Oregon Bill: Same Reimbursement of Independent NPs and PAs as Physicians

[baby tooth]

---

Members do not see this ad.

Orgeon recently passed this bill: http://gov.oregonlive.com/bill/2013/HB2902/


TLDR version: "HB 2902 B would require insurance companies to reimburse nurse practitioners (NP) and physician assistants (PA) in independent practice the same rate as physicians when providing the same primary care and mental health services and billing under the same code. The bill defines independent practice as any nurse practitioner or physician assistant who bills under their own name and national provider identifier (NPI)."

(From: http://www.oregonrn.org/displaycommon.cfm?an=1&subarticlenbr=670)


What do you guys think of this? Serious/intelligent discussion only, please!

 

[1012526fs]

Orgeon recently passed this bill: http://gov.oregonlive.com/bill/2013/HB2902/


TLDR version: "HB 2902 B would require insurance companies to reimburse nurse practitioners (NP) and physician assistants (PA) in independent practice the same rate as physicians when providing the same primary care and mental health services and billing under the same code. The bill defines independent practice as any nurse practitioner or physician assistant who bills under their own name and national provider identifier (NPI)."

(From: http://www.oregonrn.org/displaycommon.cfm?an=1&subarticlenbr=670)


What do you guys think of this? Serious/intelligent discussion only, please!

Don't know about Oregon, but a lot of states do not allow PA's to bill under their own name to begin with, so it would be a moot point. Don't know about NP's. Since most don't require physician oversight, they could potentially do this.

 

[Nissan GTR]

.

 

[whatbout2morrow]

It means job security for physicians.

Who would you want to see if it cost the same- a physician or a mid-level?

 

[1012526fs]

It means job security for physicians.

Who would you want to see if it cost the same- a physician or a mid-level?

👍 Good point.

 

[Mt Kilimanjaro]

I get NPs, but why PA? Their role is as an extender, not an independent clinician.

NPs should have to pass Step 1, 2, 3 to get paid the same.

 

[Socrates25]

There is no such thing as "independent" practice for PAs in Oregon. By law they must have a "collaborating" physician on record.

 

[yehhhboiii]

It means job security for physicians.

Who would you want to see if it cost the same- a physician or a mid-level?

job security at lower pay
as if family docs aren't having trouble keeping their doors open already

 

[DocVapor]

job security at lower pay
as if family docs aren't having trouble keeping their doors open already

Yup. I see this lowering physician pay instead of raising NP pay.

 

[Status Sciaticus]

job security at lower pay
as if family docs aren't having trouble keeping their doors open already

Actually it's the other way around.

NPs want to be billed at the physician level.

Doesn't mean that docs will be payed less. Rather NPs will be payed more than what they are now.

This bill is funny because I am sure the NPs pushed for this but it seems to have backfired.
I don't know of anyone that would visit an NP over an MD/DO if they each cost the same.

 

[def1]

Actually it's the other way around.

NPs want to be billed at the physician level.

Doesn't mean that docs will be payed less. Rather NPs will be payed more than what they are now.

This bill is funny because I am sure the NPs pushed for this but it seems to have backfired.
I don't know of anyone that would visit an NP over an MD/DO if they each cost the same.

There is nothing stopping insurance companies from dropping physicians reimbursment and making everyone lose here.

I think if that happens, most PCP will move out of that state and leave ORegon in a worse shortage than it has now. A stupid bill any way you look at it imo.

 

[whatbout2morrow]

job security at lower pay
as if family docs aren't having trouble keeping their doors open already

True. But unless keeping physicians part of the primary care force becomes more important to the public, the government and physicians, and ways to incentivize going into primary care despite lower reimbursements are not found, perhaps physicians will start moving away from primary care altogether. Unless of course, someone is willing to take on the increasing debt and opportunity cost for the diminishing pay.

Actually it's the other way around.

NPs want to be billed at the physician level.

Doesn't mean that docs will be payed less. Rather NPs will be payed more than what they are now.

This bill is funny because I am sure the NPs pushed for this but it seems to have backfired.
I don't know of anyone that would visit an NP over an MD/DO if they each cost the same.

They are referring to the decline of reimbursements in general. The cost of medical education and opportunity cost of over a decade of training factor into the argument of why reimbursement should not be decreased. NPs & PAs can be produced in almost half the time with a fraction of the debt, and this will be a bargaining point for insurance companies to lower reimbursement for primary care services in general. In other words, if it costs less to produce a primary care provider (in this case NPs and PAs), why should insurance companies pay more?

 

[BABSstudent]

So should they change everything so it costs the same?

Like should regular gas cost the same as premium gas? I mean, they both make your car run.

They should also change the prices of hotels to have a Motel 8 cost the same thing as the Merriott because they both let you sleep there for a night.



Anyway you look at it, why would you go to a NP or PA now? If it is going to cost you the same as going to an MD or DO, why would you choose less education and training?

 

[SilverCat]

Would it be possible in future for the government to cut residency and physician training spending, and place NPs and PAs on the insurance plans to decrease healthcare spending? I could absolutely see them importing more foreign doctors to avoid the expenditure for training AMGs.

Disclaimer: I have little knowledge of this topic, so if this seems ridiculous, my apologies.

 

[Gut Shot]

What do you guys think of this? Serious/intelligent discussion only, please!

I think you shouldn't have posted this in multiple forums.

 

[Mt Kilimanjaro]

Just noticed the DP. that's annoying.

 

[yehhhboiii]

Actually it's the other way around.

