Survey: Health insurers show advances in NP credentialing, reimbursement

PHILADELPHIA — More health insurers are credentialing nurse practitioners as primary care providers, but there is room for improvement, according to a recent national survey of health insurers.

The survey of health insurers, specifically Health Maintenance Organizations — conducted by the National Nursing Centers Consortium, a support organization for nurse-led care — found that 75% of HMOs credential with nurse practitioners as primary care providers, an increase over previous years.

Data were collected from 258 health maintenance organizations managed by 98 insurance companies across 50 states and the District of Columbia in from June 2011 to May 2012.



“Compared with similar research we’ve done previously, this survey seems to indicate that more health insurers are credentialing nurse practitioners as primary care providers, which is an improvement. But it won’t be enough given the millions more Americans who will be insured after 2014 and a projected shortage of primary care physicians of about 60,000 by 2015. Unless we get to 100% credentialing, we should expect a repeat of the circumstances in Massachusetts in 2007, when the supply of primary care providers was far too low to meet new patient demand,” stated Tine Hansen-Turton, CEO of NNCC.



Out of 499 total attempted contacts, 258 HMOs participated and were included in the survey sample. Of these, 192 (74%) indicated that they credential nurse practitioners as primary care providers. Two of the plans (fewer than 1%) did not normally credential nurse practitioners as primary care providers but indicated they would occasionally make exceptions if nurse practitioners provided care in underserved rural areas.



"Increased credentialing of nurse practitioners as primary care providers is important, but it is not enough to ensure patients have the access to care they need and to alleviate the growing national shortage of primary care providers,” added Amy Bell, senior finance director at the Larry Combest Community Health and Wellness Center in Lubbock, Texas. “Sometimes insurers will credential us but will not reimburse us directly, will not list us on their websites as primary care providers or they will put stipulations in our contracts. For the healthcare system to be ready for the huge influx of new patients in 2014, all nurse practitioners must be able to practice to, and be compensated for, the full scope of their ability."

Hansen-Turton added, “This is the time to leverage our lower cost structure by combining with safety-net provider networks to offer new, low price-point, high quality, holistic options in state insurance exchanges’ targeted areas.”



Since HMOs may serve any combination of Medicaid, Medicare and commercial enrollees, the survey categorized the 258 responding HMOs by product line. The Medicaid group consisted of 119 HMOs, of which 90 (76%) credentialed nurse practitioners as primary care providers. Of the 89 HMOs in the Medicare group, 74 (83%) credentialed nurse practitioners as primary care providers. The commercial HMO plans, numbering 111 in this survey, credentialed nurse practitioners as primary care providers at the lowest credentialing rate, with 74 (67%) affirming that practice.

“As state health insurance exchanges add millions of newly insured lives, they also drive the need for more providers in the private insurance market,” stated Hansen-Turton, “the low number of commercial insurance plans that credential nurse practitioners will increasingly be a challenge.”

Login or Register to post a comment.