Leading Nurses Union Wants to Make Equal Pay for Nurse Practitioners Permanent

In 2013, the Oregon Legislature restructured the health insurance law to require insurers to pay for primary care based on the services delivered and prohibited insurers from compensating nurse practitioners less, an insurance practice that had threatened patient access in rural Oregon as well as underserved urban communities.

The Oregon Nurses Association is supporting legislation to lift the sunset on a 2013 payment parity law that requires health insurers to pay primary care providers, including doctors, nurse practitioners and physician assistants the same rate for the services rendered irrespective of the license of the provider.

“The policy is working well and meeting the objectives that we thought it would when we passed it,” ONA lobbyist Jenn Baker told The Lund Report. “It’s a move to ensure that there’s a payment for each individual service, and we’re not discriminating by provider type.”

The law was first passed after some insurers, such as Regence BlueCross BlueShield, drastically and arbitrarily cut rates for some nurse practitioners and physician assistants who were operating independently, while preserving rates for physicians performing the same services and even nurse practitioners who worked in larger clinics and therefore had more leverage over payments.

The actions by the insurers threatened access in several rural communities, where nurse practitioners are often the only primary care providers willing to work with lower volumes and profit margins.

Like before, their bill faces opposition from the Oregon Medical Association and other statewide physician organizations, who argue the policy does not take into effect the higher costs that doctors incur for insurance and education.

OMA lobbyist Courtni Dresser told The Lund Report that her organization still hoped to find a better payment reform plan than simply paying primary care doctors and independent nurse practitioners the same rates. New legislation from 2015 -- Senate Bill 231 -- authorized the Health Policy Board to convene competing providers and insurance companies to negotiate a new payment scheme that compensates quality over quantity, but work from that bill so far has made little progress.

“There’s no reason to lift the sunset when we have another year to continue the discussion,” Dresser said.

ONA lobbyist Jack Dempsey countered that the law has worked well without hurting physician practices. His organization is eager to protect nurse practitioners now -- while they have solid support in the Democratic legislature.

Sen. Laurie Monnes Anderson, D-Gresham, a retired nurse, supports such legislation in the February, while Sen. Elizabeth Steiner Hayward, D-Beaverton, a family practice physician, also indicated she’d support the bill on the Senate floor.

Chris can be reached at chris@thelundreport.org.

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Comments

When I read about FNP and PA pracitioners, my understanding is that the goal of the Oregon Health Authority to have them practice at the "top of their license." In other words, because they are paid less than physicians, money can be saved by having them do more and physicians less. Since they are providing care and primary care physicians are underpaid relative to to the time necessary to provide effective care, of course they should be paid more. The system can't save money by paying so little, even a provider with a less expensive degree just can't do it. Based on personal bias and experience, believe that the current reimbursement physicians get is too little for any provider, compelling all pracitioners to overutilize very expensive medical resources, compounding the lack of money to pay us to do the job right in the first place. Finally, if FNP's are successful and are paid the same as physicians, this negates the "practice at the top of license" goal of having less expensive providers saving the system money. So perhaps the nurses union will tackle physician reimbursement next, as apparently nurses are the only ones with enough wherewithall to understand neglecting one's profession in the policital system doesn't work well (being a bit cynical here). We physicians don't seem to want to stand up to the system ourselves.

If there is parity of FNP/PA reimbursement, why go see an FNP/PA?  

Why should medical students choose primary care if FNP/PA pay is the same, yet med students have much more debt and more years in education/training? My understanding of human nature is that this will accelerate the death of primary care. Once medical students learn that in Oregon, the pay is the same, no matter the degree, they will understand something is indeed wrong with primary care in black and white terms - FNP/PA practitioners will have higher take home pay as they won't be paying back massive loans and start practicing sooner.

What does pay parity suggest about the work of primary care? If someone with much less training can do it, does this mean physicians are over trained, incorrectly trained or even possibly practicing at the bottom of their license? If practicing at the bottom of their license, might it be a good idea to also get physicians to practice at the top of their license? 

Anyway, those are my thoughts on the matter. Perhaps someone with a better understanding can help enlighten me.

Dr. Mike Henderson