May 29, 2013 — The Senate Health Committee has passed a nurse practitioner pay parity bill that has found consensus between the Oregon Medical Association and the Oregon Nurses Association, bringing to a resolution one of the most divisive issues in the state medical community this legislative session.
“I’m so happy we have these two organizations up here in a very nice ‘Kumbaya,’” said Sen. Laurie Monnes Anderson, D-Gresham, the chairman of the Senate Health Committee, before the vote last week.
House Bill 2902 sought to remedy steep rate cuts that certain health insurers, led by Regence BlueCross BlueShield, imposed on nurse practitioners and physician assistants, particularly those who practice on their own and lack bargaining power with insurance companies. It requires private insurers to pay doctors, independent nurse practitioners and independent physician assistants the same rates for the same services.
Task Force Ordered
The Senate consensus keeps the heart of the bill about pay equity intact, but prohibits insurers from lowering rates to physicians. It also calls for a government task force to study and make recommendations for a payment structure that promotes the expansion of primary care services to ensure that all primary care and mental health practitioners are compensated fairly. The legislation will sunset in 2018.
Sen. Elizabeth Steiner Hayward, D-Portland, said the expiration date was included to force the task force to take this directive seriously because the Legislature intends to weigh in again in either 2015 or 2017. Legislators don’t want the task force to produce a report that will simply sit on a shelf and collect dust.
This was exactly the idea proposed by Rep. Jason Conger, a Bend Republican, but opposed by Rep. Mitch Greenlick, a Portland Democrat, who was concerned that attaching the budget needs of a task force and an official study meant HB 2902 would be sent to the Committee on Ways & Means where it might die.
Steiner Hayward said budget chairman Sen. Richard Devlin, D-Tualatin, confirmed that the bill would indeed be sent to Ways & Means, but would be less likely to never see the light of day, and promised to expedite it. Any bill that includes a task force has a budget impact since it requires government staff to prepare a study.
Officially, Senate President Peter Courtney, D-Salem, has not yet assigned the bill, and Sen. Jeff Kruse, R-Roseburg, indicated he was still hopeful it could go straight to the Senate floor.
HB 2902 addresses a problem that has become particularly acute in parts of rural Oregon, like Oakridge and Josephine County, where communities have only one primary care practitioner. Finding a physician can be a luxury, and, in such instances, nurse practitioners and physician assistants have stepped in to fill the gap.
But the payment cuts have also affected access to care in urban areas. Sen. Chip Shields, D-Portland, a sponsor of HB 2902, works in a small primary clinic in north Portland, Hands on Medicine, where his wife, Shelda Holmes, a nurse practitioner, had her payments gouged in recent years by insurance companies, he said.
The House bill restored payment levels for these providers by requiring insurers to pay them the same rate as primary care doctors for the same services — which had been standard practice prior to 2009, and continues today for most nurse practitioners, according to the ONA.
“We support the [Senate compromise]. It brings attention to the concerns raised by the nurses’ association,” said OMA lobbyist Bryan Boehringer. “It also brings together all of the stakeholders on a task force.”
OMA Proposal Rejected
But clearly, it was the Oregon Medical Association, not the Oregon Nurses Association that gave up the most ground to reach a consensus on House Bill 2902.
Leaders of physician groups and medical students spoke adamantly against paying nurse practitioners and physician assistants the same rates as doctors, telling legislators it would devalue the profession for primary care doctors.
“It will make it impossible to recruit medical students in those areas in Oregon,” Dr. Tan Ngo, a psychiatric resident at Oregon Health & Science University told the Senate Health Committee in early May.
The OMA tried to head off pay equity for nurse practitioners after the bill passed the House and needed the approval of a new set of lawmakers in the Senate. The compromise by the Oregon Medical Association would have created the task force and allowed insurers to pay nurse practitioners at 85 percent of doctors, a formula modeled after Medicare’s reimbursement rate.
But this idea ran into unequivocal opposition from the Oregon Nurses Association, whose representatives said it would only encourage insurers to lower payments to all nurse practitioners to 85 percent, including many who've not seen any change in their reimbursement.
Not all nurse practitioners have seen insurers cut their rates. According to Jack Dempsey, a lobbyist for the ONA, the majority of nurse practitioners still get paid the same rates as before — and the same as physicians when providing the same services.
“We’re not asking to raise the ship of every nurse practitioner in Oregon,” Dempsey said.
Ironically, it’s the nurse practitioners and physician assistants most needed to provide primary care access statewide — those working on their own in solo practice — who were most likely to see their rates cut by insurance companies.
Dempsey said nurse practitioners who work in groups have better bargaining power with insurance companies and are less likely to be affected by the payment changes.
Image for this story by Produnis (CC BY-SA 3.0) via Wikimedia Commons.
Christopher David Gray can be reached at [email protected].