‘Advanced Practice’ or ‘Scope Creep?’

ʯ Authorize certified nurse-midwives (CNMs) to bill for services related to training medical interns and residents in obstetrics in teaching facilities.

ʯ Enable CNMs to be included alongside nurse practitioners and physician assistants as providers eligible to certify and recertify a Medicare beneficiary for home health services without being subject to physician supervision.

ʯ Enable CNMs to issue a prescription or written order for durable medical equipment, prosthetics, orthotics

Who’s who in the exam room

Physician assistants

Physician assistants are healthcare professionals licensed or credentialed to practice medicine with physician supervision. According to the American Academy of Physician Assistants, they generally can: ʯ Take medical histories ʯ Conduct physical exams ʯ Diagnose and treat illness ʯ Order and interpret tests ʯ Develop treatment plans ʯ Prescribe medication ʯ Counsel on preventive care ʯ Perform procedures ʯ Assist in surgery ʯ Make rounds in hospitals and nursing homes ʯ Do clinical research ʯ Counsel on preventive care

Despite the current healthcare workforce shortage, the PA profession continues to grow, says Jennifer Orozco, president and chair of the AAPA, noting that the Bureau of Labor Statistics estimates the profession will grow 28% between 2021 and 2031. “PAs account for more than 500 million patient visits each year –a number that will continue to grow as we push to modernize healthcare teams and use every team member to the fullest extent of their education and training,” she says.

In 2021, the AAPA passed a policy affirming “physician associate” as and supplies (DMEPOS) to Medicare beneficiaries as well as provide face-to-face encounters without being subject to physician supervision.

“Modern healthcare requires flexibility,” said ANA President Ernest Grant, PhD, RN, FAAN, when ICAN was introduced. “We cannot not be hindered by antiquated barriers to practice or petty turf wars over perceived hierarchies. The health of our patients and communities must come first.” the official title for the PA profession. (The title will be phased in over time.) “The new title directly addresses the common misperception that PAs merely ‘assist’ physicians, when in reality, they do so much more,” she says.

Advanced practice registered nurses

Advanced practice registered nurses hold at least a master’s degree in addition to the initial nursing education and licensing required for all registered nurses (RNs). They include nurse practitioners, clinical nurse specialists, nurse anesthetists and nurse midwives.

Nurse practitioners (NPs) take health histories and provide complete physical examinations; diagnose and treat common acute and chronic problems; interpret laboratory results and imaging studies; prescribe and manage medications and other therapies; provide health teaching and supportive counseling; and refer patients to other health professionals as needed. An NP’s practice may also include education, research, and administrative services. Specialty areas include: ʯ Acute care ʯ Adult health ʯ Family health ʯ Gerontology ʯ Neonatal health ʯ Oncology ʯ Pediatric/child health ʯ Psychiatric/mental health ʯ Women’s health

Clinical nurse specialists are advanced practice registered nurses who have graduate preparation (a master’s or doctorate) in nursing, according to the National Association of Clinical Nurse Specialists. In the majority of states, clinical nurse specialists must obtain certification based on a population area. Current certification examinations based on population include: ʯ Adult/gerontology ʯ Pediatrics ʯ Neonatal

“CNSs are unique and one of the most versatile APRNs,” says Phyllis Whitehead, PhD, CNS/APRN, ACHPN, PMGT-BC, FNAP, FAAN, president of the National Association of Clinical Nurse Specialists. “They can work at hospital/health systems, medical practices, longterm care facilities, retail clinics, and home care.” The top 10 hospitals in the country employ CNSs, she says, and 62% of CNSs work in hospitals that are either accredited by the American Nurses Credential Center Magnet™ Recognition Program or are seeking accreditation.

Is Responsible For Over 10 Million Visits To Physician Offices Per Year

Cepheid’s Xpert® Xpress MVP test aids in diagnosing conditions related to vaginitis

Vaginitis and vaginosis are responsible for over 10 million visits per year to physician offices by women in the U.S., making it the most common gynecologic diagnosis in primary care.1

The Xpert® Xpress MVP (multiplex Vaginal panel) test from Cepheid is a new FDA-cleared on-demand PCR test designed to aid clinicians in diagnosing distinct sexually transmitted infections, including bacterial vaginosis (BV), Candida species associated with vulvovaginal candidiasis, and trichomoniasis, that cause overlapping symptoms in women and potential co-occurrence.

“There’s a significant need in the marketplace for this test,” said Cisco Merrill, National Sales Director, Alternate Site for Sunnyvale, Calif.-based Cepheid.

Easy-to-use testing

The test is for patients ages 18 and up. Its single sample collection is designed to run on the easy-to-use GeneXpert® systems for increased efficiency and to reduce repeat visits. And its easy-to-use testing provides physicians with same-day results for appropriate treatment the first time. There is less than one minute of hands-on time and results within one hour.

“Patients may present with what’s considered cross infections and will test positive for one or two of these different infection states,” Merrill said. “But if a clinic is only testing specifically for one infection state, something may be missed. So, a patient might not get put on a good treatment plan.”

Merrill says this can lead to mistrust for patients.

“It’s a sensitive subject,” he said. “So, the ability to test in-house and meet and treat in one visit is powerful.”

“Our Xpert Xpress MVP test allows clinicians to test for three different infection states,” he continued. “That way, the treatment can align with the ailment. These infection states present similarly but are treated very differently. Getting patients on the right path to recovery is a winning proposition that resonates with our distributor reps and their customers.”

Target markets

Most women depend on their primary care physician or OB-GYN to diagnose vaginitis and vaginosis. But urgent care is also emerging as an alternative market. These markets, as well as labs that reps usually call on, are four primary target markets for the Xpert Xpress MVP test.

“It’s a moderately complex test and we have a very strong program that helps customers transition from waiver to moderate complexity,” Merrill said. “A strategic team will assist throughout the entire licensing process and the team can also work with licensing agencies that assist clinics from waiver to moderately complex.”

Merrill says Cepheid is seeking a CLIA waiver but launched the Xpert Xpress MVP test in the moderately complex category.

Cepheid’s GeneXpert systems and Xpert tests automate highly complex and time-consuming manual procedures for institutions of any size to perform best-in-class PCR testing.