Improving Access to Care through Ambulatory Care Nurse Visits

One common problem faced by primary care practices today is the limited access for patient appointments. “With larger numbers of older adults comes an increased need for primary care, including care for individuals with chronic physical and mental health diagnoses and comorbidities. A total of 60% of adults in the United States have at least one chronic illness and 42% have multiple chronic illnesses.” Nurses working at the top of their license can provide education to help patients prevent or improve management of their chronic disease. These nurses, who have the clinical skills, knowledge, and experience can provide care for patients with chronic diseases by performing nurse visits. “Physicians and advanced practice providers alone cannot meet the growing demand for primary care. Registered nurses working to the full extent of their licenses will be needed at the front lines of care delivery.” Through collaboration with the providers, nurses partner with the patient by driving patient self-management of their chronic disease with a plan to influence lifestyle changes.

A chronic condition that is preventable and treatable is “high-blood pressure (also known as hypertension) is a common condition that can have serious health consequences, contributing to nearly 500,000 deaths per year in the United States. Nearly 1 out of 2 adults—around 108 million—have high blood pressure, and only 1 in 4 have their condition under control.” Using a team-based approach, the nurses and providers in our primary practices strategize and develop care management of the hypertensive patient. By using this approach, nurses work at the top of their license by providing nurse visits, which are driven by the care of the primary care provider.

The in-person visits require specific criteria that must be met prior to the nurse visit. If the criteria are met, the visits are billable, by using the CPT code 99211. At our organization, we partnered with our financial and data team to differentiate nurse and provider visits. This request was achieved by adding RN to the end of the 99211 CPT code (i.e., 99211RN). A report is generated weekly providing the number of billable visits completed by the nurse. Primary care nurse visits were initiated in March 2022, and by the end of the fiscal year, 209 visits had been completed. These visits increased to 811 in fiscal year 2023.

Barriers were identified after implementing nurse visits, such as high triage call volume, staffing vacancies, and other demands of the practice. Sadly, not all providers have supported nurse visits; however, with increased need for access, our providers have begun to recognize the benefits of the team-based approach on chronic disease management. Currently, all billable nurse visits occur in our organization’s primary care practices; however, we are working toward expanding into our specialty practices. It’s a work in progress.