Remove treatment barriers for advanced degree nurses

Posted 3/12/24

In medicine, innovation drives discovery, which leads to new treatments, perhaps even...

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Remove treatment barriers for advanced degree nurses


From mail-order prescription drugs to accessing electronic medical records by text message, health care delivery is vastly different in 2024 than when I started in the field nearly two decades ago.

In medicine, innovation drives discovery, which leads to new treatments, perhaps even cures.

At Premier Mobile Health Services, our innovation is one borne of necessity: bringing lifesaving medical care – via an RV converted into a doctor’s office on wheels – to our community’s most vulnerable residents directly in the neighborhoods where they live and congregate.

It’s a job that keeps our small staff plenty busy – we visit a half-dozen locations in Lee County each month, from the Pine Manor Community Center in Fort Myers to the Café of Life resource center in Bonita Springs. That’s in addition to our (brick-and-mortar) walk-in clinic on Colonial Boulevard.

Earlier this winter, I joined my fellow members of the American Association of Nurse Practitioners (AANP) in Washington in support of changing outdated federal policies that stifle innovation and unnecessarily limit patient access to health care.

House Resolution 2713/ S. 2418, the Improving Care and Access to Nurses (ICAN) Act, is a bipartisan measure that would significantly improve access to care for Medicare and Medicaid beneficiaries by removing barriers to practice for nurse practitioners (of which I am one, with a doctorate in the field) and other advanced practice registered nurses.

Anyone who’s received medical care lately knows how integral such health care professionals are to frontline patient care. Federal government data shows that nurse practitioners make up about one-third of the country’s primary care workforce in the U.S. and up to half in rural areas. Over 40% of all Medicare patients – a group that consists of one in every four Floridians – receive billable services from a nurse practitioner.

Here are some of the ways the ICAN Act would strengthen patient access to vital care through increased authority for nurse practitioners and advanced practice registered nurses:

Allow them to order cardiac and pulmonary rehabilitation for Medicare patients.

• Allow them to certify the need for therapeutic shoes for Medicare patients with diabetes.

• Authorize the assignment of patients to Medicare Shared Savings Program without requiring the patient to receive a primary care service from a physician.

• Authorize referral of Medicare patients for medical nutrition therapy.

• Authorize establishment and review of home infusion care plans for Medicare patients.

• Authorize hospice care programs to accept certification and recertification of eligibility orders for Medicare beneficiaries, and better align hospice billing policies for nurse practitioners and physicians.

• Remove the requirement that skilled nursing facility care be provided under the supervision of a physician and authorize nurse practitioners to perform admitting examinations and all required Medicare patient assessments.

Since our clinic opened in 2018, we have served more than 12,000 patients, providing frontline care during the COVID-19 outbreak, in the aftermath of Hurricane Ian and now, day in and day out in Lee County.

Our services include early-detection health screenings, blood pressure and diabetes checks, drug screenings, basic metabolic profiles, nutrition counseling, basic vaccinations, school and sports physicals for children, and more.

The mobile units include our own pharmacy, an in-house laboratory and an electronic medical records system that allows us to digitally track patient care. We have affiliate agreements with multiple universities, offering valuable real-world training to a steady stream of medical residents, nurse practitioner students and other healthcare professionals transitioning to professional careers.

Thanks to generous private donors and grants from such community partners as Lee Health, United Way of Lee, Hendry and Glades, and others, patients without health insurance and with proof of income below 200 percent of the federal poverty guidelines receive complimentary care, while those who exceed those income limits are provided care at a significantly reduced rate.

Whether here in Fort Myers or across the country in Fargo, North Dakota, the growing and essential role of advanced-degree nurses in frontline patient care needs support, not outdated restrictions.

Policies and regulations that have not been modernized, and which prevent us from practicing to the full extent of our education and clinical training, reduce access to care, disrupt continuity of care, increase health care costs and undermine quality improvement efforts.

Please join me in urging our members of Congress representing Southwest Florida to support this critical legislation.

Nadine “Deanie” Singh, DNP, APRN, FNP-BC, is founder and chief executive officer of Premier Mobile Health Services.

health, medicine, treatment, nursing, nurses, patient