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Resource Management in Primary Care

          An APRN that works in Family Practice specifically Family Nurse Practitioner (FNP) functions as the primary care provider in many different settings. Some of the settings that a family nurse practitioner can work in can be an inpatient in a hospital such as in an emergency room, a medical-surgical unit, or a critical care unit to name a few. A family nurse practitioner’s scope of practice also allows for them to work with specialties such as orthopedics or oncology and see patients in the hospital or clinic setting. Some of these specialties may require additional training and education. Other employment options for family nurse practitioners could be to work in a primary health care setting such as doctor’s office, urgent care, community outreach program, or own practice for full practice state.  
Becoming a family nurse practitioner will give you the opportunity to help all kinds of patients throughout the lifespan. You may find that you really enjoy working with children or you may really enjoy working with the geriatric population. Remember, regardless of the path you choose, we have a duty to our patients to do the best for them (Schlette, n.d.) 

          Allowing NPs to perform full practice was proven to have a tremendous impact on healthcare costs. Two different conditions that may have a significant impact on revenue in the care setting based on Joel’s textbook, Box 11.1, could be the Salaries and Wages and Total Operating Revenue. Based on a systematic review of 37 studies, Newhouse et al (2011) found consistent evidence that cost-related outcomes such as length of stay, emergency visits, and hospitalizations for NP care are equivalent to those of physicians. In 2012, modeling techniques were used to predict the potential for increased NP cost-effectiveness into the future, based on prior research and data. Using Texas as the model state, Perryman (2012) analyzed the potential economic impact that would be associated with greater use of NPs and other advanced practice nurses, projecting over $16 billion in immediate savings that would increase over time. 

          Collaborative NP-physician management was associated with decreased length of stay and costs and higher hospital profit, with similar readmission and mortality rates (Cowan et al., 2006; Ettner et al., 2006). The introduction of an NP model in a health system’s neuroscience area resulted in more than $2.4 million in savings the first year and a return on investment of 1,600 percent; similar savings and outcomes were demonstrated as the NP model was expanded in the system (Larkin, 2003). 


Resource Management in Primary Care 

An APRN working in a Community Health Center is responsible for making certain that the patient receives high-quality care. A Community Health Center reduces the disparities in healthcare by being available to see everyone and using a sliding scale for any uninsured patients. APNs play a role in coordinating with many professionals. At many Community Health Centers, a patient can preventive, integrative care that provides medical, dental, mental health, and health promotion all under one roof. Since a substantial portion of Community Health Centers is set up in poorer neighborhoods, an ANP needs to be savvy on the other needs of their patients in order to provide what they need to be healthy. APNs in Community Care Centers also help refer patients to social workers and set up connections for food and housing assistance. Nearly 50% of the patients that frequent the Community Health Centers are on Medicaid, with the ACA and federal funding from the ACA Community Health Center Fund having assisted in the expansion of care for many patients (Lewis 2019). 

Follow-up care from hospitals would be part of the care provided by the APRN at the Community Health Center. Hospital Acquired Infections are those infections that were not present when the patient was admitted to the hospital for treatment. These are also known as HAI’s. An HAI impacts a patient’s quality of life and increases treatment costs (Kirtil 2018). Two of these HAIs that may be seen in the Community Health Center by the APN are surgical site infections, and Catheter-associated urinary tract infections (UTI) that occurred while hospitalized (Joel 2018). Unfortunately, some patients are discharged prior to the infection manifesting symptoms, and they are found when doing follow-up cares. This affects the payments if associated with the hospitalization, and if a claim is placed against the hospitalization, or the patient is readmitted for this, payments may be reduced (Ericson 2021). HAIs can occur in any healthcare setting. 

These types of infections when treated by the APN at a Community Health Center affect the variable supplies budget due to the increased supplies required to treat the patient. It also affects the volume and productivity of the Center due to additional time spent with the patient and reducing time able to be spent with other patients (Joel 2018). Because of the decline in fee-for-service, if an HAI is established, the Community Center may not be reimbursed or may receive reduced payment for the care given. “Health Centers have increasingly worked to adapt or adopt innovative models of care that link payment to performance, with the goal of improving quality and cutting costs” (Lewis 2019 paragraph 22).

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