Officials at the College of Nursing and Health Innovation said nurse practitioners could play an increased role in expanding access to primary health care if limits to their practices are resolved.
As the number of primary care physicians decreases, the number of nurse practitioners has continued to rise because they are offering an alternative to primary health care.
The school’s dean, Bernadette Melnyk, said one of the biggest barriers nurse practitioners must overcome is getting insurance providers to offer the same reimbursement rates as they do for physicians.
Nurse practitioners can perform a range of duties similar to a physician such as admitting patients, treating them for illnesses and prescribing medication. However, insurance companies still don’t consider them equal, Melnyk said.
Only 53 percent of insurance providers today consider nurse practitioners to be primary care providers and provide the same payment they would give a practitioner, according to the American Academy of Nursing.
Because of this low rate, nurse practitioners aren’t being fully reimbursed by insurance companies despite providing an equal alternative to primary care physicians, Melnyk said.
“We’re going to need to expand primary care providers as fast as we can produce them,” Melnyk said. “The big challenge that nurse practitioners face is that they can’t be designated as primary care providers.”
Denise Link, associate dean for Clinical Practice and Community Partnerships at the nursing school, said even when insurance providers do recognize nurses as primary care providers they don’t always offer the same compensation they would give a physician.
“I have a difficult time understanding why,” she said. “The cost of the visit should be the same if you’re getting the same services.”
Link said according to Medicare regulations, nurse practitioners can’t certify patients for home health care even if they are the patient’s primary care provider.
A physician has to approve this care, meaning patients often have to wait longer for treatment, which increases the cost of care.
Tiffany Jackson, a certified midwife and nurse practitioner, said Arizona allows nurse practitioners to independently treat and admit patients to hospitals.
However, laws that regulate hospitals don’t permit nurse practitioners to independently admit patients under their name so they must use a doctor’s name instead.
“It makes no sense,” she said. “It almost seems like that would be fraudulent.”
Tyke Hanisch, a faculty member at the nursing school, said in regard to expertise, nurse practitioners are limited only because they aren’t required to earn doctoral degrees.
The required education level for a nurse practitioner is a master’s degree. Starting in 2015, however, nurse practitioners will also be required to earn a doctorate, she said.
“To have an equal fitting with [doctors], we’re going to have to push to get the same education,” Hanisch said. “There is room for all of us.”
One of the main reasons these regulations haven’t been updated is because of misunderstanding about the education and abilities of nurse practitioners, Link said in an e-mail.
In order to overcome these barriers, nurse practitioners must actively educate the public and legislators so that laws will be changed, Link said.
When nurse practitioners first started to practice there was no research demonstrating they were capable of practicing safely without additional oversight. With the intention of protecting the public, state legislators created laws that allowed nurse practitioners to practice but only with restrictions, Link said.
New research proves additional oversight is unnecessary, Link said.
It’s now up to nurse practitioners to distribute that evidence so laws can be changed, insurance providers can allow nurse practitioners into their provider networks and nurse practitioners can receive equal reimbursement for their equal level of service, she said.
“We never want anybody to think we’re trying to replace another profession,” Link said. “We need every primary care provider we can get.”
Reach the reporter at daniel.baxley@asu.edu.
