Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of the American Association of Nurse Practitioners (AANP), spoke with Clinical Advisor amidst the rapidly expanding novel coronavirus (COVID-19) pandemic in the United States.
Q: As we speak, the federal government is issuing waivers to allow many health care practitioners to transfer their practices from in-person to remote or telehealth systems, and the House and Senate are working on legislation specifically designed to help health care providers fight the COVID-19 pandemic. Please tell us how this is affecting nurse practitioners (NPs) around the country?
A: As an association, AANP sent on open letter to governors around the country, affirming the commitment of the 290,000 NPs serving on the front lines of our health care system as part of the robust response to combat the spread of COVID-19 while continuing to meet the need of ongoing primary care in communities across the nation.
We asked the governors to waive existing state-level restrictions that prevent NPs from responding at the top of their education and national certification. In 22 states, Washington DC, 2 US territories, the Veterans Health Administration, and the Indian Health Service, NPs are authorized to directly provide these services.
In the remaining jurisdictions, outdated regulation needlessly bottlenecks the workforce by making it illegal for NPs to provide these services unless they maintain a collaborative or supervisory contract with a physician. This requirement ties a state’s capacity to use NPs to meet health care needs to the supply and availability of the physician workforce; needlessly restricts the number of NPs who could otherwise evaluate, diagnose, and treat patients; and creates unnecessary geographic maldistribution of services and delays in care.
Additionally, AANP has requested that the National Governors Association work with states to address the need for a surge in health care providers by encouraging states to expand emergency health care workforce declarations that authorize states to use out-of-state health care licensees to include clinicians with retired or inactive states to resume work, provided their inactive or expired license was in good standing.
Q: How will the passage of the COVID-19 stimulus package affect NPs and their patients? What steps have Medicare and Medicaid taken to waive restrictions on practice?
A: After our letter to the governors, the Trump Administration has taken action to expand access to NP care and other health care providers during the COVID-19 pandemic. In a letter sent to all 50 governors on March 24, 2020, Health and Human Services (HHS) Secretary Alex Azar also urged the suspension of state regulatory barriers to practice that limit patient access to care, including NPs.
The administration has already taken important steps to lift federal barriers within Medicare and Medicaid so that NPs can combat this crisis. Now, it’s critical that states answer the call to suspend state barriers to care so that NPs can meet the urgent needs of patients and address this challenge head on.
Addressing our nation’s needs will require all hands on deck. Given the nationwide scale of COVID-19 cases, states will not be able to rely on neighboring states to send health care providers to meet the demand. Authorizing recent licensees to return to the workforce offers a way to bolster our reserves and utilize the qualified clinicians already in our communities.
The legislation passed by the Senate and House, and now signed into law by the president, includes a provision authorizing NPs to certify and recertify home health care services for Medicare patients. Once implemented, this will ensure that millions of seniors are able to receive critical health care services at home during this crucial time. Not only will the new law help make certain seniors have timely access to home health care services, it will also help ensure they are less likely to be exposed to COVID-19 by being having to seek health care at large health care facilities.
Lifting state restrictions that prevent NPs from providing home health care will not only improve care for seniors and limit the spread of COVID-19 but will also maximize the availability of hospital beds for those with coronavirus.
Telehealth is suggested by the Centers for Disease Control and Prevention as an alternative for in-office appointments, and for triaging and assessing ill patients by telephone, text monitoring system, or video conference. Waivers have been issued to allow NPs to use Facetime and other video conferencing technology without violating HIPAA regulations. Telehealth methods can reduce the chance of exposure for staff members and minimize a surge on health care facilities.
Q: Are nurse practitioners equipped with enough personal protective equipment (PPE)?
A: AANP has been monitoring the situation and are hearing every day from NPs across the nation who must risk their health to care for patients due to the lack of available PPE. The recent action by Congress and the president on the COVID-19 stimulus package will hopefully provide vital funding to protect health care providers working on the front lines of this crisis.
Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of the AANP, is a family and pediatric nurse practitioner at the Daughters of Charity Health System in Kenner (New Orleans), Louisiana. Her clinical practice has focused on providing care to the medically underserved families. In addition to her advocacy work, Dr Thomas is on the clinical faculty for Georgetown University’s FNP program.