It’s not that often that change and I see eye to eye—but welcoming NNPEN co-founder Dr. Lynn Rapsilber as NNPEN’s CEO on July 1, 2021 is one of those times. Lynn is my dream-come -true to take the baton: DNP, healthcare policy wonk, sought-after national Billing & Coding presenter, GI practitioner and tested consensus-builder! And she knows that nurse-led start-ups have the power to solve the primary care access crisis in America. She will drive NNPEN to answer this question: How will that NP practice ownership explosion happen?
In this win-win, Sandy relinquishes CEO responsibilities and takes on Priority #1 for me personally, and NNPEN derivatively, which is NP Payment Reform. To lean into this initiative, the post July 1 Sandy is tasked with driving an NNPEN payment strategy whose goal is expanded NP practice participation in risk-based Alternative Payment Models (APM). Say what???
We have worked tirelessly to reduce barriers to NP entrepreneur [NPE] practice ownership: finding collaborating physicians, health benefits options for NPEs and their families; and business basics course work accessible 24/7that lays a foundation for the developing NPE business brain ...with more to come.
Looking back at earlier blogs, the need for payment reform has been lurking since NNPEN’s beginning. To be concrete: out of a total of 15 website blogs I’ve written since March 2018, payment reform appears 9 times. Why?
Because NO MARGIN NO MISSION. When we first birthed NNPEN and put those words on a slide as our call to action, the return was puzzled looks from NPs. The battle was/is Full Practice Authority [FPA] in all 50 states. But the potential for practice ownership in FPA states soon ran into this reality: even with FPA, Fee For Service reimbursement is not a sustaining revenue base. “Sustaining” as in paying your bills including your own salary, and having money left over [the margin] to invest in your mission of growing your practice, offering patient services you were educated to view as a piece of patient-centered primary care – not indulgences. And having time to engage with your patients!
We know there are barriers to negotiating sustaining payment for NPs. The big three are:
- 1. Critical mass: can NPs, happy to finally be owners of their own practices, be persuaded to look beyond their practice walls to aggregation of distinct nurse-led practices and their compelling quality and cost outcomes data? With NPs on so many different electronic health records, data aggregation, national or regional, is a costly challenge. How do we skin this cat?
- 2. Appreciation of the need to preserve nurse-led care and its framework, the nursing model. We need enlightened payers who see that nimble small practices go to where their patients are and must be sustained to ensure a primary care access solution in America. We then need payers to design APMs modified for small independent primary care practices, not just for the big groups and healthcare systems.
- 3. NPs’ ingrained risk aversion culture, including aversion to value-based payment risk. Maybe the pandemic has demonstrated that nothing is risk-free: when patient traffic stopped, FFS revenue stopped, while APM cash flow continued. Let me share how Doug Watson, CFO of Dignity Health [featured in a panel convened May 2021 by HealthLeadersMedia.com to explore Balancing Risks and Opportunities in Value-Based Care] answered the perennial question of how a provider/practice will know it’s time to leave FFS behind:
“I believe it is important to look at what risk allows you to accomplish
in terms of delivering better value to decide how and when to proceed.”
NP practice owners recognize the gap between what patient-centered services their training would dictate for their patients and the scope of patient-centered services FFS payments allow. You will become informed risk-takers when delivering a broader basket of patient services is the only path forward consistent with the analytics of the nursing model.
So I have my work cut out for me—and that works for me. Lynn says ditto.
How grateful we are that the NNPEN board was and is unanimous that the time to lean in, to invest in accelerating the pace of sustainable nurse-led practice growth, is now.
Here we go!