Update: Physician Extenders Lobby to be Credentialed within Insurer Networks

by webadmin on September 17, 2013

NPW-thumb1As we covered previously on this site, nurse practitioners recently lost a significant legislative fight in California over the expansion of their authority and responsibilities as medical professionals.

But this defeat, not to mention the beleaguered battles being fought elsewhere in the country, has only motivated NPs to refocus their efforts.

Now, Julie Appleby for Kaiser Health News reports nurse practitioners are appealing to the government, “asking the Obama administration to require insurers to include them in the plans offered to consumers in new online marketplaces, which open for enrollment Oct. 1.”

Once again, NPs are using a rather convincing argument to plead their case: access.

With “millions of newly insured consumers [needing] access to primary care,” Appleby writes, Karen Daley, president of the American Nurses Association, is warning the government that they will not be able to receive care “if private insurers continue to exclude or restrict advanced-practice registered nurses from their provider networks.”

Therefore, NPs want credentialing. They want the insurers to include them in their networks. They want insurers to “be required to credential a minimum number of advanced-practice nurses.” They want the authority “to bill insurers directly for services” without needing a physician to sign off on it.

You may recall physician associations argue more authority for nurse practitioners and physician assistants is not the solution; enhancing the quality of team-based care is, however.

And that’s the side on which most insurers seem to be coming down.

Alissa Fox, senior vice president of the Blue Cross Blue Shield Association, said, “We think the future is in the coordination of team-based care. And nurses are a key part of the team.”

America’s Health Insurance Plans spokeswoman Clare Krusing is remaining neutral on the issue, but “noted the percentage of HMOs that credential nurses is rising,” saying it’s “a reflection that new models of care are being implemented.”

Appleby reports physician groups continue to express their skepticism about expanding NP (and PA) power. They “question whether allowing nurses to bill insurers directly would increase access to primary care.”

According to the article, the Obama administration has decided against changing the final rule, but promised to keep an open mind about the issue in the future.

As healthcare executives, are you caught in the middle of this battle between physicians and physician extenders? Do you see a danger in credentialing nurse practitioners within insurer networks? Do you believe that expanding the authority of extenders would indeed ease the physician-shortage crisis and create better access for newly insured patients?

-by Pete Fernbaugh

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