Nurse practitioner-owned practices and value-based payment.

BACKGROUND: The United States is steadily shifting away from volume-based payments toward value-based payment for health care. The nursing model's emphasis on high-value care, such as disease prevention and health maintenance, ideally positions nurse practitioner (NP) practice owners to contribute to the goals of value-based care. However, little is known about NP participation in value-based care. PURPOSE: To better understand NP-owned practice participation in value-based care. METHODOLOGY: Using convenience sampling, we developed a registry of NP owned practices, which we used to conduct a web-based survey from November 2019 to February 2020. RESULTS: Of the 47 NP-owner respondents, 40 practice in primary or specialty care. Practices are relatively small with a mean clinical staff of 4 full-time equivalent (FTE; range: 1-17), mean total staff of 7 FTE (1-28.5), and with a mean of 325 patient visits annually. A third participate in value-based payment arrangements, whereas a half are considering and three quarters are knowledgeable about value-based payment arrangements. Over 70% of practice owners report lack of knowledge, lack of financial protections, and lack of payer partnership as barriers to participation in value-based payment models. CONCLUSIONS: NP practice owners face many challenges to taking on risk, including insufficient patient volume. IMPLICATIONS: Joining together may allow small NP practices to participate in and thrive under value-based payment. Reducing the barriers and regulation of all NPs will enable the health care system to capitalize on the nursing model to meet the goals of value-based care.

Nurse Characteristics and the Effects on Quality.

The release of a quality study by the Institute of Medicine in 2001 challenged health care providers to deliver safe, quality care. Research has focused on 2 primary categories of nursing characteristics: demographic data and emotional intelligence and personality traits. The research has shown a correlation between nursing characteristics and quality care and patient outcomes. Factors not considered in this article include hospital teaching status, type of unit, unit skill mix, hospital safety culture, and total nursing hours per patient day. These factors may contribute to quality of care and patient outcomes.