Nurse Practitioners—Valuable but Undervalued


For Nurse Practitioner World News
May/June 2010
By Carla Mills, ARNP

The day healthcare reform was signed into law, the future prospects for nurse practitioners (NPs) changed—whether for better or worse remains to be seen. Thirty million newly insured patients will enter the healthcare system over the next few years, all seeking primary care. Community health centers have already been targeted to receive $11 billion dollars in government funding. But, as valuable as NPs are, the profession continues to be undervalued in terms of reimbursement and practice authority. Reduced Medicare reimbursement rates for NPs compared with physicians and the lack of direct reimbursement to NPs from most private insurers will make it difficult, if not impossible, to make NP run community health centers—or any NP care delivery site—financially viable.

Under present laws, NPs are reimbursed only 85% of the amount Medicare pays physicians for the same services. Private insurers usually tie their reimbursement practices to what Medicare allows. This is an open-and-shut case of unequal pay for equal work. If NPs’ payments were to drop to 85% of the proposed 21% cut to physicians’ pay, it will put NPs out of business altogether. When reimbursement falls below the cost of delivering care, no healthcare provider—whether a physician or an NP—can stay in business.

The assumption that the law of supply and demand will solve the provider shortage is flawed. It takes years of education and clinical experience to grow a skilled clinician, and we already have a shortage of providers, even before 30 million more people seek care. Medical professionals have been increasing their patient volumes for more than a decade in an effort to compensate for pay cuts. Current patient volumes have already dramatically reduced patient visit times, which has done nothing to either reduce costs or improve care.

There are nearly 150,000 NPs already trained and currently practicing, who are hampered at every turn by low reimbursement rates and restrictions against practicing to the full extent of their education and ability. The professional energy that NPs are spending to try to remove these barriers wastes valuable time that would be much better spent creating innovative, patient centered healthcare delivery systems. Community health centers and convenience-care clinics are just two examples of new ways NPs are finding to provide direct care to patients.

Valuing the Right Things

In the last 40 years, chronic diseases have become epidemic. Obesity and smoking are now the leading causes of preventable premature death. These problems and other unhealthy lifestyle behaviors lead directly to a host of other expensive and disabling chronic diseases. While physicians have insisted on having complete and final authority over every aspect of health and medical care in this country, the state of Americans’ health has continued to decline.

Historically, physicians have been the most valued and highly paid health providers in the system. They deserve and have received credit for giant strides made within their scope of practice, which is primarily treating diseases and performing many life-saving treatments and procedures. Although these functions are very important, they come late in the process, while disease prevention, which is the focus of many NPs’ practices, may result in greater overall cost savings for the individual and the healthcare system as a whole.

Purely medical fixes send the wrong message to patients: don’t bother taking care of yourself. Eat yourself into a diabetic state, and when you are 100+ pounds overweight, come to us and we’ll fix it. The focus on treating, not preventing, disease has created a country of uneducated and dependent patients. If there is to be any hope for health and healthcare reform, it will depend on independent, well-educated patients who are skilled in preventive self-care. It’s time to stop over-valuing those providers who treat the sick and under-valuing those providers who promote health. It’s time to empower NPs. It is the only way the healthcare system can be brought into balance.

The Value of NPs

Under the physician-controlled medical system, patient education has suffered more than any other aspect of care over the last 40 years. It is an area in which NPs have proven themselves to be superior providers. I am constantly shocked to see my patients making important health choices based on incomplete knowledge and/or misinformation.

Educating patients takes time and patience—two qualities that physicians freely admit are in short supply in their own practices. Patients need reassurance, support, good information, and acceptance in order to learn to how to effectively prevent or self-manage chronic diseases. Finding effective treatment approaches that fit an individual’s world view can be tedious and frustrating work. There are small victories and frequent setbacks. The work is far from glamorous, and there is absolutely no reimbursement for it under the current payment structure. This explains why physicians are opting out of primary care—no money, no glamour. They have become accustomed to having plenty of both.

Valuing NPs

There is a tsunami of patients on its way. More than thirty million patients will become insured over the next 10 years. It is predicted that 10 million of them will enter the system with chronic diseases that have never been diagnosed or treated. The remaining 20+ million are predicted to be younger and basically healthy.

Never has such an opportunity to put prevention into practice been offered to healthcare professionals. It’s a historic chance to start turning back the scourge of chronic disease. As Florence Nightingale transformed medical care over a century ago, NPs are poised to transform it for the next 100 years. How? By being creative and innovative!

NPs have a responsibility to make their value to the healthcare system clear to everyone involved. But NPs need support too—from their patients, from the physicians with whom they work, from the media, and, most urgently, from lawmakers. It’s time for everyone to stand up for NPs and acknowledge their value. It’s time to remove the practice barriers that prevent them from being as effective as they could be. It’s time for NPs to have full practice and prescriptive authority within their scope so that they can practice without dependence on physicians.

The principle of equal pay for equal work demands that NPs receive the same reimbursement from Medicare and private insurance companies that physicians do for providing the same services. If the value and valuation of NPs are not reconsidered and the crippling financial and practice restrictions persist, there is a very real danger that NPs’ unique brand of healthcare will disappear. And if it does, its innovations and insights will disappear with it.

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.

Permalink  ·  

#1 | On July 09, 2010, Rachel Maples said:

Great article!! (Nurse Practitioners -
Valuable but Undervalued). As an FNP
who has been out of the game (raising
kids) I eagerly await the results of recent
legislation & hopefully future
opportunities for me as an NP. I am
also hoping that “re-training” programs
will become more abundant. With maybe
6 months of re-training I should be able
to jump back in.

#2 | On January 10, 2011, jen said:

perhaps NP’s need to delay participation until there is release of practice restriction in all states and payers agree to reimburse and at the same rates as other PCP’s. We speak the language of care, they speak the language of business and money.

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