Colo. nurse practitioners struggle for recognition, reimbursement; Mass. struggles with health care access

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Nov 18 2010

The Denver Post: "When nurse practitioner Mary Lou Hendrix opened her own high-risk-pregnancy practice in Evergreen and Cherry Creek last spring after more than 25 years of providing such care in physicians' offices, she was well-prepared for the medical challenges she would face. But she was not ready for the still-unresolved nightmare of trying to get recognized and reimbursed by insurance companies. ... This is happening to advanced-practice nurses in solo practices across Colorado despite a 2008 state law that specifies nurse practitioners do not need to work under the auspices of a physician to be credentialed and reimbursed by insurance companies. State law also requires that these advanced nurses be reimbursed the same as physicians for providing identical services" (Lofholm, 11/17).

The Associated Press/The Boston Herald: "Access to health care in Massachusetts remains tight, with hospital emergency rooms increasingly picking up the slack, even as the state has experienced a surge in the number of insured residents. Those are some of the findings of an annual report released Tuesday by the Massachusetts Health Council that looks at a range of health-related factors, from tobacco use and obesity to violence and infectious blood-borne diseases like HIV. The report found that while 97 percent of the state's residents were insured, in part due to the state's 2006 health care law, finding a doctor wasn't always easy. Only 44 percent of primary care doctors are accepting new patients, and primary health services are increasingly being provided by hospital emergency departments, where care is typically more expensive than in a doctor's office" (11/16).

Stateline.org: "Before there was a federal health care overhaul, and before there was a Massachusetts law to use as a model for the national plan, there was Dirigo. That's what Maine called its first-in-the-nation attempt at achieving universal health coverage when Democrats approved the plan back in 2003. Now, the Maine program may be one of the first casualties of the Republican landslide in state capitals. Maine's incoming governor, Paul LePage, pledged during the campaign to 'repeal and replace' the plan, which is Latin for 'I lead' and is the state's motto. Republicans also took control of the Maine House and Senate, making the state one of only two to flip from total Democratic control to total control by Republicans (Wisconsin was the other)" (Prah, 11/17).

The Birmingham News: "A proposal by Alabama's Board of Medical Examiners would make pain management services more expensive and harder to find, according to the Federal Trade Commission, which is asking the state board to reject the rule. The Board of Medical Examiners in July, citing patient safety concerns, recommended that certain treatments for pain be performed solely by doctors and not be delegated to others. But the FTC said there is no evidence that allowing certified registered nurse anesthetists to do the work has harmed patients, and barring them from it could make things worse for people suffering from chronic pain" (Orndorff, 11/16).

The Hartford Courant: "Anthem's request to raise premiums by 20 percent for some Connecticut health plans isn't justified in the documents the company filed with state regulators, Attorney General Richard Blumenthal said Monday. Blumenthal, who on Monday was granted intervenor status in the case, is asking the state Insurance Department to demand more information from Anthem Blue Cross and Blue Shield in Connecticut before considering the rate request at a hearing scheduled for 9 a.m. Wednesday at the department's Hartford offices. The hearing, Blumenthal said, 'will be a mirage without critical data on this massive 20-percent rate hike … the Insurance Department must delay or deny this rate increase until it can properly review and analyze all the facts'" (Sturdevant, 11/15).

The Associated Press/The Boston Globe: "Anthem Blue Cross and Blue Shield and opponents to its request for a nearly 20 percent increase in health insurance rates will confront each other at a state hearing. The two sides will face off Wednesday at a hearing scheduled by the Connecticut Insurance Department. The commissioner will decide within 30 days whether to grant the increase for as many as 48,000 individual policy holders" (11/17).

The Associated Press/Bloomberg Businessweek: "A hearing officer for the Connecticut Insurance Department has brushed aside objections and scheduled a hearing for a proposed health insurance rate increase. State Attorney General Richard Blumenthal had asked that the hearing be postponed. He said more information is needed" (11/16).

The Philadelphia Inquirer: "An affordable health-insurance program for low-income working people that was started by Gov. Tom Ridge and expanded under Gov. Rendell is projected to run out of money within weeks after Gov.-elect Corbett takes office, administration officials said. Contractual obligations mean that insurance-termination notices may need to go to tens of thousands of subscribers in the program, known as adultBasic, even before the new governor is sworn in, if more than $50 million is not found before then, they said. As attorney general, Corbett joined a lawsuit seeking to overturn President Obama's health-care overhaul" (Sapatkin, 11/17).

The Washington Post: "Starting Wednesday, the [District of Columbia] health department will e-mail the physicians asking them to complete a 15-question online survey. They'll be asked to rank the parts of the city and age groups with the highest prevalence rate and to say whether they are aware of the local and federal recommendations about screening. The survey will run through Dec. 3. The District's HIV/AIDS prevalence rate is the highest of any city in the nation. Officials and advocates say local studies and anecdotal evidence point to a gap in understanding among doctors about the severity of the epidemic in Washington. Many doctors may think that only high-risk groups need regular testing, the officials said. But since 2006, the city's health department has recommended that all residents ages 13 to 84 be screened annually for HIV, the illness that causes AIDS" (Sun, 11/16).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.