re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187

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would you do me a favor and explain your logic here?

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To increase the likelihood that young MD's will pursue primary care out of med school, I think you will have to increase PCP reimbursement to a level that it becomes inequitable with the larger fee schedule.

PCP's billing a level 3 will have to get more reimbursement than a specialist billing that same level 3. Equitable work, inequitable reimbursement. I'm just curious if physicians as a whole would be ok with this.

caveat: I don't think this happens. I'm on record as saying mid levels are where government will expand access. But the phrase "incentivise (sp?) doctors to go into primary care" has been used multiple times in this thread. What are the feasible methods to do that? I'm not accounting for cost concerns in that question, just curious about the "optimal" incentives.

ETA: All based on FFS reimbursement, of course. Not P4P.

Thank you.

Initially I thought you were implying that primary care sees non complex visits where as specialist are seeing the complex visits. And then applying those financial proposals to that underlying theme.

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But the phrase "incentivise (sp?) doctors to go into primary care" has been used multiple times in this thread. What are the feasible methods to do that? I'm not accounting for cost concerns in that question, just curious about the "optimal" incentives

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The problem is not a simple clean cut issue and thus the answer will not be either.

You are kind of blurring issues. There need to be more physicians choosing to do primary care. There are also areas of need across this country like HPSAs and MUAs where medical need is not being met. Although issue one may contribute to issue two it is far from the sole reason. They are separate issues. Simply creating more physicians or providers of any type is not going to fix issue two.



Many of the MUA are simply geographically and socioeconomically undesirable places to live and work. This truth is applicable across all providers, physicians and NP's. When violent and non violent crime rates are high at the same time education level and opportunity, employment rates and opportunities, property values, and patient reimbursement potential are low you will find no providers flocking to the area. Couple this with high litigation (like that seen in the RGV where the lawyers literally ran every OBGYN practice out of town) and you double the effect.

Dive deeper into the statistics and you find that many HPSA are no necessarily a geographical provider saturation issue. They are the result of subsets of populations not having enough medical providers. Even in large metroplex areas where there are thousands of physicians, clinics, nurse practitioners, you will still find HPSA based on population subsets. There is plenty of data to show that despite the identification of the disparity certain populations just do not want to utilize services when they are provided and available.




Correcting some of those issues may never realistically be an option. Tort reform, Medicaid expansion, increased use of implantable extended period contraception, and intensive educational programs have shown some advancement and improvement in outcomes.




As far as simply increasing the number of students who choose the primary care route, there are many things that could be done.

reducing the ever increasing government forced paperwork and restrictions on physicians

increasing the reimbursement of Medicaid to MCR rates

tort reform and protection from frivolous legal actions (LA system is actually pretty good)

providing financial assistance with overhead based on providing care in designated areas (already happens to some extent)

using FFS flat percentage increase for designated areas (already happens for some rural areas)

better adjustments of standard goals based on patient demographics in P4P models

etc. etc.

not even close to voting, they are arguing over a constitutional convention, this bill is pretty far down on the agenda

PT bill up for debate currently

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But the Louisiana model as is currently in place is superior? We are ranked 50th in heathcare. Anyone with common sense should look at these other states and attempt to mimic parts of what they are doing. They are doing it better than us.

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Oh you mean get rid of fat poor people. Good idea.

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Expanding access to care is a bunch of bullshitee

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I meant this in reference to NPs argument about expanding access to care. Ulterior motives. Many NPs stand to benefit financially from passage of this bill. And I'd argue that's their primary gain.

The same can be said about MDs concerns as well.

Fair enough

Am

In

You my friend are the proud new owner of an NP pseudo autonomous upper mid level sort of long white coat