for Medicare reimbursement Safriet 1998 The law providing Medicare Part B

For medicare reimbursement safriet 1998 the law

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for Medicare reimbursement ( Safriet, 1998 ). The law, providing Medicare Part B direct payment to NPs and CNSs, regardless of their geographic area of practice, allowed both types of APNs to be paid 85% of the fee paid to physicians for the same services. Moreover, the law's inclusion and definition of CNSs corrected the previous omission of this group for reimbursement ( Safriet, 1998 ). The possibility of reimbursement for services was an important step in the continuing development of the CNS role because hospital administrators would continue to focus on the cost of having APNs provide patient care. Some CNS roles require prescription of medications and the ability of a CNS to prescribe depends on state regulations. As of January 2012, CNSs have independent prescriptive authority in 11 states and in Washington, DC, no prescribing authority in 15 states, and nonindependent prescriptive authority in the remaining 24 states ( National Council of State Boards of Nursing, 2012 ). Nurse Practitioners Early Public Health Nurses' Role in Direct Care The idea of using nurses to provide what we now refer to as primary care services dates to the late nineteenth century. During this period of rapid industrialization and social reform, public health nurses played a major role in providing care for poverty-stricken immigrants in cities throughout the country. In 1893, Lillian Wald, a young graduate nurse from the New York Training School for Nurses, established the Henry Street Settlement (HSS) House on the Lower East Side of Manhattan. Its purpose was to address the needs of the poor, many of whom lived in overcrowded, rat-infested tenements. For several decades, the HSS visiting nurses, like other district nurses, visited thousands of patients with little interference in their work ( Wald, 1922 ). The needs of this disadvantaged community were limitless. According to one account ( Duffus, 1938 ): There were nursing infants, many of them with the summer bowel complaint that sent infant mortality soaring during the hot months; there were children with measles, not quarantined; there
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were children with ophthalmia, a contagious eye disease; there were children scarred with vermin bites; there were adults with typhoid; there was a case of puerperal septicemia, lying on a vermin-infested bed without sheets or pillow cases; a family consisting of a pregnant mother, a crippled child and two others living on dry bread … a young girl dying of tuberculosis amid the very conditions that had produced the disease … ( p. 43 ). In addition to making home visits, the HSS nurses saw patients in the nurses' dispensary in the settlement house. There they treated “simple complaints and emergencies not requiring referral elsewhere” ( Buhler-Wilkerson, 2001 ). For a time, their work usually went unnoticed, but interprofessional conflict was inevitable. According to nurse historian Karen Buhler-Wilkerson (2001) : As the number of ambulatory visits grew, the settlement risked attracting the unwelcome attention of the increasingly disagreeable “uptown docs.” The New York Medical Society's
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