Nurses Raise Battle Cry Over Reimbursement
January 23, 2012 -- Kathy Moon, a nurse practitioner at Dunes Family Health Care, is one of the lucky ones whose practice hasn’t closed down or had to slash services because nurses now make less for performing the same functions as physicians.
Not that her patients wouldn’t notice the strain on her practice, she points out. But while it doesn’t affect her personally, being on a salary, it does affect the clinic’s ability to hire help in the office.
“My overhead is the same—we don’t pay medical assistants less if they’re in our office than if they were in a physician’s office,” Moon said.
Hundreds of other nurse practitioners in Oregon have fallen into the same trap so far without a legislative fix. Reimbursement parity for nurse practitioners became a concern after insurance companies in 2009 started sending newsletter emails (rather than official documents) saying that they were reducing reimbursement rates for services rendered by “non-physician” providers.
“We’re not asking to be paid more than we have in the past—we’re asking for the same that we had been receiving,” Moon said. “Nurse practitioners provide care that’s been shown to be just as high quality and sometimes even better than their physician counterparts.”
During last year’s legislative session, she and other members of the Oregon Nurses Association worked on reversing cuts of reimbursement rates by 40-55 percent for psychiatric and primary nurse practitioners. With sponsorship from Reps. Tina Kotek (D-Portland) and Bill Kennemer (R-Oregon City), they introduced legislation that would require insurers to reimburse providers at equal rates when they perform equal services.
But House Bill 3028 stalled before coming to a vote, and those cuts remain intact. When the Legislature meets again in February, the ONA plans to introduce similar legislation, and dozens of nurses converged at the Capitol on Jan. 18 for Payment Parity Lobby Day.
After a full day of talking with elected representatives, ONA Executive Director Susan King was hopeful they were being heard.
“It’s a significant problem that needs to be solved, and I think the legislators understand the problems associated with a lack of reimbursement parity,” King said. “There’s no current law that speaks to payment for services in the private insurance business, and so they can just set the numbers wherever they want.”
Moon argues the stakes for success are especially high in the large area of the state outside of the Willamette Valley.
“Oregon is comprised of a lot of rural and frontier areas where access to services is a paramount problem,” said Moon, who works in the small south coast town of Reedsport. “The idea that we should be paid less for whatever reason is a big disincentive to nurse practitioners to enter practice, especially in rural areas where clinics are run on a shoestring to begin with.”
King said that more than 10 ONA members are reporting “significant changes” such as limiting their practice or firing staff, and at least two have closed down as a result of the recent changes in reimbursement rates compared to physicians.
Physicians must co-sign?
That’s not all that’s ailing Oregon nurses at the moment.
Like physicians, nurse practitioners are trained to perform physical assessments and treat their patients’ illnesses, including helping their elderly patients find home healthcare. But language in Medicare regulations prevent nurse practitioners from ordering home care services, and they must get their orders co-signed by physicians, which causes delays in their patients obtaining timely care.
This rule makes little sense particularly for nurses in Oregon, where their practices can function with their own licenses and can be completely separate under their own roofs from physicians.
That’s why the ONA supports the Home Health Planning Improvement Act introduced by Congressman Greg Walden (R-Oregon) and Congresswoman Allyson Schwarz (D-Pennsylvania) to allow physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives to order home health services.
“It’s an obstacle for me to get an order for home health through if everything needs to be co-signed because of antiquated language in Medicare,” Moon said. “It makes my work a lot harder to do, and it’s unfair that my patients have to wait a lot longer to get the same service.”
Advocates don’t know how reimbursement policies would change as a result of medical homes, but the ONA does have hope for the new coordinated care organizations getting under way in July, assuming the Legislature approves the plan submitted by the Oregon Health Authority. They believe it’s essential that nurse practitioners get a seat at the table in discussions on the formation of medical homes and that nurses are recognized as a key part of the team.
“It’s important to know that the bill we’re proposing is a fix for the current system, and we’re hopeful that sometime in the future, when we have a more global system, hopefully we’ll fix some of these other problems that happen when one piece of Medicare gets changed and the rest of the statutes don’t move along,” King said.