Attempts to Amend Nurse Practitioner Bill Failed
February 24, 2012—Some legislators, including Rep. Alissa Keny-Guyer (D-Portland), hoped that the referral of a bill reimbursing nurse practitioners at the same rate as physicians to the House Rules Committee wouldn’t mean that the bill would die, but that it could be amended to address the concerns of various constituencies.
But with the Oregon Nurses Association unwilling to submit a new amendment to House Bill 4010, and with the amount of time left for this month’s short session, it appears that the bill truly is dead.
Keny-Guyer told the Lund Report yesterday that there were attempts made to amend the bill, including using language suggested by the Oregon Medical Association, and supported by the American Academy of Physicians, that would have brought the reimbursement rate of nurse practitioners to the level they were before 2009. At that time their reimbursement rates were not always on par with primary care physicians, according to Betsy Boyd-Flynn, executive vice president of the Oregon Medical Association.
One of many problems the Oregon Medical Association had with House Bill 4010 was that it “sought to unilaterally increase all nurse practitioner reimbursement rates to 100 percent of physicians, regardless of specialty or past reimbursement history.”
Keny-Guyer, who was one of two votes in the House Health Care Committee opposing the bill, agreed. “If you have a physician and a nurse practitioner suturing, there should be nurse parity,” she said.
But there are complex medical cases that a psychiatrist, who has nine years of training, is more able to treat as opposed to a psychiatrist nurse practitioner, who has only two years of training. Those sorts of cases, she said, do not warrant equal pay.
When they do a diagnosis, and someone with two years does a diagnosis, is it really equal work?” Keny-Guyer asked during the healthcare committee’s vote on February 3. “That is something that has really plagued me. I think nurses have a fairness issue, and I think people with nine years [of training] have a fairness issue.
There was another amendment that would have changed the reimbursement rates only for nurse practitioners in rural areas.
Jack Dempsey, the lobbyist for the Oregon Nurses Association, said that none of those concepts would have received a hearing in the Rules Committee.
“It would have depended on the amendment,” said Rep. Tina Kotek (D-Portland), who co-chairs the Rules Committee and is a staunch advocate of changing the reimbursement rates for nurse practitioners.
Dempsey said the Oregon Medical Association amendment would not achieve reimbursement parity because it would not reimburse nurse practitioners at the current rate. Dempsey adamantly opposed the amendment which would have only impacted the rates of nurse practitioners in rural areas, saying it would have discriminated against nurse practitioners doing the same work elsewhere such as Portland.
“The bill died when it got sent back to the Rules Committee,” he said. “I don’t think there’s any amendment that we could write to get the bill out of the Rules Committee.”
Numerous groups opposed the bill, including the Oregon Medical Association, the Oregon Academy of Family Physicians, the Oregon Psychiatric Association and the Oregon Society of Clinical Social Workers, the National Federation of Independent Businesses, the Taxpayer Association of Oregon and Regence BlueCross Blue Shield.
Among their concerns were that insurance companies would decrease the reimbursement rate of physicians and psychiatrists rather than increase the rates paid to nurse practitioners; that reimbursing nurse practitioners at an equal rate would increase healthcare costs, and that reforming a reimbursement structure based in the fee-for-service model ran counter to the state’s efforts transform the Oregon Health Plan’s delivery system, and moving away from a fee-for-service payment system to a global budget focused on providing more efficient care.
“Every business group, insurer, and provider group opposed the bill,” Dempsey said.
The bill, which was one of five bills sponsored by the entire House Healthcare committee, was vetted numerous times before the current session. But an interim hearing in November only invited the testimony of the Oregon Nurses Association, and not any opposition groups. When asked why the association did not pursue a consensus bill, Dempsey said that he wasn’t sure that could have happened.
But, he said, the Oregon Nurses Association will be back next session for what will be their third attempt at changing reimbursement rates. “This issue isn’t going away,” he said.