Calls to fund nurse practitioners in private hospitals

Funding nurse practitioners through private health insurance could be instrumental in tackling Australia’s chronic disease burden, according to CEO of the Australian College of Nurse Practitioners, Adjunct A/Prof Leanne Boase.

Speaking ahead of the Health Insurance Summit, Boase said the current lack of funding for nurse practitioners in private hospitals was an “artificial barrier” to progress in healthcare, and a missed opportunity to gain contributions from an “underutilised workforce”.

Without funding, nurse practitioners who currently work in private hospitals are either billing patients privately, where reimbursement isn’t available, or working within the broader hospital budget. Private health insurance funding – a more efficient funding avenue – could lead to greater levels of representation and a range of positive outcomes, she said.

“The sector is pretty much in agreement now, that if nurse practitioners are to be funded through private health insurance, we’ll see more of them in private hospitals. And that could be really beneficial for patients.

“They are diverse professionals that are qualified to manage patients independently, and can help with the treatment of both general medical and specialist issues. They could be focused on reducing length of stays, readmission rates, preventing deterioration for – and generally making hospitals more efficient,” she said.

Despite these opportunities, Boase said there is “no clear way” to fund nurse practitioners in private hospitals and that a variety of efforts are needed to break down barriers.

“There are creative private hospital operators who are finding ways to do it, but this has limited the number of nurse practitioners we are seeing in private hospitals,” she said.

Additionally, there are misconceptions around the nurse practitioner role that need to be addressed.

In recent history, nurse practitioners had to fight for recognition of their skill level and salary band.

While their status has since been improved, Boase believes there is more to do in terms of shifting industry perceptions. Ironically, the best way to do this would be through funding, she argued.

“Acceptance of roles tends to change when funding does – and I think this is why we have such an under-utilised nurse practitioner workforce,” she said.
“At the moment, there’s a bit of a misconception that if it’s not funded then it’s not worthy – and the two things are actually very separate.

“We are different to doctors, there’s no question about that. But that doesn’t mean that we can’t actively contribute at a very high level,” she added.

Boase also believes the misconception comes from comparisons with Medicare – a system that tends to set a precedent for broader healthcare.

“My understanding is that there needs to be approval at the Medicare level before private health insurance can be accessed. And when our initial Medicare Access was established back in 2010, there was no consideration of the nurse practitioner role in private hospitals.

“Since then, there have been many improvements to how we can provide care in the primary healthcare system. We have the scope of practise, we have the authority as far as regulation, the Drugs and Poisons Acts – all of those other boxes are ticked. It’s just the funding that remains a barrier in private hospitals.”

Alongside misconceptions, Boase said there tends to be a specialist focus in managing chronic diseases at the policy level, which can mean nurse practitioners are unfairly overlooked.

“It’s great that a lot of work in the private sector is specialist focused – that’s what we need. But let’s not forget, a nurse practitioner is able to provide generalist services, and specialist services depending on their experience and education.”

“You might have patients admitted for a particular type of condition that’s managed under a specialty, and the nurse practitioner can provide assessment, and management of other underlying chronic diseases.

“They can reduce the potential for complications, relating to their reason for admission, and also prevent future complications and health deterioration. They also have a lot of experience in care coordination and case management for complex patients.”

With chronic disease on the rise, Boase said the urgency to act has already reached a “critical point”, but she is reassured by the industry consensus.
“It’s great that private hospital operators, private health insurers, etcetera are in agreement that we need to focus on chronic disease management in private hospitals – and that most are supportive of this approach.

“Of course, nobody is suggesting it will fix all the problems, but it will most certainly help, and significantly contribute to better outcomes.”

Despite the consensus, Boase believes there is a way to go before change is affected within government.

“We have had conversations. We’ve presented information. It’s been received with some positivity, but also an acknowledgement that it’s going to take a bit of work within the department to address this. Key changes need to be identified and approved, and legislation needs to change – so there is a bit of work ahead and a timeline associated with that.”

Hoping to spur the necessary conversations along, A/Prof Boase will present at the upcoming Health Insurance Summit, hosted by Informa Connect.

This year’s event will be held 23-24 June at the Crown Melbourne.

Learn more and register your tickets here.

About Leanne Boase

Adj. A/Prof Leanne Boase BN MN(NP), MHSc(Ed), MAICD, FACNP is the CEO of the Australian College of Nurse Practitioners, and Executive Director of Clinical Services for Luminar Health and Fullarton Clinic.

She has over 25 years’ experience working in a wide range of hospital and private health settings, including metropolitan and regional areas, and primary care. Leanne is a practising Nurse Practitioner, endorsed since 2009, working in her own primary care practice, and is a past President of The Australian College of Nurse Practitioners. Leanne has been involved in the education of undergraduate and postgraduate nursing students since 2004, and is an Adjunct Associate Professor with Latrobe Rural Health School.