Medical-home concept drives debate about nurses


A state legislative push to create pilot programs to test the patient-centered medical-home concept has bled over into a long-running debate about advanced- practice nurses’ role in medicine.

That debate has taken on new urgency amid a statewide and national shortage of primary-care doctors.

Still, some advocates fear House Bill 198, which would create PCMH pilot projects in the Dayton area and Toledo, will stall if disagreements over the role of advanced-practice nurses aren’t resolved quickly.

“I think what we have right here right now is a tipping moment,” said Dr. Ted Wymyslo of Family Medicine Dayton. Wymyslo is a key orchestrator in the PCMH initiative.

The bill needs to “move favorably, or it might get mired and lose momentum,” Wymyslo said.

The Ohio Association of Advanced Practice Nurses is pushing for changes to the bill that would let not only primary-care physicians but also advanced-practice nurses head up PCMHs.

“We would like to be recognized as leaders of the medical-home model,” said Jacalyn Golden, legislative co-chair for OAAPN, which represents 8,000 advanced- practice nurses statewide and is based in Centerville.

Advanced-practice nurses want their outcomes to be compared with those of their physician colleagues through the proposed pilot programs, Golden said.

“If we’re not included in demonstration models, the research won’t bring to light what we believe to be quality, accessible alternative health care for Ohioans,” she said.

Testimony presented in October in favor of letting advanced- practice nurses lead medical homes claim APNs already account for 25 percent of all primary-care providers and are entering primary care at nine times the rate of physicians.

“The reality is we don’t have enough physicians,” Golden said. And she said advanced-practice nurses have proved themselves since they began providing primary care in 1965. “You just can’t discard us and dismiss us, say we’re not capable or competent.”

Advanced-practice and other nurses are an important part of the health-care delivery system, Wymyslo said. Still, he’s concerned that including APN-led medical homes in the study could undercut outcomes and stray from national, physician-crafted definitions of PCMHs. The Ohio State Medical Association also opposes letting advanced-practice nurses lead PCMHs.

“In Ohio, you can’t have a nurse-run practice,” Wymyslo said. “If you’re a nurse, you have to have a collaborative relationship with a physician.”

State Rep. Peggy Lehner, R-Kettering, one of the bill’s co-sponsors, said the bill was designed to promote education around how to run physician-led medical homes.

“We don’t need to be bogging it down with other groups,” Lehner said.

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