Nurse Practitioners Seek Payment Parity from Insurers

But legislators are unlikely to take action because of the strong lobbying efforts by insurance companies

November 29, 2011—The Oregon Nurses Association (ONA) is trying to convince legislators that insurance companies should pay nurse practitioners the same amount as primary care physicians for the same services.

But the association’s president, Susan King, said its efforts are being stonewalled by some insurance carriers. After meeting with representatives from five insurers over the past few months, the information they’re sharing about their reimbursement policies is opaque, at best.

“Our desire would be that this problem would remedy itself with reasonable people trying to come to a decision about what’s in the best interests of consumers,” King told the Legislature’s Senate and House healthcare committees recently. “It’s very difficult to get there if the basis for decisions isn’t known or can’t be figured out or is misrepresented.”

King didn’t identify the names of the insurance companies, signaling the delicacy of the issue.

Since the insurers have such a powerful lobby, the ONA faces an uphill battle with legislators during their upcoming February session.

“I don't think we're addressing this in 2012...unless things can be resolved,” said Sen. Laurie Monnes Anderson (D-Gresham), a retired public health nurse.

Currently, only one insurance company pays nurse practitioners and primary care physicians the same rate. King, who’s been meeting with the other companies to better understand how they determine payment methodologies, called the differences – for lack of a better word -- “variably variable.”

Until 2009, nurse practitioners were paid the same rate as physicians until one insurance company, which King wouldn’t identify, lowered its rates. Other carriers followed suit.

Some clinics staffed solely by nurse practitioners have reduced their hours because of lower payments. And the lower reimbursements have created problems with recruiting and retaining nurse practitioners who’ve turned to higher paying jobs in specialty care.

“The capacity of our primary care system is extremely stressed,” King said. “We fail to understand at a time when we’re trying to shift to primary care and prevention as a basis for our health care system how we rationalize reimbursement policies.”

“They provide the same care that primary care physicians provide,” said John Ross, who runs two clinics in Redmond and Madras that use nurse practitioners. “It is very bad in primary care to remove the parity of reimbursement.”

Sen. Alan Bates (D-Ashland), supports payment parity for nurse practitioners who work in a primary care setting, but not for those in specialty care who already earn a higher salary. “The incentive needs to be you get full pay for what you do in primary care,” he said.

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it is clear that insurance companies look at every avenue to reduce "costs" from paying too little to primary care and mental health NPs to cutting coverage in order to continue to pay extraordinarily high executive salaries and to accumulate huge "reserves" which are then passed on to the parent company without a peep from the insurance regulators. Legislators must take on these issues or face increasing social services costs as consumers find too few NPs or too little coverage so go without sufficient insurance, winding up in emergency rooms. The "strong insurance lobby" ought to be recognized as not looking out for the consumer but only for their corporate bosses. Of course if we had an oversight board with the teeth to actually regulate, it would be the best answer but those same lobbyists have convinced the legislature that it is unnecessary.

Maybe the insurance companies will decrease the compensation to primary care physicians instead , that would fix the problem. Unfortunately, having worked in the past as a physician for an insurance company, the comment submitted on 12/01/2011 is completely accurate.