Collaborators for change

Because it requires forging alliances among all pediatric providers to initiate and effectively change policies to provide quality healthcare for all children and adolescents, this is a tough one: a collaboration that may not be embraced by everyone. Policy changes are needed in the current government oversight and insurance regulations as current policies adversely influence child healthcare. This is the theme embedded throughout the words of Dr Andrew Schuman, as he reflects upon better times for pediatric practices and, with tongue firmly planted in cheek, impishly borrows a political campaign slogan for the title of his article, Make pediatric practice ‘great again’!

What have we lost?

In his article, Dr Schuman discusses practices in the 1980’s when pediatric practices were about caring for children and helping families raise healthy children, rather than the pediatric practices of today that are immersed in problems. Problems include insurance companies limiting access to needed medications and diagnostics tests; requirements for prior authorizations and the staff time to obtain the authorizations; and electronic health records that hinder practice productivity, rather than support practice documentation. Is it possible to provide quality care to the children when these practice issues abound not only for pediatricians but also for pediatric nurse practitioners (PNPs)?

Care quality or economics?

Furthermore, many hospitals have purchased private pediatric practices, often with the unintended outcome of limiting access to pediatric healthcare providers. Another emerging trend from Affordable Care Act incentives is the opening of urgent care centers without the availability of pediatric providers at critical times when the child is ill. With these substantial changes in the provision of care to children-including restrictive regulations and access to pediatric providers-we must question: Are policy decision-makers focused on providing quality health care for infants, children, and adolescents or focused on economic issues?  

Bonding for betterment

I believe a very strong bond between pediatricians, PNPs, and all pediatric providers is the desire to provide quality healthcare for all infants, children, and adolescents. Our collaborative efforts in rethinking the current way services are approved for children, removing the barriers that impede practice, and assuring that every child has access to a pediatric provider will significantly benefit children and their families.

Pediatric nurse practitioners are faced with significant regulatory barriers despite the Institute of Medicine Future of Nursing Report (2011) that supported nurse practitioners (NPs) practice to the full extent of their education. Nurse practitioners have been battling for years to change a national regulatory law that denies their patients access to home health services and durable medical equipment if ordered by a NP. Not only are children denied these services by this regulation, but also every patient throughout the United States is denied these services when ordered by a NP. Really, does that make sense to anyone?