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Remarks to American Association of Nurse Practitioners

Alex M. Azar II
American Association of Nurse Practitioners
March 10, 2020
Washington, D.C.

Your work to expand access to care, especially primary care, is absolutely essential to delivering the kind of healthcare system that this administration envisions

As Prepared for Delivery

Thank you, Sophia, for that introduction. Good morning, everyone, and thank you so much for having me here today.

It is always a pleasure to address healthcare providers who are on the frontlines of improving Americans' health and well-being, but I am especially grateful for such an opportunity at this time.

As the United States, and the entire world, confronts the challenge of the novel coronavirus, we are asking more than ever of our healthcare practitioners—and I have great confidence that all of you will rise to the challenge.

So, before I turn to discussing the role of nurse practitioners in our healthcare system more generally, I want to provide an update on the administration's response to the COVID-19 outbreak.

President Trump has made the safety, security and health of the American people his top priority from day one of our response to the outbreak.

Our hearts go out to people affected by this virus and our gratitude goes out to everyone who has helped respond so far, including those of you who have been on the frontlines.

The President's bold actions to restrict travel and impose historic federal quarantines have bought incredibly valuable time for our healthcare system to prepare for the virus and for the possibility that we need to mitigate its spread here. When we talk about how Americans can be reassured that they have the world's best healthcare and public health systems, we're talking about the confidence we have in providers like you.

America's healthcare system is that much stronger because we have a diverse, flexible healthcare workforce that includes our 290,000 nurse practitioners. Wherever you work—whether you serve patients at your own practice, in an emergency department, at a community health center, or elsewhere—I am grateful for the work all of you have already done to keep Americans safe, and I want to thank you for your dedication in the weeks and months to come.

At this time, the risk to most Americans from COVID-19 remains low. But that risk can be higher for those who may have exposure to confirmed cases and for those who have traveled to affected areas. In addition, we now know from the progression of the disease that older people and people with severe underlying health conditions are at higher risk of serious illness or death.

Conditions that raise the risk can include lung disease, cancer, heart disease, stroke, renal disease, liver disease, diabetes, and immunocompromising conditions. The CDC has put out guidance to remind people who fall into these groups, and families who live with them, that they should be taking particular actions to prepare and protect themselves.

That means community planning around COVID-19 should take into consideration the needs of older adults in particular. Long-term care facilities and home healthcare services need to be especially vigilant about this virus, for which the CDC has provided specific guidance.

Generally, older adults and people of all ages with severe underlying health conditions should be taking steps to limit their risk.

On top of avoiding contact with people who are sick, washing their hands often, and paying attention for particular symptoms, they should also avoid crowds and places where people gather together in groups, especially in poorly ventilated spaces.

The CDC will be working to spread this information to these populations at particular risk, and I want to encourage all of you to do so as well.

More generally, we've created coronavirus.gov, where you can find useful tools and information, including guidance for families, employers, and schools, which we posted last night.

This public health awareness work is just one piece of the Trump Administration's unprecedented whole-of-government approach to protect the American people.

At the end of January, he established the White House Coronavirus Task Force.

In recent weeks, he has added Vice President Pence to lead the overall, whole-of-government response, as well as Ambassador Debbie Birx, a career global health diplomat and infectious disease expert, to serve as White House Coordinator for the response.

HHS and the White House have been aggressively reaching out to governors and other state and local officials, as well as private industry and provider groups, to ensure we are well-prepared.

We've been in especially close contact with officials in Washington State regarding the outbreak there, to provide them with the expertise they may need.

As you know, on Friday, President Trump signed a supplemental funding bill that provided around $8 billion for the COVID-19 response.

The legislation includes more than $3 billion to support development of vaccines, diagnostics, and therapeutics.

It includes nearly $1 billion for medical supplies, healthcare preparedness, and surge capacity, including the purchase of supplies for the Strategic National Stockpile, which exists to meet emergency shortages of medical countermeasures.

There is more than $2 billion in funding for public health preparedness at CDC, including nearly $1 billion to support state and local governments. Finally, there is $300 million in funding to support the affordability of an eventual vaccine.

I want to give you a sense of how that work is already proceeding on each of these fronts right now.

Late last month, the NIH launched the first U.S. clinical trial for an investigational antiviral for the virus, at the University of Nebraska Medical Center, and other trials are ongoing around the world.

