February 17, 2012—Legislation that would reimburse nurse practitioners at the same rate as primary care doctors failed to pass on the House floor last week as expected, and instead was sent to the Rules Committee where such bills usually die.
The motion made by Rep. Jason Conger (R-Bend) seemed to catch people off guard, yet had bipartisan support with a 33-26 vote. Conger said House Bill 4010 needed to go to the Rules Committee because he was concerned about the definition of a nurse practitioner’s “service area.”
By that, he didn’t mean the specialty of a nurse practitioner, but the geographic area where that person worked. Conger said he was concerned because a nurse practitioner could negotiate a reimbursement rate with an insurance company that was different than the rate paid to another provider in the same town.
“As it stands, the bill would not be specific as to what an ‘area’ would be used in determining what reimbursement rate should be applied to nurse practitioners,” Conger said.
He fumbled multiple times through his explanation, and Co-Speaker Arnie Roblan (D-Coos Bay) admonished Conger more than once to be clear.
“I’m not sure I can actually claim to be clear,” Conger said at one point.
Sources also say there was a burst of last-minute lobbying last week opposing the bill after it passed the House Healthcare Committee by the Oregon Medical Association, the Oregon Academy of Family Physicians, the Oregon Psychiatric Association and the Oregon Society of Clinical Social Workers.
If the bill passed, they claimed, insurance companies would decrease the reimbursement rate of primary care physicians rather than increase the rates paid to nurse practitioners.
Those organizations also argued that it was inappropriate to change the reimbursement rates for one provider group at the same time Oregon is transforming 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.
“Any dialogue about reforming payment and realigning incentives should occur in tandem with health delivery system reforms and must include input from all physicians and other healthcare providers as the system is redesigned to be meaningful,” according to testimony submitted by the Oregon Academy of Family Physicians.
Other opposition came from the National Federation of Independent Businesses and the Taxpayer Association of Oregon, a conservative watchdog group that advocates for taxpayers. They claimed reimbursing nurse practitioners at an equal rate would increase healthcare costs.
Regence BlueCross BlueShield used that same argument. “The bill ties our hands to be fully engaged in the reform efforts that I think we all support to attempt to bend the cost curve,” said Tom Holt, director of legislative and regulatory affairs. “We don’t think it’s productive to enshrine in statute something that is really attached to a fee-for-service system that everyone hates, and that we know is [the reason for] a very severe increase in the affordability of [insurance].”
Before the bill was sent to the Rules Committee, lawmakers on both sides of the aisle urged their colleagues to oppose Conger’s motion. Rep. Mitch Greenlick (D-Portland), who co-chairs the House Healthcare Committee, said that the definition of a service area was not “properly” raised in committee, where the bill could have been amended.
Rep. Peter Buckley (D-Ashland) argued that the bill should be passed, stating that Conger’s concerns could be dealt with by the Senate’s Healthcare Committee
“To refer a bill to another committee in this short session, if we’re not careful, is about killing the bill,” said Rep. Bill Kennemer (R-Oregon City).
He went onto to say that the bill would impact 200 to 300 nurse practitioners who might have to close their practices because of the lower reimbursement payments. “It is a crisis,” Kennemer said. “The opportunity to kill this bill would damage them and our healthcare delivery system.”
Rep. Julie Parrish (R-Tualatin), who freely admitted that House Bill 4010 was “not the type of bill I would normally support and get behind,” shared that concern.
But Parrish supported the bill because she knows people in rural areas who rely on nurse practitioners as their only healthcare provider. “It’s an access issue,” she said. “They’re (nurse practitioners) in high demand.”
Until 2009, nurse practitioners were paid the same rate as primary care physicians. Then, insurers began reducing the payment rates for psychiatric and primary nurse practitioners by as much as 55 percent, despite the fact that they performed the same functions as a physician.
The bill, Greenlick said on the House floor is about “equal pay for equal work.”
“Nurse practitioners have the same scope of service that physicians have,” he said. “[They] do, generally speaking, the same things as doctors in the same specialty.”
Legislation to achieve payment parity appeared in the 2009 and 2011 legislative sessions, but failed to gain momentum.
Now the legislation waits in the Rules Committee, co-chaired by Rep. Tina Kotek (D-Portland), who sponsored a similar bill in 2011, and Rep. Andy Olsen (R-Albany). Both legislators must agree to give it a public hearing before the bill can pass out of their committee. Thus far, no hearing has been scheduled.
“At this point, we're running out of time,” Parrish said. “I hope we get it solved in this session.”
The Oregon Nurses Association is more pessimistic, believing the bill is dead. “Unfortunately, the short February session, Oregon's difficult economic issues, the powerful influence of health insurance providers, physician groups and business associations all combined to make passing this important legislation impossible this session,” the association told The Lund Report. “ONA and our partners are committed to returning to this issue in the future and working hard to ensure that nurse practitioners receive the payment parity that they deserve.”
