Unequal reimbursement to Nursing Practitioners (NP) compared to physicians.
I would like to address the state and federal health officials over the unequal reimbursement to Nursing Practitioners (NP) compared to physicians. The present situation is that NP are reimbursed up to 15% less for provision of primary care services while physicians get 100% of the total cost incurred. This is despite the fact that there is no clear justification for this kind of discrimination. NPs provide the same quality services, and in cases which require personal communication, even better care than physicians. The healthcare reimbursement system should be changed to promote equality and fairness among all primary healthcare providers.
The difference in the valuation of the services provided by NP and physicians is just a reflection of the historical perception of the two professions. Doctors have long been thought as the custodians of health. Physicians have both social and cultural recognition for their role in the healthcare system. They conduct patient examinations and give diagnosis. They have authority to declare a patient mad, clinically dead or plain dead. This translates into enormous cultural power which they have wielded for years. Physicians should cede part of the cultural power to NPs who have proven their capability as primary healthcare providers. It is a shame that since the establishment of NP practice in the 1960s, their legitimacy is still in doubt.
Apart from the society, physicians also have additional authority over nurses and other healthcare workers. They give orders on treatment procedures which have to be followed. The law gives them the sole authority to conduct some medical procedures deemed to be critical. The medical profession contributed to this allocation of authority and bias towards physicians. The system has ensured that physicians retain this virtual monopoly of authority, knowledge and skills through legal restrictions such as licensing and legal responsibility.
A Nurse Practitioner (NP) is a highly skilled nurse who has successfully completed graduate studies in Nursing. Most NPs are either masters or doctorate graduates in their profession. The graduate studies equip them with the knowledge and skills to practice as primary healthcare providers. NPs are able to cater to the needs of patients of all ages within their specialties. NPs are just as skilled as physicians, and are able to provide quality healthcare to their patients just like physicians.
It is necessary at this stage to note that NP and physicians have different approaches to patient care. Physicians are more concerned about curative medicine while nurses use a preventive approach to healthcare. Both healthcare practitioners begin their work by examining the patient and gathering information on their health history. Nursing involves gathering additional information on the social life and the living environment of the patient. The next stage in the treatment is similar for both professions. Both doctors and NPs conduct a detailed physical examination to diagnose the patient. However, the nurse goes further by attempting to find connections between physical conditions and other personal circumstances. Factors such as the patient’s family, work and community enable the NP to understand the patient at a personal level. Nursing care approaches healthcare holistically while medical care is driven by scientific facts such as laboratory results, medical imaging and pharmaceuticals only.
Still on the aspect of better healthcare provision, many an article and studies have shown that care provided by NPs deserves equal or much respect as compared to care provided by physicians. The release of metaanalysis in Nursing Economics shows that NPs outshined physicians in 11 categories out of 24 categories, with the other 13 13 care categories being equal to that of their physician counterparts. Other key areas where NPs perform better than physicians include but not limited to performing diagnostic tests, physical examination, guiding and counselling patients, physical therapies, and provision of prenatal care.
Healthcare has become increasingly expensive in the recent past. Many insurance companies are placing limits on the types of medical conditions they cover in their policies. The government had made budgetary cuts on health care. This has affected healthcare national healthcare plans such as Medicare and Medicaid. In Texas, 34% of the doctors have reduced the number of Medicare patients they treat or have declined to accept more. Medicaid patients are worse off because even more doctors are unwilling to render healthcare services to them. The doctors are fed up by the Government’s poor reimbursement record. They are also protesting against the rigid regulations and paperwork which increase administrative costs for private practitioners.
The introduction of ObamaCare is expected to make the bad situation worse. The new plan, which will increase the number of insured Americans by 32 million, will increase access to healthcare by keeping the costs down. This basically means that physicians and NPs will be doing more work but with poor reimbursement from the government. There will be a mass exodus of physicians into other fields within medicine or into new professions. Up to 19% of doctors are expected to make this career move to avoid poor pay. NPs are expected to fill up the deficiency created by exiting doctors. This clearly demonstrates that NPs are equal to physicians but are still considered as the cheaper replacement.
