Insurance Companies Helping to Delay Nurse Practitioners Role in Primary Care

While demand for primary care providers is projected to increase dramatically following implementation of the Affordable Care Act, insurance companies and physician groups remain opposed to the credentialing of nurse practitioners to provide primary care services.

Advanced practice registered nurses hold a master’s degree and have an additional 700 hours of supervised clinical experience, allowing them to diagnose and treat many common illnesses as well as to administer anesthesia or deliver babies with the proper specialization. Despite their licensing, however, many states do not allow nurse practitioners to operate without physician oversight and many insurance providers will not credential them as primary care providers in their plans.

Physicians argue that the clinical role of nurse practitioners is different from that of doctors and that ensuing confusion could affect the quality of patient care; however, there is also a financial element regarding the current requirement that nurse practitioners bill through a physician’s office for service.

The American Nurses Associate submitted comments on the federal rules governing the national healthcare marketplace, set to open enrollment tomorrow, in which they encourage the Obama administration to include provisions requiring insurance providers to credential a certain number of nurse practitioners for independent practice. For their part, insurers are more focused on increasing access to primary care through other, “team-based” means.

At present, roughly half of the 250,000 advanced practice nurses in the United States work in physicians’ practices; many of them, it seems, would open their own practices if they were able to bill patients directly and insurers would include them in provider listings.

Learn more about funding options for nurse practitioners and other primary care providers.