One currently available resource for examining the role of providers in primary care is the National Provider Indicator (NPI). While the NPI is a mechanism for tracking billing services, this data source at the Centers for Medicare and Medicaid Services (CMS) could be thought of as an opportunity to collect workforce data and conduct research on those nurses who bill for services, primarily nurse practitioners. The committee believes the NPI presents a unique opportunity to track and measure nurse practitioners with regard to their practice, such as where they are located, how many are billing patients, what kinds of patients they are seeing, and what services they are providing. These data would be a significant contribution to the supply data currently being collected, adding to the knowledge base about practice partnerships, utilization of services, and primary care shortages. The committee encourages CMS to make these data available in a useful way to workforce researchers and others who might contribute to this knowledge base. prendre 40 mg de tadalafil clear maca und cialis also naltrexone for weight loss 50 mg recently tadalafil in thailandia.
The current state of the U.S. economy and its effects on federal, state, and local budgets pose significant challenges to transforming the health care system. These fiscal challenges also will heavily influence the implementation of the committee’s recommendations. While providing cost estimates for each recommendation was beyond the scope of this study, the committee does not deny that there will be costs—in some cases sizable—associated with implementing its recommendations. These costs must be carefully weighed against the potential for long-term benefit. Expanding the roles and capacity of the nursing profession will require significant up-front financial resources, but this investment, in the committee’s view, will help secure a strong foundation for a future health care system that can provide high-quality, accessible, patient-centered care. Based on its expert opinion and the available evidence, the committee believes that, despite the fiscal challenges, implementation of its recommendations is necessary. utilizzo di tadalafil within viagra cialis bangkok also naltrexone alcoholism medication for sale now tadalafil 30 tablet fiyatları. The United States has nearly 400,000 primary care providers (Bodenheimer and Pham, 2010). As noted in Chapter 3, physicians account for 287,000 of these providers, nurse practitioners for 83,000, and physician assistants for 23,000 (HRSA, 2008, Steinwald, 2008). While the numbers of nurse practitioners and physician assistants are steadily increasing, the number of medical students and residents entering primary care has declined in recent years (Naylor and Kurtzman, 2010). In fact, a 2008 survey of medical students found only 2 percent planned careers in general internal medicine, a common entry point into primary care (Hauer et al., 2008).
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