Meanwhile, while we're still in the early stages of development, we hope to have an effective vaccine in as little as a year to a year and a half.

We've been extremely focused on expanding our testing capacity so that healthcare providers can test patients as needed. By the end of this past week, 1.1 million tests had been shipped out, to public health laboratories and private labs, made by the CDC and by a private manufacturer. At this time, another 1 million tests are available to fill orders or are being shipped.

This private manufacturer, and a number of other private manufacturers, are now ramping up production of their tests such that they will have produced an additional 4 million tests by the end of this week.

We're also aware that the outbreak will likely have some impact on the medical product supply chain, so we've been paying close attention to that issue.

FDA has been proactively reaching out to hundreds of manufacturers to gather information about the supply chain, has identified one shortage so far, and is prepared to use the full range of tools they have, and often use, to mitigate shortages.

We're keenly focused on making sure that frontline healthcare responders like you have the protective equipment you need for treating patients.

The FDA and CDC already took action to expand the array of respirators available for use by healthcare personnel. In addition, last week, we put out a solicitation to purchase 500 million N95 respirators over the next 18 months for the Strategic National Stockpile.

Our procurement will encourage manufacturers to ramp up production immediately, knowing that they won't be stuck with leftover product.

To the extent you are involved in running a healthcare organization yourself, or assist with preparedness planning in your workplace, please ensure that your organization is continuing to review the plans you have, lean in on preparedness, and be ready to execute on any necessary actions. Please be especially mindful of infection control and your protocols for minimizing nosocomial spread from individuals coming to you for evaluation and treatment.

I want to encourage your organizations, as needed, to be in touch with us through our Office of Intergovernmental and External Affairs, and please be in touch with your state and local public health departments as well.

And, of course, you don't need me to remind you of what good hygiene and basic best practices for keeping healthy looks like.

Over the past few weeks, I feel like I've told a lot of people how to properly wash their hands, but I know you all have a lot more practice at that than I do.

For a one-stop resource for recommendations like this, I encourage you to remind your patients that they can find the latest information at coronavirus.gov.

Now, I'm pleased to turn to the topic of today's conference: the role that nurse practitioners and allied health professionals play not just in providing healthcare for Americans at times of stress for our healthcare system, but also in making healthcare more accessible and more affordable every day.

As some of you may know, one step forward in the ongoing expansion of the role of nurses and nurse practitioners actually occurred in a time of crisis. During the Vietnam War, American service members in the field were often treated for serious conditions by non-physicians, like medical corpsmen and nurses.

When they returned home, there was a much broader realization of the role that nurse practitioners, physician assistants, and other allied health professionals can play in expanding access to healthcare.

Decades later, there is still room for our system to grow in recognizing and rewarding the value provided by nurse practitioners, but much progress has been made.

Your work to expand access to care, especially primary care, is absolutely essential to delivering the kind of healthcare system that this administration envisions.

President Trump has promised an affordable, patient-centric system that puts you in control, and treats you like a person, not a number. The driving force behind the President's healthcare efforts is to protect what works and make it better.

In more tangible terms, here's what that means: We're going to protect Americans' ability to choose the insurance plans and providers that work for them, while delivering that experience with lower costs, less paperwork, more options, and more control. Importantly, a patient-centered, personalized healthcare system also means lower burdens for providers—and opportunities for providers like NPs in particular.

Just yesterday, we finalized our historic rules around interoperability of healthcare information, so that patients will have easy, digital access to their records at no cost. Through what are known as application programming interfaces, or APIs, patients will be able to use smartphone apps to have all their health records and health claims data easily at hand.

Today, all that time patients are spending to assemble hard copies of their records—and all that time you spend sending faxes and CDs—can be replaced with the work of an app that seamlessly gathers and retains all that information.

That shift will benefit all providers, and we've also made sure that our general burden reduction efforts are reaching all allied health professionals.

So far, we estimate that CMS's Patients over Paperwork initiative has saved the healthcare system at least $6.6 billion and eliminated 42 million hours of provider burden through 2021.

Some of you are aware of one specific change we made to free up time for allied health professionals.

Based on feedback we were getting from clinicians, CMS modified its documentation policies so that NPs and other allied health professionals can just review and verify, rather than re-documenting, notes made in the medical record by other professionals, medical students, or other members of the care team. We've already heard positive feedback about the benefits this change has had for both clinicians and their students.

