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Proposed law in PA mandates that nurses get paid same amount as doctors

Discussion in 'Topics in Healthcare' started by MacGyver, May 11, 2007.

  1. MacGyver

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    http://www.earthtimes.org/articles/show/news_press_release,104436.shtml


    How long before the nursing lobby pushes a bill thru Congress that mandates that Medicare pays the same amount to NPs as doctors per procedure?

    Another thing to consider: more "providers" sticking their finger into the funding pie means less pie for everybody. Next teh acupuncturists, physical therapists, chiropractors will stick their grubby fingers into the pie. Remember guys, docs get paid out of the same pool of money as the rest of these frauds. Funding for NPs, chiros, etc = less money for docs.
     
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  3. McDoctor

    McDoctor Over One Billion Cured
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    The bill has not been formally announced to the public as of yet. Specifics still are not available on the PA house of representatives website.

    Its worth noting that the bill has little power over what insurers or medicare is willing to reimburse for services provided by a mid-level. The governor is pandering to his audience here, just a little. Even the statewide medicaid program in PA is outsourced to private companies and is pretty much beyond the reach of this legislation.

    These proposed bills just redefine scope of practice by proposing changes within the licensing board in Pennsylvania. Of course, its definitely worth watching closely if you live in PA. But it doesn't mean that insurance companies now have to change their fee schedules. Or medicare. Or even medicaid in pennsylvania, since its outsourced to the private industry.
     
  4. Miami_med

    Miami_med Moving Far Away
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    I'd have to respectfully disagree. The private insurance industry is heavily regulated, and a government mandate can and will influence what they do. This is especially true if they are a company taking government money.
     
  5. McDoctor

    McDoctor Over One Billion Cured
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    I'm referring to this proposed law, which only makes changes to scope of practice specified in PA licensure. As far as I can tell, there is no proposed mandate to affect fee schedules in this series of bills. Of course, hard to say for sure until they are available to the public for scrutiny.
     
  6. Miami_med

    Miami_med Moving Far Away
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    Ah ok
     
  7. McDoctor

    McDoctor Over One Billion Cured
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    As an analogy, my PA license states "osteopathic physician and surgeon". I undergo the same licensing process as surgeons in Pennsylvania. Our scope of practice as far as the semantics of our licenses are concerned are identical. Nonetheless, medicare never has, nor never will, reimburse me for performing a lap cholecystectomy.
     
  8. pufftissue

    pufftissue Junior Member
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    I have no problem with nurses and NPs and CRNAs and anyone else making the same amounts of money as MDs.

    But...just give them the same amount of legal and occupational responsibility as the MDs. If they want the same pay, either increase the schooling required to be a nurse, for example, or cut back the schooling required to be a doctor. If they want the same pay, make them take overnight call and make the same decisions that MDs do.

    There are nurses who could do a given procedure much better than an MD who hasn't done it but 3 times during a residency. In my experience, MDs have a better grasp of the why behind a procedure, whereas nurses are better at carrying out a procedure. It's a matter of a different expectation, culture, and focus of training. I personally think that those who are pushing for the equal pay bills are those who feel like b/c the end result (intubating a patient) is all that matters. But when it gets complicated and a situation needs more in-depth understanding of what to do, that's where the MD comes in. You're paying them more for the potential problems and expertise that is not used in everyday situations, but sure nice to have when the time comes.
    If one argues that we can just change nursing education or have "super nurse s", then it's simply a matter of semantics. The MDs of today would then be the "super nurses" of tomorrow. The bottom line is that you need "experts," and I think it's illogical to pay them less.
     
  9. Shpamme

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    I don't have a issue with NP's and other healthcare providers getting paid the same as doctors, provided they treat with care. But at the same time, some consideration must be given to the fact that many doctors, especially solo practitioners, have overhead costs that a lot of NP's and other providers do not. The doctor who hires the NP or physical therapist for his/her private clinic, for instance, has to purchase all the equipment the NP uses, print business cards, e.t.c. Even for NP's who are employed by hospitals, they don't have the costs that hospital employed physicians do. I mean, a quick survey of NP malpractice premiums tells you that doctors are paying close to 2-3x what they pay. And in many instances (don't quote me on this though, I learned this tidbit from talking to a friend who is a NP), their malpractice premiums are paid for by their employers, negotiated as part of their employment package. I really think reimbursements need to be made in light of the increased costs doctors face.

