The Expanding Role of Nurse Practitioners in Home-Based Primary Care: Opportunities and Challenges.

Abstract

Approximately 93% of Medicare spending is for beneficiaries with multiple chronic conditions. Costs of poorly coordinated or delayed care for this vulnerable population are staggering-not just measured in dollars and cents, but in overall psychosocial burdens of poor health and diminished quality of life. Home-based primary care (HBPC) practices are an effective way to meet needs of frail older adults who find it difficult, if not impossible, to leave home for medical care with an overall cost savings to Medicare. Nurse practitioners (NPs) provide more than 825,000 HBPC visits per year. Their training and education uniquely prepare them to address whole person aspects of health, including medical, psychosocial, and quality of life realms. Despite proven benefits of NPs providing HBPC, Medicare regulatory barriers disallow NPs from certifying or recertifying Medicare home health or certifying terminal illness for hospice patients. These barriers decrease patient access to timely care and increase Medicare costs. [Journal of Gerontological Nursing, 45(6), 9-14.].