In states where NPs are allowed to practice to the top of their education without physician involvement, they receive reimbursement from Medicare that is only 85% of what a physician would receive for the same service. In states where NPs operate under physician supervisions or a collaborative agreement, their services are billed under the physician’s Medicare number, and the physician receives 100% Medicare reimbursement. Payments to NPs and PAs accounted for 4% of fee schedule spending in 2011 – double what it was 5 years ago, MedPAC said, while APRNs and PAs account for about 15% of providers.
Commission members discussed whether increasing payments made to NPs would help address the primary care physician shortage. Increasing payments may make the profession more desirable and therefore inject more primary care providers into the system. The commission also discussed the possibility of giving financial incentives to NPs who choose to practice in rural and underserved areas hit hard by the physician shortage.
The commission took no official action on the topic during the meeting, but encouraged MedPAC staff to develop more policy recommendations. The next MedPAC meeting is scheduled for September.