A recent article written for Kaiser Health News, reveals that one nursing association is switching the nurse practitioner (NP) scope of practice attack from state legislators to the insurance providers.
Despite the fact that several states recognize NPs as primary care providers, some insurance companies limit the number of NPs they accept into the network. Others will only credential NPs if they work in rural areas. For example, Blue Cross Blue Shield of Massachusetts has about 3,200 nurse practitioners in its network, but fewer than 100 are credentialed as primary care providers.
NPs are not allowed to bill insurance companies directly if they are not credentialed in the network. Instead, NPs need to bill through a physician with whom they have a collaborative agreement. This essentially negates any scope of practice laws that allow NPs to practice independently. The American Nurses Association (ANA) wrote a letter to the head of the Centers of Medicare and Medicaid Services (CMS), Administrator Marilyn Tavenner, asking the agency to write a proposed rule requiring insurers include NPs in the plans offered via the Affordable Care Act’s online marketplaces.
The move is one of several that have been a part of the lengthy NP scope of practice battle. Recently, a California bill that would have extended NP scope of practice in the state died in committee after aggressive lobbying from the California Medical Association. Many healthcare experts feel that allowing NPs to practice independently will help alleviate the physician shortage, particularly in primary care. Physicians see NPs as valuable members of integrated medical teams and would like to see them continue to operate alongside, and under the supervision of, physicians. They argue that nurse practitioners who strike out on their own would leave access problems in the practices they leave behind.