Include Nurse Practitioners in the Definition of Medical Homes

The “medical home” concept rewards primary care providers (PCPs) for providing ongoing care and coordination of care, particularly for complex patients.  These services are extremely valuable in keeping costs down, by avoiding complications and the unnecessary use of specialists.  Yet primary care services are widely recognized to be both time-intensive and undervalued, contributing to a shortage of PCPs, particularly among physicians.

In the Medicare Improvement and Extension Act of 2006, Congress created the Medicare Medical Home Demonstration Project, the first attempt to create medical homes at the federal level.  Unfortunately, the 2006 Act’s definition of a “medical home” for primary care was limited strictly to a “board certified physician,” thus excluding nurse practitioners -- and other health care providers who currently provide primary care.  While the Medicare demonstration project is somewhat narrow in its scope, we are very concerned that its definition of medical home could become the rule for all of Medicare, and then all of health care.

Many nurse practitioners serve as PCPs, and their background and nursing perspective often lead them to excel in this role, as recognized by patients and many other health care providers.  As providers of high quality, safe, coordinated care, NPs meet the National Committee for Quality Assurance (NCQA) standards for a medical home.  In rural and underserved areas, NPs can be the only PCPs available.  Unfortunately, their valuable contributions to primary care have not been fully acknowledged, both within the states and at the federal level, particularly when “primary care” and “medical home” are defined in terms of physicians only.

The Senate Finance Committee has been developing legislation to expand the Medicare Medical Home Demonstration Project, which is likely to become part of a comprehensive bill addressing Medicare in general.  The ANA has been working with Senate Finance Committee Chairman Max Baucus (D-Montana), and other nursing organizations, to specifically include nurse practitioners within the definition of “medical home.”  As we reported in Capitol Update, MedPAC, the Medical Payment Advisory Commission, has also recently approved the inclusion of nurse practitioners within the definition of primary care providers eligible to become medical homes.

You can help!

Check to see if your Senator is a member of the Senate Finance Committee—if so, you can help by urging them to include NPs in any proposed medical home expansion.  The Committee is deciding this issue now, so please use our talking points to call your Finance committee members TODAY!