But we want to go further than just relieving paperwork burdens. We're exploring every avenue possible to support allied health professionals' ability to practice to the top of their license and be fairly reimbursed for it. That was a specific ask made by President Trump's executive order on strengthening and protecting Medicare, and we're hard at work on that.

One opportunity we've recently launched is the CMS Innovation Center's Primary Cares initiative, which has a range of voluntary payment models that we expect to enroll up to one-quarter of Medicare beneficiaries.

NPs who run otherwise eligible primary care practices can participate, and I appreciate that AANP has already been working to drive interest in these models.

They represent what we hope to be the future of not just primary care, but healthcare more broadly: where the patients are at the center; where the provider is paid for health and outcomes, rather than procedures and paperwork; and where your primary care provider is your home within the healthcare system.

We know there are real benefits to expanding nurse practitioners' ability to lead primary care practices.

One study found that patients with multiple chronic conditions, which are a focus of ours at HHS, have lower costs and fewer inpatient visits when their primary care is overseen by a nurse practitioner or physician assistant.

To maximize these benefits, we often need to see reform at the state level, too.

Medicaid's ability to pay for services by allied health professionals without physician supervision, for instance, is limited by whether states require that supervision. Issues like this were a focus of a historic report that the Trump administration published at the end of 2018, and we have been strongly encouraging states to examine how regulations like these are getting in the way of better care and lower costs.

The Trump Administration has also identified some particular, impactable public health challenges to focus on, where nurse practitioners often have a role to play.

I'll mention two in particular, which often intertwine: our country's crisis of opioid addiction and overdose, and our country's rural health crisis.

When I began working on the opioid crisis as Secretary, I made a very clear commitment: Our work has to be science- and evidence-based, and the science and evidence on opioid use disorder are clear.

The gold standard of treatment is medication-assisted treatment, and more Americans need access to it.

Thankfully, we are seeing real progress: In 2019, our estimates suggest more than 1.3 million Americans were receiving medication-assisted treatment—up 38 percent since 2016.

Nurse practitioners have played a key role in that. As many of you know, since Congress gave nurse practitioners the ability to receive DATA waivers to prescribe buprenorphine, the number of NPs who can provide this treatment has exploded.

Today, there are more than 19,000 nurse practitioners and other advanced practice nurses who are waivered to prescribe buprenorphine, and I know that AANP has played a role in providing the necessary training.

We've done our part through regulatory work at HHS, too, with SAMHSA substantially expanding the number of patients that NPs can treat with a waiver.

Best of all, many of the waivered NPs are in places where access is needed most. One study found that Medicaid beneficiaries were especially likely to receive buprenorphine from an allied health professional, and rural areas have benefited disproportionately. In fact, in 285 rural counties across America, the first prescriber of buprenorphine to receive a waiver was a nurse practitioner or physician assistant. That's counties that are home to 5.7 million Americans, now with the ability to access MAT.

That brings me to the final point I wanted to make: the vital role that nurse practitioners can play in expanding access to healthcare in rural America. For decades now, CMS-certified Rural Health Clinics have been making full use of the practicing capabilities of nurse practitioners, and we recently expanded these 4,500-plus clinics' ability to be reimbursed for virtual check-ins.

The areas I've just identified, where NPs have such an important role to play, represent some of the key focuses for the future of healthcare in America: How can we put the patient at the center, and help providers focus on health and outcomes rather than procedures and paperwork? How can we tackle the particular health challenges we face? How can we ensure that Americans receive the best quality care—while also keeping it affordable?

The answer, so often, is going to be empowering nurse practitioners and allied health professionals. That means all of you, especially the students we have in this room, have an incredibly bright and exciting future ahead of you.

I believe there has never been an administration that is as focused on expanding your ability to provide care and take a leading role in improving patients' health.

So I want to encourage you to continue bringing your ideas to us about how we can empower you.

As I mentioned, the President's goal is to protect what Americans love about our healthcare system, but with less paperwork, lower costs, more options, and more control.

Delivering that vision is going to mean more of the personalized, patient-centered care for which nurse practitioners have long been renowned.

So thank you for your efforts in that direction already, thank you for the work you are doing on the frontlines of our healthcare system, and thank you again for having me here today.

Content created by Speechwriting and Editorial Division 
Content last reviewed on March 10, 2020