The Role of Nurse Practitioners in Healthcare | Secretary Alex Azar’s Remarks to the AANP


Good morning, and thanks to all of you for
having me here today. It is always a pleasure to address healthcare
providers who are on the frontlines of improving Americans health and well-being, but I am
especially grateful for such an opportunity at this particular time in our history. As the U.S. and the entire world, confronts
the challenge of the novel coronavirus, we are asking more than ever of our healthcare
practitioners and I have great confidence that all of you will rise to this challenge. So, before I turn to discussing the role of
nurse practitioners in our healthcare system more generally, I thought it might be useful
to provide an update to you on the response to the COVID-19 outbreak. So President Trump has made the safety, security
and health of the American people his top priority from day one of our response on the
outbreak. Our hearts go out to people affected by this
virus and our gratitude goes out to everybody who has helped respond so far, including those
of you who have been on the frontlines of this response. The Presidents bold actions to restrict travel
and impose historic federal quarantines have bought incredibly valuable time for our healthcare
system to prepare for the virus and for the possibility that we need to mitigate its spread
here. When we talk about how Americans can be reassured
that they have the worlds best healthcare and public health systems, we’re talking about
the confidence that we have in providers like you. America’s healthcare system is that much stronger
because we have a diverse, flexible healthcare workforce that includes our 290,000 nurse
practitioners. Wherever you work whether you serve patients
at your own practice, in an emergency department, at a community health center, or elsewhere
I am grateful for the work all of you have already done to keep Americans safe, and I
want to thank you for your dedication in the weeks and months to come. At this time, as we have said, the risk to
most Americans from COVID-19 remains low. But that risk can be higher for those who
may have exposure to confirmed cases and for those who have traveled to affected areas. In addition, we now know that older people
and people with severe underlying health conditions are at higher risk of serious illness or death. Conditions that raise the risk can include
lung disease, cancer, heart disease, stroke, renal disease, liver disease, diabetes, and
immunocompromising conditions. The CDC has put out guidance to remind people
who fall into these groups, and families who live with them, that they should be taking
particular actions to prepare and protect themselves. That means community planning around COVID-19
should take into consideration the needs of older adults in particular. Long-term care facilities and home healthcare
services need to be especially vigilant about this virus, for which the CDC has provided
specific guidance. Generally, older adults and people of all
ages with severe underlying health conditions should be taking steps to limit their risk. On top of avoiding contact with people who
are sick, washing their hands often, and paying attention for particular symptoms, they should
also avoid crowds and places where people gather together in groups, especially in poorly
ventilated sites. The CDC will be working to spread this information
to these populations at particular risk, and I want to encourage all of you to do so as
well please. More generally we have created coronavirus.gov
where you can find useful tools and information including guidance for families, employers
and schools which we posted just last night. This public health awareness work is just
one piece of our unprecedented whole-of-government approach to protect the American people. At the end of January, the President established
the White House Coronavirus Task Force, and in recent weeks, he has added Vice President
Pence to lead the overall, whole-of-government response, as well as Ambassador Debbie Birx,
a career global health diplomat and infectious disease expert, to serve as White House Coordinator
for the response. We at HHS and the White House have been aggressively
reaching out to governors and other state and local officials, as well as private industry
and provider groups, to ensure we are well-prepared. We’ve been in especially close contact with
officials in the state of Washington regarding the outbreak there, to provide them with the
expertise they may need. As you know, on Friday, President Trump signed
a supplemental funding bill that provided $8.3 billion for the COVID-19 response. The legislation includes more than $3 billion
to support development of vaccines, diagnostics, and therapeutics. It includes nearly $1 billion for medical
supplies, healthcare preparedness, and surge capacity, including the purchase of supplies
for the Strategic National Stockpile, which exists to meet emergency shortages of medical
countermeasures. There is more than $2 billion in funding for
public health preparedness at CDC, including nearly $1 billion to support state and local
