The health care sector is responsible for offering quality health care that is efficient, effective, timely, accessible, equitable and patient centric. This can be achieved only when the players in the health care sector interact and have goals which are aligned to deliver quality services. The health care sector is guided by policies which control the interactions of the players in the health care sector. Health care policies should be evaluated occasionally to ensure that they are effective in promoting quality health care. This essay considers policy decision regarding the reimbursements Nursing Practitioners (NPs) receive from Medicare, Medicaid and private insurance for their provision of primary care versus the reimbursement physicians receive for the same services. NPs receive reimbursements of 85% while physician receive 100%. This discrepancy affects the role of NPs and a policy change is needed to ensure that NPs receive 100% reimbursement just like physicians.
The health care sector has undergone changes in the recent past t meet the health care needs of an aging population. In addition the rise of lifestyle diseases has stretched health care facilities to the limit. Professionals in the health care sector have adapted to this changes by taking more roles. Advanced Practice Nurses such as NPs are more available in a community setting than physicians. Due to their training which emphasizes on primary prevention and holistic primary care, NPs offer high quality and culturally sensitive health services. NPs are the primary care providers in the rural areas and in the underserved populations. The effectiveness of NPs in offering primary care is attested by Gogan and Maybee, who found that many patients strongly agree or agreed that NPs are better listeners and offer satisfactory care especially for minor cases (2011). The waiting time to see and NP even with no prior appointment is significantly lower than that of a physician due to their availability even in rural and underserved populations. This is in stark contrast that NPs cannot offer quality health care that meets and exceeds the patient’s expectations unless they are supervised by physicians. The role of NPs in primary health care will continue to rise as more physicians take family and internal medicine specialties. Kirch estimates that the US will have a shortage of 45,000 physicians in primary care by the year 2020 (2012). This gap is expected to be largely filled by NPs.
Health care policies dictate reimbursement that health care providers can get from Medicare and private insurance companies. Currently NPs are reimbursed at 85% while physicians are reimbursed at 100% for offering the same services. This inequality violates the principle of equity at the workplace where workers doing the same job should be compensated on the same level. The cost of health care is a concern in any health care system. Since NPs provide care of equal or better quality and at a lower cost compared to physicians, there is a need to encourage their operation. Currently Medicare “incident to” billing lets physicians to bill for services provided by other members of their care team including NPs provide the service is provided under the physician’s supervision (Poghosyan, Lucero, Rauch & Berkowitz, 2012). An NP working under a physician can get 100% reimbursement through incident to billing but when working independently, the NP will get 85% reimbursement for the same job. This reasoning is flawed and discriminatory. APNs undergo rigorous education training which emphasizes on their independence as providers of primary care. Encouraging NPs to work under physicians denies them a chance to utilize their skills and knowledge and reduces their effectiveness (Lowery & Varnam, 2011).
Quality primary health care is provided mainly by multidisciplinary teams. However, Medicare, Medicaid and private insurance classify providers of primary health care as ether physicians or non-physicians. Under the description of non-physicians, NPs loose their professional identity as independent providers of primary care. This has been the basis used by major health care payers to reimburse NPs at a lower rate even when they perform the same duties as physicians. There is need to educate policy makers on the roles of NPs. Reimbursing NPs at a lower rate demoralizes them and can compromise quality since adequate compensation for the workers is a requirement in any health care system. Policy changes which require NPs to be recognized as independent primary health care providers will encourage their practice and utilize the existing NPs fully thereby improving the quality of health care offered (Bauer, 2010).
Another challenge that leads to NPs being compensated at a lower rate is lack of standard regulation in their practice. Although their educational training is guided by common accreditation agency and certification examination, the scope of practice of NPs varies with he state and various other regulatory agencies such as boards of nursing, medicine and pharmacy (Poghosyan, Lucero, Rauch & Berkowitz, 2012). The difference in regulation hampers the ability of NPs to give quality care because some states prevent NPs from admitting patients or certifying long term care. Recognition of NPs will enable tracking of health outcome data by Accountable Care Organizations (ACOs) which monitor quality of care offered and hold providers as accountable for quality improvement. Standardized regulations will promote the identity of NPs and health outcome data will warrant equivalent reimbursement for comparable services regardless of the practitioner (Naylor & Kurtzman, 2010).
NPs play a critical role in offering managed care in Patient Centered Medical Homes (PCMH). The role of PCMH in the health care sector will increases due to an increase of chronic diseases. Chronic diseases account for 78% of health care spending translating to an economic impact of more than $1 trillion per year (DeVol & Bedroussian, 2007). This big chronic disease burden can be eased by promoting primary health care and improving quality in PCMH. Since NPs play a central role in the two settings, their role in managing health care costs can not be overemphasized. Reimbursing NPs on a lower rate than physicians will not ease the burden of chronic diseases. Adequately compensated NPs available even in rural and underserved areas will drive down the costs as NPs are trained in preventive measures to mitigate chronic diseases.
NPs provide primary care services and are more available than physicians. Research shows that patients are satisfied by the service offered by NPs ass it is of high quality comparable to what physicians offer. However they are reimbursed at a lower rate than physicians by major health care payers for giving comparable services. This is discriminatory and goes against the principle of equitable compensation for comparable work. A policy change is needed to bring NP reimbursements at par with that of physicians. This will motivate NPs and promote their role in offering primary care services.
References
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