New Research Shows That Insurer Contracting Policies Threaten Success of Health Care Reform

New Research Shows That Insurer Contracting Policies Threaten Success of
Health Care Reform
At a time when improving access to primary care is crucial, less than half of
managed care insurers routinely recognize nurse practitioners as primary care
providers

PHILADELPHIA, Oct. 26 /PRNewswire/ -- A study conducted by National Nursing
Centers Consortium (NNCC) has found that nearly half (48%) of all major
managed-care organizations in the United States do not credential or contract
with nurse practitioners as primary care providers. "Policies like these
jeopardize the success of health care reform at a time when we need more
qualified and cost-effective primary care providers than ever before," says
Tine Hansen-Turton, CEO of NNCC.

(Logo: http://www.newscom.com/cgi-bin/prnh/20091026/PH98554LOGO )

The American Academy of Nursing has identified nurses who have developed
innovative models of care that could support the infrastructure that the
United States needs to provide more health promotion, prevention and chronic
care management. But, the Academy's CEO Pat Ford-Roegner notes that, "Insurers
must remove the barriers to full utilization and credentialing of the advanced
practice nurses if we're to spread these models of care that we know improve
health outcomes and reduce costs."

In nurse-managed health centers, community health centers, and nurse-led
private practices throughout the country, nurse practitioners provide
comprehensive primary care to patients with similar outcomes to primary care
physicians. Insurers' prohibitive reimbursement policies reduce these
practices' capacity for growth and threaten key components of the health care
safety net. "To improve our health care system, we need to improve access not
only to health insurance, but to health care providers as well," says Ann S.
Torregrossa, Director of the Pennsylvania Governor's Office of Health Care
Reform. "Health reform legislation will dramatically increase the number of
Americans with health insurance. We need to make sure that we are using our
existing primary care workforce -- including nurse practitioners -- to meet
the new demand."

To collect data, NNCC researchers contacted major managed care insurers
offering HMO product lines in all 50 states and the District of Columbia in
the summer of 2009. NNCC administered a brief survey to health plan staff
using a uniform script. Only 48% of health plan staff surveyed said that they
credential nurse practitioners as primary care providers. Four percent of
respondents stated that while they did not normally credential nurse
practitioners as primary care providers, they would occasionally make
exceptions, especially if nurse practitioners provided care to Medicaid
beneficiaries or patients in rural areas where few primary care physicians
exist. The remaining insurers recognize nurse practitioners as primary care
providers.

Federal health care reform will result in tens of millions of newly insured
patients nationwide. In the face of acute primary care physician shortages and
steady reductions in the number of physicians willing to accept Medicaid and
Medicare, it is unclear whether the health care system can meet the needs of a
universally-insured nation, unless it better utilizes nurse practitioners as
primary care providers. In 2006 in Massachusetts, passage of a similar
universal insurance plan overwhelmed the health care system's existing supply
of primary care physicians. "Passage of a law in 2008 was designed to address
just this problem by requiring health insurers to recognize nurse practitioner
primary care providers and reimburse them fairly," says Therese Murray,
Massachusetts Senate President. "While we are still in need of more primary
care providers in Massachusetts the legal requirement has allowed nurse
practitioners to fill a huge gap."

NNCC conducted a similar study in 2007 and found that 53% of managed care
insurers recognized nurse practitioners as primary care providers. Data from
its new study demonstrates that two years later, many managed care insurance
companies still do not consider primary care nurse practitioners equal to
primary care physicians. Findings also show that state and federal laws
designed to prohibit unfair discrimination continue to provide little
protection to nurse practitioners. "Equitable credentialing and reimbursement
for nurse practitioner primary care providers will remain elusive as long as
managed care insurers view nurse practitioners as primary care providers of
last resort," said Hansen-Turton.

ABOUT THE NATIONAL NURSING CENTERS CONSORTIUM

The largest organization of nurse-managed health centers in the United States,
National Nursing Centers Consortium (NNCC) works to advance nurse-led health
care through policy, consultation, programs and applied research to reduce
health disparities and meet people's primary care and wellness needs.
Nurse-managed health centers are community-based practices led by advanced
practice nurses (primarily nurse practitioners). The nation's 250
nurse-managed health centers reduce health disparities by providing high
quality comprehensive primary health care, health promotion, and disease
prevention services to uninsured and vulnerable patients in rural, urban, and
suburban communities. In coming months, NNCC researchers will further analyze
study results and prepare them for third-party publication.

ABOUT THE AMERICAN ACADEMY OF NURSING

The American Academy of Nursing anticipates and tracks national and
international trends in health care, while addressing resulting issues of
health care knowledge and policy. The Academy's mission is to serve the
public and nursing profession by advancing health policy and practice through
the generation, synthesis, and dissemination of nursing knowledge.

SOURCE National Nursing Centers Consortium

Tine Hansen-Turton of National Nursing Centers Consortium, +1-215-731-7140 or
+1-215-219-8857, tine@nncc.us