governments. Finally, there is $300 million in funding
to support the affordability of an eventual vaccine. I want to give you a sense of how that work
is already proceeding on each of these fronts right now. Late last month, the NIH launched the first
U.S. clinical trial for an investigational antiviral for the virus, at the University
of Nebraska Medical Center, and other trials are ongoing around the world. Meanwhile, while we’re still in the early
stages of development on vaccine, we hope to have an effective vaccine in as little
as a year to a year and a half. We’ve been extremely focused on expanding
our testing capacity so that healthcare providers can test patients as needed. By the end of this past week, 1.1 million
tests had been shipped out, to public health labs, to hospitals and to private labs, made
by the CDC and by a private manufacturer. At this time another 1 million tests are available
to fill orders for being shipped. We literally have a surplus at the moment
of available tests to fill orders. This private manufacturer, and a number of
other private manufacturers, are now ramping up production of their tests such that they
will have produced an additional 4 million tests by the end of this week. We’re also aware that the outbreak will likely
have some impact on the medical product supply chain, so we’ve been paying close attention
to that issue. FDA has been proactively reaching out to hundreds
of manufacturers to gather information about the supply chain, and we have identified one
shortage so far, and is prepared to use the full range of tools they have, and often use,
to mitigate shortages. Fortunately, the one we have identified has
abundant readily available alternatives that can be used for a generic medicine. We’re keenly focused on making sure that you
as frontline healthcare responders like you have the protective equipment you need for
treating patients. The FDA and CDC already took action to expand
the array of respirators available for use by healthcare professionals. In addition, last week, we put out a solicitation
to purchase 500 million N95 respirators over the next 18 months for the Strategic National
Stockpile. Our procurement is encouraging manufacturers
to ramp up production immediately, knowing that they won’t be stuck with leftover product. To the extent you are involved in running
a healthcare organization yourself, or assist with preparedness planning in your own workplace,
please ensure that your organization is continuing to review the plans you have, lean in on preparedness,
and be ready to execute on any necessary actions. Please be especially mindful of infection
control and your protocols for minimizing spread from individuals coming to you or your
organization for evaluation and treatment. I will encourage your organizations, as needed,
to be in touch with us through our Office of Intergovernmental and External Affairs,
and please be in touch with your state and local public health departments as well. They are the trusted source. They are at the front lines for any preparedness
and response. And, of course, you don’t need me to remind
you of what good hygiene and basic best practices for keeping healthy looks like. Over the past few weeks, I feel like I’ve
told a lot of people how to properly wash their hands, but I know you all have a lot
more practice at that than I do. I must say I am personally delighted that
we are advising moving away from hand shaking to elbow bumping, or a graceful nod of the
head. I always wanted that so. For a one-stop resource for recommendations
like this, I encourage you to remind your patients that they can find the latest information
at coronavirus.gov. That links into all the CDC resources there
we have got basic fact sheets and information. I am an individual patient. I think I might have coronavirus, what do
I do? It walks you through that. It walks you through for providers. What should you be doing. What are common questions that you should
be prepared to answer. We also, today. So last night as I mentioned we put out some
really important guidance based on an Australian peer reviewed study of basic measures that
families, employers and schools can and should take in a situation like that so that’s available
at coronavirus.gov. Today I anticipate us publishing our concrete
guidance and recommendations to California, the State of Washington and New York for community
mitigation steps. We coordinated that with the governors and
local health officials. And then hopefully later this week our goal
is to publish a matrix of recommendations on community mitigation. Approaches based on whether you are seeing
any spread of the disease in your community. Sporadic or if you are seeing community spread. And then what that guidance might look like
for individual family members, employers, for schools and for public health leaders
and governments. So that whole matrix, just a transparent set
of recommendations out there for all as they might see any type of spread. So now, let me to turn to the topic of today’s
conference: the role that nurse practitioners and allied health professionals play not just
