Insurer contracting policies can jeopardize health care system, says NNCC study

Oct 27 2009

A study conducted by National Nursing Centers Consortium (NNCC) has found that nearly half (48%) of all major managed-care organizations in the United States do not credential or contract with nurse practitioners as primary care providers. "Policies like these jeopardize the success of health care reform at a time when we need more qualified and cost-effective primary care providers than ever before," says Tine Hansen-Turton, CEO of NNCC.

The American Academy of Nursing has identified nurses who have developed innovative models of care that could support the infrastructure that the United States needs to provide more health promotion, prevention and chronic care management. But, the Academy's CEO Pat Ford-Roegner notes that, "Insurers must remove the barriers to full utilization and credentialing of the advanced practice nurses if we're to spread these models of care that we know improve health outcomes and reduce costs."

In nurse-managed health centers, community health centers, and nurse-led private practices throughout the country, nurse practitioners provide comprehensive primary care to patients with similar outcomes to primary care physicians. Insurers' prohibitive reimbursement policies reduce these practices' capacity for growth and threaten key components of the health care safety net. "To improve our health care system, we need to improve access not only to health insurance, but to health care providers as well," says Ann S. Torregrossa, Director of the Pennsylvania Governor's Office of Health Care Reform. "Health reform legislation will dramatically increase the number of Americans with health insurance. We need to make sure that we are using our existing primary care workforce -- including nurse practitioners -- to meet the new demand."

To collect data, NNCC researchers contacted major managed care insurers offering HMO product lines in all 50 states and the District of Columbia in the summer of 2009. NNCC administered a brief survey to health plan staff using a uniform script. Only 48% of health plan staff surveyed said that they credential nurse practitioners as primary care providers. Four percent of respondents stated that while they did not normally credential nurse practitioners as primary care providers, they would occasionally make exceptions, especially if nurse practitioners provided care to Medicaid beneficiaries or patients in rural areas where few primary care physicians exist. The remaining insurers recognize nurse practitioners as primary care providers.

Federal health care reform will result in tens of millions of newly insured patients nationwide. In the face of acute primary care physician shortages and steady reductions in the number of physicians willing to accept Medicaid and Medicare, it is unclear whether the health care system can meet the needs of a universally-insured nation, unless it better utilizes nurse practitioners as primary care providers. In 2006 in Massachusetts, passage of a similar universal insurance plan overwhelmed the health care system's existing supply of primary care physicians. "Passage of a law in 2008 was designed to address just this problem by requiring health insurers to recognize nurse practitioner primary care providers and reimburse them fairly," says Therese Murray, Massachusetts Senate President. "While we are still in need of more primary care providers in Massachusetts the legal requirement has allowed nurse practitioners to fill a huge gap."

NNCC conducted a similar study in 2007 and found that 53% of managed care insurers recognized nurse practitioners as primary care providers. Data from its new study demonstrates that two years later, many managed care insurance companies still do not consider primary care nurse practitioners equal to primary care physicians. Findings also show that state and federal laws designed to prohibit unfair discrimination continue to provide little protection to nurse practitioners. "Equitable credentialing and reimbursement for nurse practitioner primary care providers will remain elusive as long as managed care insurers view nurse practitioners as primary care providers of last resort," said Hansen-Turton.

SOURCE National Nursing Centers Consortium