A recent survey conducted in 2010 for the advancement of the course of NPs and Physician Assistants, (PA) found that they earned an average annual income of $ 90,770 working fulltime. NPs working in emergency departments earned $13,779 more than their regular counterparts. In comparison, physicians earned $100,000 and $ 175,000 doing similar work.
The American Academy of NPs quoted the average salary of NPs in 2011 at $91,310 while their physician counterparts earned an annual salary of $175,000 to $220, 195. This increases the height of biasness as far as reimbursement is concerned despite the equivalence of services provided. With increase in debates regarding reimbursement and payment of health care, the Academy of NPs has urged policy decision makers to implement measures aimed at promoting sustainability in payment. The academy insists that reimbursement policies need to be based on the actual costs associated with care provision. The prevailing reimbursement system largely depend on the preparation discipline thereby increasing disparities.
NPs in private practice face more discrimination than physicians. Some states allow them to practice independently while others require physicians to co-sign certain medical decisions made by NPs. In Oregon, an NP cannot recommend home care independently. Such orders have to be co-signed by a physician yet an NP is equally qualified to make accurate medical conclusions.
The lack of parity in reimbursement is the clearest indication of the limited value placed on medical services provided by NP. In 2009, insurance companies sent news letters to medical practitioners warning them that they would only pay full reimbursement to physician healthcare providers. They indicated that “non-physician” providers would be reimbursed at 97% and or lower rates of the total of service. There was no justification for this discrimination apart from the fact that there were physicians and NP primary healthcare providers. Many NP practices closed down because they could not cover all their administrative costs, in addition to the actual costs of providing healthcare services.
Both nurses and physicians possess some elements of power in the healthcare industry. However, what matters the most is the perception and level of acceptance of these powers in the public. Similarly, the point at which each profession reaches its power limit matters in formulating policies for the reimbursement. As mentioned in the fact sheet there is a growing trend where clients and tend to appreciate and focus more on comprehensive and holistic approach to healthcare. Presently, the role of nurses in healthcare has become more defined. Nurses are gaining more expertise in meeting the growing healthcare needs of people within the society while the number of physicians continues to decline in the society.
Nurses are becoming more aware and assertive in claiming their rights and are gradually making initiatives that overt some of the negative perception about the relationship between medicine and nursing. The opportunity to offer primary care to patients gives nurse practitioners consistency in practical roles similar to their rigorous preparation. It has also been noted in research studies that the role of nurses is strategically placed to contain cost of primary healthcare and provide a competent system of delivery.
I would blame the inequality witnessed between nurse practitioners and physicians to a general lack of knowledge or to ignorance by the public about the nature of nursing work. There is little information about the nature of nursing especially to significant stakeholders primarily involved in policy making. Inter-professional relations between nurses and physicians do not have to overlap and create conflict. Traditionally, it was regarded that nurses primarily focus on the care aspect of healthcare while physicians focused on the cure aspect. These two functions of healthcare are each important and there is need to avoid overlapping between these two roles. It is clear from this traditional perception on nursing and medicine that both professions are interdependent and equally important for the other. Notably, it would only be prudent to ensure parity and equity in reimbursement rates.
The role of nursing care has also been studied with the interest of patients’ perception. It has therefore been established that patients no longer are passive recipients of primary healthcare. The manner in which patients consume primary healthcare is such that they become active consumers. The services provided to clients are considered needs and it’s only necessary that the needs of consumers be met satisfactorily. Consumers appreciate preventive care where they get to develop a certain lifestyle which will assist in reducing the risks involved with the development of health conditions.
The first solution will involve a change in legislation to allow NPs to access reimbursement from insurance providers and Medicare without the need for co-signatories. Since NPs are qualified primary healthcare providers, they should be given the legal powers to sought payment for their services without unnecessary bottlenecks. The reimbursement rates should be harmonized to reflect the value that NPs and physicians have in the industry. NPs should be fully paid for their services. They provide the same quality of healthcare services and incur the same administrative costs as their physician counterparts. There is no justifiable reason why NPs should be paid anything less than 100% of their costs. Any price cuts necessitated by budgetary cuts and harsh economic times should be implemented equally for all primary care service providers.
