Compensation-To-Profit Analysis

It is believed that NPs can overcome challenges with billing and coding, as well as Medicaid and Medicare, third party payers, commercial managed care companies’ reimbursements through appropriate coaching and remaining up to date on regulations. As mentioned earlier, implementing compliant electronic systems, staying well-informed of billing regulations, evaluating weekly reports, and consulting with compliance experts can aid in accurate reimbursement for NPs in primary care.

Poghosyan and Knutson conducted a survey of 278 APRNs to better understand their independence and role in New York State primary care settings. Forty two percent of the APRNs surveyed stated they have their own patient panel and do not share panel with physicians and two thirds are able to review the outcome measures of the care they deliver. The study found that despite the restrictions on APRNs they freely apply their clinical knowledge

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

Financial Incentives for Primary care: Comparison costs of practices using PCMH model to those that do not and achieved savings (by reducing hospital admissions and unnecessary tests, they can get half $ back. The catch is that they only get the $ if they’ve met a whole checklist of quality measures for preventive care, chronic disease management and so on. Primary Care is rewarded for efficiency without sacrificing quality. Half of savings goes to Geisinger’s own health plan that funds extra services and creates medical homes. The health plan earned 2.5 times its R.O.I. back in the first year.

There is a growing trend where physicians are choosing different specialties instead of choosing primary care, primarily due to the low reimbursement rate in primary care. According to Iglehart (2014),” the Association of American Medical Colleges (AAMC) still projects a shortage of 130,000 physicians by 2025, split almost equally between primary and specialty care” (para. 1). With this decline comes an answer, an increase in the number of nurse practitioners providing patient care, reported 154,00 in 2012 and growing every year (Iglehart, 2014). This increase in nurse practitioners’ helps fill that gap, allow greater health care access to the community, especially special populations. By gaining access to healthcare were a nurse practitioner is the provider not only with the special population have high quality affordable health care, a trusting long lasting relationship will develop. This relationship will break the barriers of; lack of trust, lack of health care education and discrimination. Nursing is a trusted profession that provides education and care that no other health care professional

According to Health Resources and Services Administration If the system for providing primary care in 2020 were to stay fundamentally the same as today, there will be an estimated shortage of 20,400 primary care physicians ("Projecting the Supply and Demand for Primary Care Practitioners Through 2020," n.d.). In addition this projection doesn’t include the decreasing number of people perusing the medical degree and the baby boomers retiring form this filed of science. In the hand we are experiencing a significant increase in NPs and PAs. Considering this projected shortage, which is actually a very frightening situation the increasing number of NPs and PAs, can effectively be integrated; we could reduce the number of physician shortage by over 69 percent in 2020.

Currently, there is still a large shortage of primary care practitioners in the United States. The margin between available providers and those in need continues to grow. Many people without proper access to care have to delay seeking help for what ails them ("Health Wanted," 2012). Glicken & Miller (2013) state that approximately 16,000 primary care providers would be necessary to meet the existing demand. Rural communities would represent the area of greatest need followed closely by low-income urban areas. The number of underserved individuals is estimated to have reached fifty-seven million. This demand will only increase, as 52,000 primary care providers are expected to be needed by the year 2025 (Glicken & Miller, 2013, p.1883-1889).

Like what was stated previously, the cost of having Nurse Practitioners in place of doctors is lower. This is because their salaries are much less and the cost structure is lower. Evidence of this can be seen with Medicare and Medicaid. These government sponsored programs will pay for 85% of these services in comparison with doctors. This is important, because it is showing how the lower cost structure is one reason why Nurse Practitioners are playing a major role inside a health care environment. (Pickert, 2009)

Providing care in primary care is less costly than a physician since since they tend

Increased evidence demonstrates APRN’s provide equivalent quality of patient care as physician and have excellent patient satisfactions scores (Hooker & Muchow, 2015). All the while, APRN’s bill at a lower rate. Hooker and Muchow (2015) state the use of APRN’s can result in a 20% in costs resulting in hundreds of millions of savings.

Reimbursement for the advanced practice nurse (APN) is improving but how they fit into reimbursement systems is vey important. One question that arises is if the APN should be paid the same fee for service as a physician or should only a percentage of the payment be received. Most third-party reimburses, which include a few large insurance companies are now reimbursing APNs and more states are getting on board with reimbursements by developing reimbursement models for APNs (Hamric, 2009). For example, Aetna US Healthcare, Anthem Blue Cross and Blue Shield of Kentucky, Medicare and Medicate all credential NPs as primary care providers and pay at 85% of the physician rate. Tricare of Kentucky credentials NPs and pays 100%.

Results indicated a 25% decline growth rate of NP’s was slower in the most restrictive states

Every individual in the world deserves to enjoy health and wellness. Maintaining or achieving proper health needs enables individuals to be productive at work and leisure. Traditionally, many people have had barriers obtaining adequate healthcare due to economic constraints or personal inconveniences. Despite impressive technological advances in medicine, the challenge of delivering quality healthcare to the Americans continues to be debated amongst the nation’s political and healthcare leaders. The aging baby-boomers and the increased number of uninsured people add to the equation of population growth which results in limited access to primary healthcare for the entire public. On the

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

On an average, primary physician groups may see about four or five patients within an hour, probably about one patient every fifteen minutes. Because of increase productivity and cost restraints and pressures, this number could increase dramatically. This trend, unfortunately, will be matching the burden of physicians declining incomes and job market. A lessor number of physicians earn what physicians earned many years ago. Primary health has been affected more as compared to services rendered. Additionally, the shift to a bundled fee for performance from the fee for service reimbursement system for force solo practicing physicians and small group practices into forming or partnering into