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Blue Cross Plans Improve Access With CRNPs

Extending some kind of insurance to forty million people when/if Obamacare takes hold presents health care with an opportunity AND a big problem.  The opportunity: new customers and increased demand.  The problem: we're thousands of physicians short of having adequate capacity to care for all those new customers.

Already we're hearing calls for massive increases in Federal funding for the training pipeline - medical schools, residencies, etc.  Some increase is probably a good idea.  After all, what's the use of having a ticket to the big game if it doesn't buy you a seat in the stadium?

But I doubt the pipeline can ramp up quickly enough, even with increased funding.  That leads to the search for alternatives.  There are, after all, many ways to build caregiver capacity besides simply producing more physicians.

We might start by redoubling efforts to increase the efficiency of practicing physicians - less paperwork, fewer hassles, better systems and processes.  More productive hours in every work day yields additional capacity (assuming physicians use those newly-found hours to see more patients.)

And, though it's hard to argue with the need for more caregivers, perhaps we don't need quite as many new physicians as originally estimated.   Involving advanced practice nurses, for example, is a timely  idea, relatively affordable and entirely workable. 

Two Blue Cross plans -  Camp Hill, Pa.-based Highmark Inc. and Baltimore-based CareFirst BlueCross BlueShield - appear to be setting the pace.  From Health Business Daily:
"Recognizing certified registered nurse practitioners’ (CRNP) ability to work up to the full scope of their medical license will allow greater access for members,” says Carey Vinson, M.D., vice president of quality and medical performance management at Highmark Inc. That plan is reaching out to several hundred CRNPs across Pennsylvania to determine if they want the designation and want to work with Highmark members as network primary care CRNPs.

"Highmark will reimburse them the same as PCPs, a spokesperson says, and hopes to make Pennsylvania more attractive to CRNPs in the process. The plan calls the practice of using only medical doctors as gatekeeper providers “a relic of the HMO days.
Gatekeeper roles.  The same reimbursement as PCPs.  Is it time to stop calling these professionals simply "physician extenders?"


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