The other recommendation is the need to recognize the nurse practitioners and the essential contributions they make towards improvement of healthcare. The reimbursement rates for both nurses and physicians need to be harmonized and any form of disparity need to be eliminated. In order to reduce medical cost, lower the rate of mortality, and create fewer return visits, the involved stakeholders need to combine both the physicians and NPs approach to healthcare.
Based on these assertions, I would recommend that the nurse practitioners be considered for an equal reimbursement with the physicians. This goes out to the policy makers and decisions makers in the industry, that there is need to have changes in the Medicare programs to have nurse practitioners receive equal reimbursement as physicians. There are so many undeserved areas where nurse practitioners offer care to. I have mentioned these areas. I have also mentioned that the role of nurses shows a lot of promise in creating a solution to numerous unresolved health issues in the society. Because of this, it is only necessary to create health policies that support the roles, initiatives, and inputs of nurses in healthcare. With the current training that nurses receive, there is virtually no role that physicians can perform which nurses cannot perform. The future of healthcare will depend more on the role of nurse practitioners because of its holistic nature in approaching healthcare.
Fact Sheet
Nurse practitioner reimbursement not equal to physician reimbursement
What is the state of reimbursement between NPs and physicians?
Primary care relies on the services of nurse practitioners at an equal extent as it relies on the services of physicians yet they only receive a portion of the reimbursement rate received by physicians. Even though promises have been made by government to have nurse practitioners be reimbursed at 100%, a similar rate to that of physician reimbursement, no effort seems to have been made to ensure equal reimbursement. So far, there is only a promise and not a reality. In order to determine the necessity for equal reimbursement and whether it will work, it is important to review differences and similarities between nursing work and the work of medicine. The main reason to base the need for equal reimbursement between NPs and physicians is the nature and amount of work each contributes to healthcare
What are the bases for the current unequal reimbursement?
- The medicine model of reimbursement is based on the fact that physicians concentrate on reporting symptoms from physiological and anatomical assessment of the human body, while the nursing model of reimbursement is based on the fact that nurses rely on medical reports prepared by physicians to perform their duties.
- Both medicine and nursing have an objective examination of a client. The both physically examine a patient through a structured and disciplined procedure.
- During diagnosis, the medicine model is limited to physical evidence while the nursing model presents the physical evidence but goes further to put in the context of the patient’s culture, work, and family.
- Medical care plan involves drugs, medical procedures, and laboratory work while nursing care plan involves all the aspects of medical care plan in addition to community support, cultural support, family support, patient’s psychological support and cure.
What are the needs for equal reimbursement?
- The nurses review the medical reports prepared by physicians from different angles hardly noticed by physicians. For instance, nursing will look at the reports through the lenses of family, work, community, and culture.
- The nurse practitioner has a more holistic approach while examining patients through the disciplined procedure. The nurse will run the examination while trying to find connections between the illness and factors such as culture, community, family and occupation.
- Through media forums consumer of healthcare value a comprehensive and a more holistic approach towards provision of healthcare. It is no longer a tradition for consumers to only accept medicine as a part of care. Nurse practitioners deliver primary care in a way that directly responds to the needs of healthcare consumers. They provide holistic health remedies, information sharing, discussion
What should the stakeholder do?
There is need to formulate policies that cater for equal reimbursement for nurse practitioners since both nurses and physicians make an equal contribution to the quality of healthcare received by patients.
References
Asubonteng, P., McCleary, K. J., & Munchus, G. (1995). Nurse practitioners in the USA - their past, present andfuture: some implications for the health care management delivery. Health Manpower Management, Vol. 21 Iss: 3 pp. 3 - 10.
Foy, R., Tidy, N., & Hollis, S. (2002). Inter-professional learning in primary care: lessons from an action-learning programme. British Journal of Clinical Governance, Vol. 7 Iss. 1.
Longino, C. F. (1997). Beyond the body: An emerging medical paradigm. American Demographics, 14-19.
