With the millions of Americans who will have health insurance coverage starting in 2014 and the subsequent influx of new patients entering the healthcare system, nurse practitioners can play an important role in meeting the primary care needs of patients. A recent survey conducted by the National Nursing Centers Consortium revealed that while there is an increase in the number of health insurers recognizing nurse practitioners as primary care providers, there is still more work to be done to ensure that the nurse practitioner community can support the expansion of care through the Patient Protection and Affordable Care Act.
The NNCC, a nonprofit organization supporting nurse-managed health clinics and nurse-led care, conducted a national survey of health maintenance organizations to study the number of insurers that recognize nurse practitioners as primary care providers. NNCC has conducted a similar study every 24 months for the past decade. Looking at data collected from 258 HMOs managed by 98 insurance companies across 50 states and the District of Columbia from June 2011 to May 2012, the survey revealed that 75% of HMOs credential nurse practitioners as primary care providers. This is an increase from previous NNCC research, with percentages below 70%, and indicates marked improvement, but it will not be enough to meet the needs of the newly insured and the projected shortage of primary care physicians of about 60,000 by 2015.
A closer look at the survey
The survey attempted to contact 499 HMOs, and ultimately had 258 HMOs participate and be included in the survey sample. Of the 258 participating HMOs, 192 (74%) indicated that they credential nurse practitioners as primary care providers. Two of the plans, representing less than 1%, did not normally credential nurse practitioners as primary care providers, but indicated they would make occasional exceptions for nurse practitioners that provided care in underserved rural 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, which totaled 111 in this survey, credentialed nurse practitioners as primary care providers at the lowest credentialing rate, with 74 (67%) affirming that practice.
Challenges and opportunities
The increase in credentialing nurse practitioners as primary care providers is important but, again, not enough to ensure patients have access to necessary care. Some of those insurers credentialing nurse practitioners will not reimburse them directly, will not list them as primary care providers on their websites or will put stipulations in their contracts. All nurse practitioners must be able to practice to, and be compensated for, the full scope of their ability to be effective in ensuring patients have access to the health care they need.
There is an opportunity right now for nurse practitioners in primary care to leverage their lower cost structure by collaborating with safety-net provider networks to offer new, low price-point, high-quality and holistic options in state insurance exchanges’ targeted areas. This is especially true for commercial insurance plans, which are the least likely to recognize nurse practitioners as primary care providers, and which will be heavily relied upon by the newly insured.
To avoid a repeat of the circumstances in Massachusetts in 2007, when the availability of primary care providers was too low to meet new patient demand, and to ensure adequate access to care as the Affordable Care Act is fully implemented, credentialing efforts and the benefits of such practices — e.g., direct reimbursement, inclusion in primary care provider listings and nonlimiting contracts — need to be top priorities.
Tine Hansen-Turton is executive director of the Convenient Care Association.