    The other problem I have with it is that let's say we give them more money. Then do we give them more duties? Duties are already getting confused and blurred between different practitioners. It's already hard enough to figure out what standard of care we apply to physicians--when you get to dueling experts in trials of specialists for example, I've seen everyone from DO's to nonspecialists offered as experts. And somehow, this flies. Now if we start introducing NP's into the mix, it's going to be even harder to establish the standards of care we need to hold physicians and doctors and nurses and ancillary providers to.

    MacGyver too has a really valid point IMHO. It's already started actually. It's not only NP's going after "a piece of the pie" as OP puts it. PT's are long known for warring with doctors to prevent them from opening outpatient therapy facilities, etc. Now it's even doctors on doctors..apparently some bill is being pushed by radiologists to prevent orthopods from opening outpatient imaging facilities. Of course, I don't blame them.. they are getting squeezed by this new Deficit Reduction Act.
     
  10. McDoctor

    McDoctor Over One Billion Cured
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    Just to clarify:

    The law has not been proposed yet. Public hearings were held throughout the month of May throughout the state. Probably, it will be written and proposed shortly.

    The law likely will have absolutely no power over how much private insurers or medicare reimburses for services provided by a mid level. Medicaid is outsourced to the private sector in PA, and these private HMO's also independently set their own fee schedules. It will not "mandate" how much levels are reimbursed. The governor is pandering to an audience dumb enough to believe him.

    The law only seeks to (potentially) expand what mid-levels can do independently by changing the scope of practice under PA licensure. To what extent isn't known yet, because the bill still hasn't been formally introduced.
    updates are available here:
    http://www.pahouse.com/PR/096050711a.asp
    and here:
    http://www.pahouse.com/sturla/

    As I alluded to earlier, my license is the same as a neurosurgeons in Pennsylvania. It's up to individual insurance companies and medicare and hospitals to determine that I shouldn't be reimbursed for performing brain biopsies.

    There is still reason to be concerned from a public health standpoint and from a financial standpoint. Mid levels are less educated than physicians. period. However, if the licensure doesn't reflect the vast difference in skill and education, there is potential for mid-levels to undercut physicians by becoming a cheaper alternative for major insurers (which really only care about dollars and cents, and would just as soon send you to a barber for your healthcare if they could get away with it).

    The proposed law is more likely to drag doctors salaries down than nurse salaries up. Shpamme, do you really think that with the Deficit Reduction Act you mentioned that medicare is eager to jack nurse practitioner reimbursement way up?

    The Pennsylvania Academy of Family Physicians has maintained a presence at the hearings on the bill proposal, and if I'm not mistaken are fighting to maintain significant restrictions. I don't think other specialists have much incentive to fight it, though, since midlevels are such a cash cow for them.
     
  11. Blue Dog

    Blue Dog Fides et ratio.
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    This isn't something unique to non-primary care fields. Higher reimbursement for mid-levels in primary care could potentially translate into more profits for the physicians who employ them.
     
  12. McDoctor

    McDoctor Over One Billion Cured
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    This tends to leave a sour taste in my mouth as a physician just out of residency. When a practice is in position to expand anymore, what I am seeing is many want to go with a midlevel and have them function independently. It does elbow us new guys out of some opportunities.

    On a certain level, I don't feel threatened by mid-levels because in the end people want to see doctors when they are ill and I could theoretically set up shop right next store to a busy practice that employs alot of mid-levels. I could market my practice as the one where "you are guaranteed to see an actual doctor." But high overhead, delayed reimbursement, relatively low reimbursement, inadequate exposure to proper coding and billing, inadequate exposure to principles of business, costs of marketing, malpractice insurance, cost of healthcare for employees, and the myriad of credentialing processes for insurers (just to name a few things...) these all create significant barriers for residents to just hang a shingle and start a practice out of residency.
     
  13. McDoctor

    McDoctor Over One Billion Cured
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    An update for anyone still interested.

    The amended bill for nurse practitioners has been proposed. You can find a copy of the actual bill here:
    http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2007&sessInd=0&billBody=H&billTyp=B&billNbr=1253&pn=2019

    The bill seems to expand the ability to order PT/OT, respiratory therapy, home care, hospice care, durable medical equipment, a few other things. Hardly earth-shattering stuff.

    Pennsylvania is very fragmented in that every seperate healthcare professional has a different licensing board. There are even seperate boards for MD's and DO's, with minor differences between the two. I didn't look at every bill for PA's, CRNA's, CRNM's, etc...but the PAFP's take on all this can be found here:
    http://www.pafp.com/members/index.htm#sop
     

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