in providing healthcare for Americans at times of stress for our healthcare system, but also
generally in making healthcare more accessible and more affordable every day. As some of you may know, one step forward
in the ongoing expansion of the role of nurses and nurse practitioners actually occurred
in a time of crisis. During the Vietnam War, American service members
in the field were often treated for serious conditions by non-physicians, like medical
corpsmen and nurses. When they returned home, there was a much
broader realization of the role that nurse practitioners, physician assistants, and other
allied health professionals can play in expanding access to healthcare. Decades later, there is still room for our
system to grow in recognizing and rewarding the value provided by nurse practitioners,
but much progress has been made. Your work to expand access to care, especially
primary care, is absolutely essential to delivering the kind of healthcare system that this administration
envisions. We have promised an affordable, patient-centric
system that puts you in control, and treats you like a person, not a number. The driving force behind our efforts is to
protect what works and make it better. In more tangible terms, here’s what that means:
We’re going to protect Americans ability to choose the insurance plans and providers that
work for them, while delivering that experience with lower costs, less paperwork, more options,
and more individual control. Importantly, a patient-centered, personalized
healthcare system also means lower burdens on providers and opportunities for providers
like NPs in particular. Just yesterday, we finalized our historic
rules around interoperability of healthcare information, so that patients will have easy,
digital access to their records at no cost. Through what are known as application programming
interfaces, or APIs, patients will be able to use smartphone apps to have all their health
records and health claims data easily at hand. Today, all that time patients are spending
to assemble hard copies of their records and all that time you spend sending faxes and
CDs can be replaced with the work of an app that seamlessly gathers and retains all that
information. Just think of it, if any of you use a Quicken
or Turbotax, you have an app that meets your needs for a purpose but you can have it pull
in data from every financial institution where you have your credit cards your bank accounts
or investment accounts. It all can seamlessly come in wherever you
are being in control. You choose the app developer; you choose the
app that meets your needs. Maybe you’re a diabetic, maybe you’re suffering
from autoimmune disease and it lets all that information be there to actively engage you,
help you manage your condition as a patient but you as a provider that information will
be readily accessible when speaking with any of your patients so you don’t have to worry
are you getting that senior citizen’s right list of medications, are you getting their
full medical history or understanding all the comorbidities, you’ve got to be thinking
about. It could all be sitting right there in the
patient’s control and accessible to you. This shift will benefit all providers, and
we’ve also made sure that our general burden reduction efforts are reaching all allied
health professionals. So far, we estimate that CMS’s Patients over
Paperwork initiative has saved the healthcare system at least $6.6 billion and eliminated
42 million hours of provider burden through 2021. Some of you are aware of one specific change
we made to free up time for allied health professionals. Based on feedback we were getting from clinicians,
CMS modified its documentation policies so that NPs and other allied health professionals
can just review and verify, rather than re-documenting, notes made in the medical record by other
professionals, medical students, or other members of the care team. We’ve already
heard positive feedback about the benefits this change has had for both clinicians and
their students. But we want to go further than just relieving
paperwork burdens for you. We’re exploring every avenue possible to support
allied health professionals ability to practice to the top of your license and be fairly reimbursed
for it. (applause)
That was a specific ask made by President Trumps executive order on strengthening and
protecting Medicare, and we’re hard at work on that. And I can tell you I am personally passionate
about this. I’ve got an RN mother and ophthalmologist
father so I’ve got a little conflict in the family. But I side with all professionals practicing
at the top of their training anywhere in the United States. One opportunity we’ve recently launched is
the CMS Innovation Center’s Primary Cares initiative, which has a range of voluntary
payment models that we expect to enroll up to one-quarter of Medicare beneficiaries. NPs who run otherwise eligible primary care
practices can participate, and I appreciate that AANP has already been working to drive
interest in these critical models. They represent what we hope to be the future
of not just primary care, but healthcare more broadly: where the patients are at the center;
