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Survey: Health insurers show advances in NP credentialing, reimbursement

BY Antoinette Alexander

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.”

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H.D. Smith completes acquisition of Calif. drug wholesaler

BY Alaric DeArment

SPRINGFIELD, Ill. — Drug wholesaler H.D. Smith has finalized its purchase of a wholesale company based in California.

H.D. Smith said Friday that it had completed its acquisition of Stockton, Calif.-based Valley Wholesale Drug, which it will run as a wholly owned subsidiary. Financial terms of the deal were not disclosed, but day-to-day operations at Valley will be run by its CEO, Stephen Shoneff.

“The close of the acquisition of Valley Wholesale Drug marks a significant step in our strategy to continue growing our national footprint to serve more independent pharmacists across the country — especially in the critical market of California, and moving forward, into the Pacific Northwest,” H.D. Smith chairman and CEO Dale Smith said. “We will continue to focus on exceptional service to our core customers — the retail independent pharmacy — and we will be well-served to execute on this objective under the leadership of Stephen Shoneff, who has managed the Valley Wholesale Drug business successfully during the last 26 years.” 

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NRF files brief opposing class action settlement of swipe fee case

BY Michael Johnsen

WASHINGTON — The National Retail Federation and more than a dozen retailers on Thusday asked a judge to reject a proposed class-action settlement of a federal antitrust lawsuit filed against Visa and MasterCard because of credit card swipe fees. The NRF suggested the settlement would not bring credit card swipe fees under control and does not give retailers who oppose it an adequate mechanism to opt out.

“The proposal pending before the court does nothing to keep these soaring fees from continuing to drive prices higher for American consumers, and would block merchants who believe in true swipe fee reform from ever having their day in court,” NRF SVP and general counsel Mallory Duncan stated. “While the remaining parties would like to treat preliminary approval as a routine procedural step, the court should recognize that this settlement is so legally flawed it cannot be tweaked into fairness," he said. “Instead of improving the situation, the proposed settlement would cast in stone the very problems that need to be fixed."

Nine merchants supporting the settlement filed a motion with U.S. District Court Judge John Gleeson in Brooklyn, N.Y., on Oct. 19 asking for preliminary approval of the proposal, and oral arguments are scheduled for Nov. 9. 

Preliminary approval would begin a months-long process in which all retailers who accept Visa and MasterCard credit cards would be sent notices giving them the opportunity to either accept the settlement or opt out of part of it. Arguments on the merits of the settlement and whether it should be given final approval would not begin until sometime next year.

NRF is not a party to the suit, but represents retailers who would be affected if the case is approved as a class action. Retailers joining NRF in today’s brief included the following 17 companies and two associations that are not parties to the suit but would be affected: Abercrombie and Fitch, American Booksellers Association, American Signature, Ascena Retail Group, Big Lots Stores, Bob Evans Farms, Boscov’s, Chico’s, CKE Restaurants, Dillard’s, GAP, JCPenney, Limited Brands, Macy’s, the National Association of College Stores, Neiman Marcus Group, Papa John’s, Saks and Target.

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