Right Roles for Clinicians

Re: "The Nurse Practitioner Will See You Now," July

Nurse practitioners and physician assistants are incredibly valuable to the physician-led health care team, but they are not the answer to the nation's health care workforce shortage. With a shortage of nurses and physicians, we need to increase the health care workforce overall so patients have access to the right care by the right professionals when they need it.

Increasing access to care in areas where nurse and physician shortages loom is a priority. Current research shows that even in states where nurses can practice independently, physicians and nurses continue to work in the same urban areas, so increasing the independent practice of nurses has not helped to solve the problem of shortage issues in rural areas.

Physicians, physician assistants and nurses have long worked together to meet patient needs for a reason — the physician-led team approach to care works. Physicians undertake 10 or more years of postgraduate medical education and have thousands of hours of clinical experience; many nurse practitioners have just three years of postgraduate education and less clinical experience than that obtained in the first year of a three-year medical residency. Patients win when each member of the health care team plays the role they are educated and trained to play.

To address the shortage issue and increase access to high-quality care for patients, the focus must remain on expanding the health care workforce overall and getting health care professionals in areas where shortages loom.

Cecil B. Wilson, M.D.
Immediate Past President
American Medical Association

Health Care's Sam Walton?

As I read the article "Health Care is not Walmart" (by Mary Grayson, June), I was struck with the fact that the author elevated Walmart to the unique plateau of being an entire industry.  Walmart is a single retailer that happens to touch the grocery industry, clothing industry, toy industry, health and beauty industry, and many others.  None of these industries are organized as systems — they are all as disorganized as health care. 

As a single entity, Walmart has made strategic decisions and investments to be successful on a scale that has never been achieved before in retailing, which no health care entity has really tried to achieve. Strategically, Walmart invested in IT, innumerable cost-reduction techniques, and logistics like no other peer — enabling it to glean information and make better decisions, which ultimately delivered higher value and saved the consumer money. There are a number of other examples from other industries that have delivered superior results as compared to their peers, too.

People forget that Walmart once was a single store. What Walmart is today is the result of leaders with a vision of a new future state that then went about creating it. Leaders like Sam Walton, Jack Welch or Steven Jobs breathed life into their respective companies and in due course into their industries … sometimes bringing a bit of organization to all the chaos. Where will a leader arise from health care who can do the same?

Todd J. Bille

Departmental Cooperation

Re: "Integrate Your Revenue Cycle," June

While supply chain executives focus on negotiating the most favorable contracts, they risk unfavorable prices and terms if they don't know how much their hospital gets reimbursed versus its costs. At a time when hospitals must do more with less, supply chain leaders must promote integration of the supply chain and the financial departments as a strategy for achieving real savings. Working together, these departments can ensure that the hospital is not overpaying for its supplies, charges and gets paid for the items it uses, and isn't racking up unnecessary expenses.

In today's resource-challenged health care environment, revenue cycle integration is nothing less than essential.

Christopher J. O'Connor
President, Nexera Inc.
Executive Vice President, GNYHA Ventures Inc.
Greater New York Hospital Association