where the provider is paid for health and outcomes, rather than procedures and paperwork;
and where your primary care provider is your home within the healthcare system. We need to start paying for the what and not
the how. Basically our model is the more you are owning
the risk of managing the person’s life and cost of care, the less we have to micromanage
and regulate the procedure of how you do that and get out of the way and enable you to really
decide how to care for your patients. We know there are real benefits to expanding
nurse practitioners ability to lead primary care practices. One study found that patients with multiple
chronic conditions, which are a focus of ours at HHS, have lower costs and fewer inpatient
visits when their primary care is overseen by a nurse practitioner or physician assistant. To maximize these benefits, we often need
to see reform at the state level, too. Medicaid’s ability to pay for services by
allied health professionals without physician supervision, for instance, is limited by whether
states require that supervision. Issues like this were a focus of a historic
report that the Trump administration published at the end of 2018, and we have been strongly
encouraging states to examine how regulations like these are getting in the way of better
care and lower costs and access for their citizens. The Trump Administration has also identified
some particular, impactable public health challenges to focus on, where nurse practitioners
often have a key role to play. I’ll mention two in particular, which often
intertwine: our country’s crisis of opioid addiction and overdose, and our country’s
rural health crisis. When I began working on the opioid crisis
as Secretary, I made a very clear commitment: Our work has to be science- and evidence-based,
and the science and evidence on opioid use disorder are clear. The gold standard of treatment is medication-assisted
treatment, and more Americans need access to it. Thankfully, we are seeing real progress: In
2019, our estimates suggest more than 1.3 million Americans were receiving medication-assisted
treatment up 38 percent since 2016. Nurse practitioners have played a key role
in that. As many of you know, since Congress gave nurse
practitioners the ability to receive DATA waivers to prescribe buprenorphine, the number
of NPs who can provide this treatment has exploded. Today, there are more than 19,000 nurse practitioners
and other advanced practice nurses who are waivered to prescribe buprenorphine, and I
know that AANP has played a role in providing the necessary training. We’ve done our part through regulatory work
at HHS, too, with SAMHSA substantially expanding the number of patients that NPs can treat
with a waiver. Best of all, many of the waivered NPs are
in places where access is needed most. One study found that Medicaid beneficiaries
were especially likely to receive buprenorphine from an allied health professional, and rural
areas have benefited disproportionately. In fact, in 285 rural counties across America,
the first prescriber of buprenorphine to receive a waiver was a nurse practitioner or physician
assistant. That’s counties that are home to 5.7 million
Americans, now with the ability to access MAT. That brings me to the final point I wanted
to make: the vital role that nurse practitioners can play in expanding access to healthcare
in rural America. For decades now, CMS-certified Rural Health
Clinics have been making full use of the practicing capabilities of nurse practitioners, and we
recently expanded these 4,500-plus clinics ability to be reimbursed for virtual check-ins. The areas I’ve just identified, where NPs
have such an important role to play, represent some of the key focuses for the future of
healthcare in America: How can we put the patient at the center, and help providers
focus on health and outcomes rather than procedures and paperwork? How can we tackle the particular health challenges
we face? How can we ensure that Americans receive the
best quality care while also keeping it affordable? The answer, so often, is going to be empowering
nurse practitioners and allied health professionals. That means all of you, especially the students
we have in this room, have an incredibly bright and exciting future ahead of you. I believe there has never been an administration
that is as focused on expanding your ability to provide care and take a leading role in
improving patients health. So I want to encourage you to continue bringing
your ideas to us about how we can empower you. As I mentioned, the President’s goal is to
protect what Americans love about our healthcare system, but with less paperwork, lower costs,
more options, and more control. Delivering that vision is going to mean more
of the personalized, patient-centered care for which nurse practitioners have long been
renowned. So thank you for your efforts in that direction
already, thank you for the work you are doing on the frontlines of our healthcare system,
and thank you again for your very warm hospitality today. Thanks

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