Nurse practitioners seek insurer credentials to practice primary care

To help meet the growing need for primary care services, nurse practitioners are asking the Obama administration to require insurers to credential them, Kaiser Health News reports.

The U.S. Department of Labor estimates approximately half of the nation's nurse practitioners (NPs) work in physicians' offices. According to Deanna Tolman, an Aurora, Colo.-area advanced practice nurse, many NPs do not go into business for themselves because it's hard to get insurers to include them. "We're in this gray area: Insurers are fine with us providing care as long as we're working for physicians. But some of us don't want to work for physicians,"  Tolman told Kaiser Health News.

Although 17 states and the District of Columbia have laws on the books allowing nurse practitioners to practice independently (most recently Nevada, which passed its law just this summer), many NPs say they have difficulty getting insurers to accept them as primary care providers. NPs must be credentialed in insurers' networks to bill insurers directly for services. Insurers maintain their hands are tied by individual state laws regarding nurses practicing independently, the article noted.

The American Nurses Association (ANA) in July submitted its recommendation that insurers be required to include NPs, during the formal comment period for proposed rules relating to healthcare reform. The group stated that insurers selling plans in the forthcoming online health insurance marketplaces should grant credentials to a minimum number of advanced practice nurses. The number of NPs insurers would have to include varies widely by state, from as low as 20 NPs to as high as 600.

While the administration declined to make any rule changes in late August, it said it would "continue assessing" whether to mandate that certain insurers credential specific providers.

Meanwhile, a Health Affairs study released in June found healthcare consumers were open to the idea of an increased role for nurse practitioners. More than one-fifth of those polled preferred to have an NP or physician assistant (PA) over a physician while searching for a new provider, and a majority said they would rather see an NP or PA sooner than a physician later, FierceHealthcare previously reported. Research has also found that higher levels of nursing education are linked to lower patient mortality rates.

To learn more:
- here's the Kaiser Health News article

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.