Affordable Care Act (ACA), Nurse Practitioners, and Provider Databases

The Affordable Care Act (ACA) has had an uneven beginning but appears to be gaining traction in expanding health insurance to uninsured Americans. The ACA will have an impact on Provider Databases as a result of increases in referrals and changes in referral patterns with new insurance networks.

One other ACA impact on Provider Databases results from the restrained growth in new physicians in the U.S. coupled with the increased retirement of the existing ‘boomer’ generation of physicians.

The demand/supply imbalance coupled with the desire to ameliorate the rise in healthcare costs will undoubtedly lead to greater use of ‘non physicians’ performing primary care services to patients. In particular there will be increases in the number of Nurse Practitioners providing healthcare and primary care services. The pharmacy networks, CVS and Walgreens, have reported to have opened over 1000 ‘Retail’ healthcare clinics staffed principally by Nurse Practitioners to provide primary care services ordinarily provided by physicians.

CVS in particular has announced adding almost 1000 more ‘Retail’ clinics in the next 3 years. This will have a large impact on referral patterns from primary care to more specialized sources of healthcare.

The accuracy required in legacy Provider databases for clinical communications, medical records, billing and continuity of care will be stressed by the Affordable Care Act because of new referral patterns and the need for care coordination. Unfortunately, accuracy is not achieved by Self-Reporting, the basis for all governmentally maintained Provider databases, nor by the historical posting of prior medical encounters. The only way to successfully achieve Provider Database accuracy is for a consistent, systematic and periodic ‘out reaching’ to Providers for direct verification of information.

FolioMed has spent over 30 years maintaining census Provider databases, including Nurse Practitioners, employing a combination of software algorithms and tools combined with proactive direct verification and data analysis. Because of its high data accuracy and interactive, real time process capabilities, FolioMed data has become a standard for many healthcare institutions and state agencies for direct data licensing and Provider database maintenance.

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September 2020
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