Tuesday July 23rd 2019

Making the case for NPs as primary care providers

As the nation moves closer to implementing the Affordable Care Act (ACA), and millions of Americans become eligible for insurance coverage, recent reports from three influential sources call for expanded use of nurse practitioners (NPs) as primary care providers.

The Health Affairs/Robert Wood Johnson Foundation brief “Nurse Practitioners and Primary Care” describes how federal and state laws and policies limit access to NP care. The brief identifies the need for states to examine their current laws and regulations to remove barriers to NP practice and care, as well as include NPs in future care models and Medicaid expansion.

The National Governors Association report, The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care, includes an extensive literature review and recommends that states amend scope of practice restrictions and modify reimbursement policies to remove barriers to APRN practice and care. Specifically, the review found:

· Expanded use of NPs has the potential to increase access to health care, particularly in historically underserved areas.

· NPs successfully manage chronic conditions, such as hypertension, diabetes and obesity.

· No studies raise concern about the quality or safety of NP-provided primary care.

Medicaid reimbursement policies and rates for NP-provided care vary widely among states. Only 33 states and the District of Columbia designate NPs as primary care providers under Medicaid managed-care models in their states. Federal Medicaid law is another barrier, as only pediatric and family NPs are named as providers that must be directly reimbursed. Private insurance reimbursement for NP-provided primary care also varies widely among states and often within states. States need to both mandate direct reimbursement of NPs by third party payers and to prohibit discrimination against NPs as primary care providers.

The National Institute for Health Care Reform research brief “Primary Care Workforce Shortages: Nurse Practitioner Scope-of-Practice Laws and Payment Policies” also calls for revising state laws and regulations to grant NPs authority as primary care providers and to encourage direct payment of NPs by private insurers. This research brief outlines Medicare barriers to NP practice and care, including the Medicare requirements for physician certification of home health or hospice services and durable medical equipment, such as wheelchairs or glucometers. These Medicare barriers limit the ability of NPs to practice in every state.

These three reports add “shovel ready” solutions to the need for more NP primary care providers for newly insured consumers. Further, another APRN category, certified nurse-midwives (CNMs), provide primary care services to women from adolescence to late life, in addition to the care they provide before, during and after childbirth. Hundreds of thousands of NPs, CNMs, certified registered nurse anesthetists, and clinical nurse specialists stand ready and able to provide the compassionate, comprehensive and quality care so many millions have gone without for far too long.  ANA is working together with its constituent and state nurses associations to help remove geographic and practice setting limitations for APRNs. Working state by state, the goal is to ensure that state laws affecting APRNs are both fair and consistent across the country, and that all APRNs can practice to the full extent of their education and training.

— Andrea Brassard is a senior policy fellow for Nursing Practice and Policy
at the American Nurses Association.

Resources

Health Affairs: “Health Policy Brief: Nurse Practitioners and Primary Care”: www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79

National Governor’s Association: The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care: www.nga.org/cms/home/news-room/news-releases/page_2012/col2-content/nurse-practitioners-have-potenti.html#

National Institute for Health Care Reform: “Primary Care Workforce Shortages: Nurse Practitioner Scope-of-Practice Laws and Payment Policies” www.nihcr.org/PCP-Workforce-NPs

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