NPs want to be billed at the physician level.

Doesn't mean that docs will be payed less. Rather NPs will be payed more than what they are now.

This bill is funny because I am sure the NPs pushed for this but it seems to have backfired.
I don't know of anyone that would visit an NP over an MD/DO if they each cost the same.

right because the insurance companies are going to just pull cash off the money tree in their backyard to pay these people more

 

[Status Sciaticus]

right because the insurance companies are going to just pull cash off the money tree in their backyard to pay these people more

You always have the option of avoiding this whole situation by being salaried a hospital or not accepting insurance with lower reimbursements.

 

[yehhhboiii]

You always have the option of avoiding this whole situation by being salaried a hospital or not accepting insurance with lower reimbursements.

if we're talking about doctors maintaining the same pay, being salaried by a hospital is not the way you want to go

 

[Temperature101]

250k student loan for physicians... NP/PA getting the same reimbursement rate... Insurance will decrease their reimbursement since NP will be happy to get about 1/2 of what physician get... What will happen to FM/PED/IM/PSCHY/ANES salaries? I am leaning strongly toward EM now...

 

[deleted393595]

So should they change everything so it costs the same?

Like should regular gas cost the same as premium gas? I mean, they both make your car run.

They should also change the prices of hotels to have a Motel 8 cost the same thing as the Merriott because they both let you sleep there for a night.



Anyway you look at it, why would you go to a NP or PA now? If it is going to cost you the same as going to an MD or DO, why would you choose less education and training?

Good point. And I think that's all the more reason to for most physicians to switch to concierge: You get a re-establishment of free market principles and competition while providing for greater quality for patients, while PCPs stop being nickled and dimed by Medicare and insurance, and finally get to focus on the patient rather than checking off boxes in an EMR. It's a win-win for everyone (except the government and insurance)

 

[Gauss44]

Orgeon recently passed this bill: http://gov.oregonlive.com/bill/2013/HB2902/


TLDR version: "HB 2902 B would require insurance companies to reimburse nurse practitioners (NP) and physician assistants (PA) in independent practice the same rate as physicians when providing the same primary care and mental health services and billing under the same code. The bill defines independent practice as any nurse practitioner or physician assistant who bills under their own name and national provider identifier (NPI)."

(From: http://www.oregonrn.org/displaycommon.cfm?an=1&subarticlenbr=670)


What do you guys think of this? Serious/intelligent discussion only, please!

Are there any specialties where this would not apply? In other words, can a NP or PA do any doctor's job, or only primary care?

IMO, this is bad news for doctors. I haven't read the bill or anything, just the OP's post. Sounds to me like other states could be next. In my experience, insurance companies like to reimburse as little as possible for everything, and are very skilled at finding ways to do so.

And if NPs can do everything that a PCP can, what's to say that PCPs won't be obsolete in several years from now? From what I've heard, if that were the case, they could all do a residency in something else and specialize. What a change that would be.

My understanding is that insurance companies are in it for the money. Period. This makes using NPs instead of doctors in their best interest. NPs can be paid less than doctors, and if insurance companies have it their way, they will pay NPs instead of doctors. Insurance companies want the cheapest price tag.

 

[EtherBunny]

Part of the problem is that the general public, and lawmakers in particular, have a poor understanding of medical education, competency assessment, and patient care. When you couple this lack of understanding with the central motive of politicians to get re-elected (which means that campaign contributions have more influence than rational arguments), this is the kind of ridiculous legislation that you see.

When you look at the FACTS, it's obvious that physicians undergo substantially more training, have higher barriers to entry, and endure a more rigorous certification process than advanced practice nurses.

The propaganda of various nursing political associations (e.g., the AANA) would have you believe that...

* The MCAT is equivalent to the GRE.
* The college education for pre-meds (4 years) and medical school (an additional 4 years) are "pretty much" the same thing as nursing school (4 years). Yep, 4=8. (How could you think otherwise?)
* Internship, residency, and fellowship are equivalent to a nursing advanced practice degree and 1 year of prior experience as a nurse.
* The NCLEX and written certification exam for advanced practice nursing is equivalent to USMLE Step 1, Step 2 CK, Step 2 CS, USMLE Step 3, and a written specialty board examination (and, in some cases, an oral examination as well).
* A nurse with a DNP is equivalent to physician with an MD who completes an internship and residency (after all, both can practice independently).

The political arm of nursing would have us all believe that these experiences are "equivalent" because nursing and medicine are really just different philosophical approaches to patient care. Nursing theory represents a different approach to patient care and, by virtue of this distinction alone, nurses can undergo less formal education (translation: shave off 5-6 YEARS of formal education), have fewer hours of clinical training (i.e., TEN THOUSAND HOURS less), and take fewer standardized exams to prove competency.

Yep, "equivalence" is a marvelous concept in the realm of medical practice. In some respects, it's downright magical. It defies all logic, mathematical laws, and common sense. That's right, in the magical world of advanced practice nursing...4=8, 7=12, more rigorous=less rigorous, and type II statistical errors=scientific truth.

 

[Gauss44]

It's also possible to just look at the bottom line statistically: How many patients see PCPs for things that NPs could take care of? How much money would insurance companies save by making patients see NPs instead? It's about making financial sense to the insurance company.

Why should an insurance company pay extra for a patient to see a PCP? Because the PCP is in debt? Because the PCP has an abundance of extra education which an NP arguably does fine without?

As a premed, I don't like the direction this may or may not be going in.