A Conceptual Model of Primary Care in New York State
The purpose of this project is to describe a conceptual Model for Primary Care in New York State (NYS). This model (Figure 1) places Nurse Practitioners (NPs) as first line primary care providers allowing physicians as specialists caring for the most difficult, complex cases. In the current model of primary care NPs are required to practice in statutory collaboration with a physician, are currently restricted from participating in many insurance panels, are reimbursed less for the same service performed by a physician, and are prevented from signing many health care orders and documents secondary to health care laws that were written prior to the establishment of NPs as care providers in the state. In the new model NPs will, continuing voluntary collaboration with physicians and other health care professionals, become full providers in the delivery of primary care. This paper will show how this new model will provide increased access to primary care services, while being patient centered, and cost-effective. With the passage of the Affordable Care Act (ACA) in 2010, millions of newly insured will be entering into the health care system. The ACA also brings recognition to the role of the NP as a qualified provider and suggesting funding for health promotion and disease prevention, along with recommending full participation of NPs as primary care providers. Collwill, Cultice, and Kruse (2008) state that there is a predicted overall shortage of primary care physicians nationwide with a 27% decline in family practice physicians. American Association of Medical Colleges (AAMC, 2009) and the American College of Physicians (ACP, 2009) states the demand for primary care services will outpace faster than any other specialty group. NPs will be needed to meet the nation's demand for primary care services and are well qualified to meet the demand and efficiently provide direct quality patient care services (ACP, 2009; National Center for Policy Analysis [NCPA], 2010; Sherwood, Brown, Fay, & Wardell, 1997). In NYS 2.6 million newly insured individuals will saturate an already overloaded primary health care system causing a delay in access to care. The new model provides for full participation of NPs who, across the continuum are autonomous, able to be reimbursed for the actual service they provide, without statutes and public health care regulations hindering their practice. In this model, physicians would become the second line of access to care as specialty providers. To do this, legislative changes are needed.