performance scores than generalist non–HIV experts on 6 of the 8 quality measures.
Limitations: These results may not be generalizable to care settings where on-site physician HIV experts are not accessible or to measures of more complex clinical processes.
Conclusions: For the measures examined, the quality of HIV care provided by NPs and PAs was similar to that of physician HIV experts and generally better than physician non–HIV experts. Nurse practitioners and PAs can provide high-quality care for persons with HIV. Preconditions for this level of performance include high levels of experience, focus on a single condition, and either participation in teams or other easy access to physicians and other clinicians with HIV expertise.
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What is the problem and what is known about it so far? |
Nurse practitioners (NPs) and physician assistants (PAs) are health
care providers who are trained to care for patients in much the same
way as doctors. They can perform physical examinations, order tests
and interpret results, make treatment decisions, and prescribe many
drugs. By law, PAs require a doctor's supervision, whereas NPs do
not. Many clinics and hospitals hire NPs and PAs to see patients when
there are not enough doctors. Nurse practitioners and PAs also see
patients with basic needs so that doctors' more limited time can be
spent on patients with more complicated illnesses. Research suggests
that NPs and PAs in primary care settings provide the same quality of
care as doctors. However, these findings may not apply to specialty
settings where patients' needs may be more complicated. Some
clinics that focus on the care of patients with
HIV
infection employ NPs and PAs to see some patients. Whether the
quality of care provided by NPs and PAs in an
HIV
clinic setting is similar to that provided by doctors is not known.
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Why did the researchers do this particular study? |
To compare the quality of health care provided by NPs, PAs, and
doctors in
HIV
clinics.
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177 doctors and 66 NPs and PAs who took care of 6651 patients in 68
HIV
clinics.
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The researchers randomly picked 5 health care providers from each
HIV
clinic. They sent a survey to the health care providers, asking them
for information about their training and experience. The researchers
also randomly chose 75 patients from each clinic. The researchers
studied patients from the group who were cared for by a health care
provider who had returned a survey. Nurses in each clinic reviewed
the charts of the patients for indications that they received
high-quality care. Measures of quality included control of
HIV
infection, screening for secondary infections, and immunizations. The
researchers then compared the quality of care provided by NPs and PAs
with that given by doctors. For the comparison, the researchers
classified doctors as
HIV
experts with special training,
HIV
experts without special training, and non–HIV
experts without special training.
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What did the researchers find? |
The quality of care provided by NPs and PAs was similar to or better
than that provided by doctors. Nurse practitioners and PAs were
better than all doctors at screening for tuberculosis and cervical
cancer. They were better than non–HIV
expert doctors without special training at giving proper anti-HIV
drugs, controlling
HIV
infection, and giving flu shots. They did not perform worse than any
other doctor at screening for hepatitis C infection and giving drugs
to prevent a common cause of pneumonia.
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What were the limitations of the study? |
The researchers could not prove that the quality measures that they
studied actually made patients healthier. Also, they studied aspects
of health care that are basic for all patients with
HIV.
Nurse practitioners and PAs might not be as good as doctors in caring
for patients with more complicated needs.
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What are the implications of the study? |
The quality of care provided by NPs and PAs is similar to or better
than that provided by doctors in
HIV
clinics.
Many studies have shown that APRNs provide cost-effective, high quality care. Many Medicaid plans reimburse APRNs at a fraction of the physician fee schedule. In addition, APRNs are often willing to provide services in rural and inner-city areas where access to physicians is limited. APRNs increase access to health care and decrease preventable acute care admissions and emergency room visits. By including the provisions of The Medicaid Advanced Practice Nurses and Physician Assistants Access Act in Medicaid reform, Congress would help ensure that Medicaid patients receive care in a timely and cost-efficient manner.