Erasing inequities between doc, advanced practitioner pay

Advanced practice registered nurses (APRNs) and physician assistants (PAs) should receive the same compensation from Medicare as physicians for performing higher-level services, a member of the Medicare Payment Advisory Commission (MedPAC) said Friday.

Craig Samitt, M.D., president and chief executive of the Dean Health System in Madison, Wis., further suggested Medicare should reduce doctor's pay by 15 percent for services better left to APRNs or PAs, reported MedPage Today.

He also proposed APRNs and PAs in rural and underserved areas be paid higher rates to encourage them to set up practice in those areas, MedPage Today noted. "Instead of trying to recruit physicians, do we try to recruit advanced practitioners for some functions?" Samitt asked, according to the article.

Samitt's comments came during a discussion among MedPAC members of how to better recognize the contribution of APRNs and PAs.

In states where APRNs may operate independently of a physician, they receive 85 percent of what a doctor would receive for providing a particular service, MedPage Today reported. In states where APRNs must work under a physician's direction, the doctor receives full payment for the service at the physician fee schedule rate.

"I would really wonder whether or not we couldn't create the conditions of participation that say you can't restrict the use of people," said registered nurse Mary Naylor, Ph.D., from the University of Pennsylvania School of Nursing, according to the article.

Some commission members argued better utilization of lower-level practitioners can help solve physician shortages.

Last year the Centers for Medicare & Medicaid Services took steps allowing APRNs and other nonphysician practitioners to be considered part of a hospital's medical staff, with associated privileges. CMS also said those practitioners can be used to free up physicians to concentrate on patients with more complex conditions.

Some states are getting behind the push to give advanced practitioners more professional leeway. Last fall lawmakers in Michigan, for example, introduced a bill allowing nurse practitioners to practice independently of physicians. Similar legislation exists in 18 other states and the District of Columbia.

To learn more:
- read the MedPage Today article