02/07/2014 04:57 pm ET Updated Apr 09, 2014

3 Words Could Save Billions in Healthcare Costs

Nelson Mandela said,"It always seems impossible until it's done." This is not impossible. The three little words will not cost anything to implement and will save American taxpayers billions. But here's the catch: Politicians have to agree on the three words.

Spending on healthcare is expected to be $478 billion by 2021. Even though consumers have been cutting back on doctors' visits, which means health-care spending will be nearly a fifth of the U.S. economy, at 19.6 percent of gross domestic product. The government share of the spending would be nearly 50 percent.

At the same time, the United States is short about 16,000 primary care doctors..

My friend Lois discovered this when she retired, moved to the Eastern Shore of Maryland (where I live) and found it impossible to find a doctor that would take her. She has a brand new Medicare card but the internists in the area do not accept Medicare patients. (The reimbursements to physicians are lower than private insurance rates.)

So, Lois turned to the only health-care provider in Talbot County that is accepting Medicare, Susan Delean Botkin, a nurse practitioner.

This is not unusual. It's happening across the country. Nurse practitioners are not physicians. They are nurses. However, they are nurses who have undergone extensive advanced training. Today, there are more nurse practitioners than primary care physicians nationwide.


Of the 250,000 nurse practitioners, 84.9 percent see patients covered by Medicare and 83.9 percent by Medicaid. According to the American Association of Nurse Practitioners, malpractice rates are low; only 2 percent have been named as the primary defendant in a malpractice case.

The nurse practitioners are helping with the shortage by filling a need, but they are being hampered by the law. Only 17 states plus Washington D.C. now allow nurse practitioners to practice autonomously or to the full extent of their education and licensure:

This means, for instance, that if Susan Delean Botkin has a patient who needs to be certified for Hospice, by Medicare Legislation she cannot authorize it. She has to call a physician to sign the authorization for her patient. The doctor then bills for an appointment, too, and taxpayers pay double.

If she has a Medicare patient who needs a nebulizer, as a nurse practitioner she can't authorize that. A physician has to approve first, and again, it is double billed... at taxpayers' expense.

You would think that with the projected shortage of primary care physicians over the next couple of decades, utilizing nurse practitioners to pick up the slack would be a desired option. Then, what's the issue?

It seems to be purely territorial. The doctors want the nurse practitioners to handle the Medicare patients but they don't want to give up control. Some nurse practitioners pay $5,000 per year to contract with a physician, which guarantees that the physician will take their Medicare patients when they need services such as being certified for a walker, or home health care, etc.

The law reads now: A physician can authorize durable medical goods, hospice and home care. It should read: A physician or nurse practitioner can authorize durable medical goods, hospice and home care.

Just add three words. It will not cost anything. It will save the taxpayers money. It is not an insurmountable issue like balancing the budget... or heaven forbid... Congress agreeing on healthcare costs.

But no. Representatives from the American Association of Nurse Practitioners (a nonprofit organization) have visited every Maryland Congressional Representative and every Senator. Even though it is not going to cost anything to implement because there is no budget item required and it will save the taxpayers billions, nothing happens. No movement.

Susan Delean Botkin says, "There is just too much rancor over healthcare to make this happen. Period."

So the question is this: Are our elected officials locked in a conventional view of the way things work, at our expense? Are they stuck with selfish motives and preconceived ideas? Or can they recognize true solutions?

I believe in Nelson Mandela's leadership style. People can be counted on to respond to the power of truth. Impossible things happen all the time. This is not impossible. It's just three little words. Come on Congress. Wake up and smell the cooperation.