The Issue Of Pay Reimbursement In Healthcare

In 2008, the coalition of members from the Alliance for Advanced Practice Credentialing and the National Council of State Boards of Nursing (NCSBN) created the Consensus Model for Advanced Practicing Registered Nurses (APRN’s). This model creates a framework for APRN’s in licensing, accreditation, certification, and education in the United States (Alleman & Houle, 2013). The establishment of this Consensus Model has developed a bases for the ARNP’s comprehensive knowledge base, ability for clinical reasoning, cultural, and ethical competencies, establishing a model of practice for ARNPs in which to follow. These concepts will be further discussed in this paper.

According to the American Association of Colleges of Nursing (2015) the traditional roles of the advanced practice nurses include nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists. Therefore, the impact of the research on the practice of the preparation of DNP nurse educator requires education in evidence-based practice, quality improvement, leadership, policy advocacy, informatics, and systems theory. Furthermore, transitioning to the DNP as a nurse educator does not change the current scope of practice of the Advance Practice Registered Nurses (APRNs) for their current roles. The transition of the DNP better prepares APRNs by utilizing new models of the care delivery system and growing complexity of health

The relationship of the advanced practice nurse and the patient, with the patient being a single individual or a family unit, is participative with the focus being on meaning as the nurse practitioner assists the patient to select one of the multitudinous possibilities in a given health situation. The nurse practitioner does not prescribe a patient to a set of interventions alone, but instead the FNP intervenes with active presence and listening to help the patient to identify their own desires for change. Instead of finding what is wrong with the patient, the nurse practitioner asks what the patient wishes to discuss during an encounter. Then, the FNP supports the patient and helps improve the patient’s quality of life through perspective, pattern recognition, and change if the patient desires. Together, the FNP and patient collaborate to achieve patient-chosen health goals.

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%.

Expanding the scope of practice for APRN remains a controversial issue in Missouri, where I currently reside. Expanding the scope of practice also remains an issue for the health care field nationwide. Stakeholders that I can identify include The American Association of Colleges of Nursing (AACN), The National Organization of Nurse Practitioner Faculties (NONPF), APRN Consensus Work Group, National Council State Boards of Nursing (NCSBN), APRN Advisory Committee, along with other health care organizations, health care educators, and health care providers nationwide (IOM Report., n.d., p. 133). Focusing in on Missouri, the stakeholders for this endeavor include health care

The historic article by Safriet (1992) fully lists and analyzes the major challenges facing the advanced practice nurse (APN). At the time the article was written compared to now, a few aspects are changing. In areas where change has occurred, it has been an exceedingly slow process. Change for APNs is often dependent on legislation and regulatory authorities which receives half-hearted support, at best, from the medical establishment (Safriet, 1992). Since the first day nurses were given any authority to practice outside of regular practice, physicians only objected when it began to encroach upon their perceived hierarchal status or potential for compensation (Hamric, Hanson, Tracy, & O’Grady, 2014). The concern that this

ARNPs can play a pivotal role in not only in outlining care for individual patients but also in promoting ideas or public health directives that can help decrease the incidences of diseases out in

Hamric explains, advanced practice nursing as patient centered and skillful activities provided to improve population outcomes. Hamric focuses on educational and clinical practice, criteria and competencies. The baseline criteria include graduate education, certification and patient/family focused. The education of an APN is graduate level with specialized knowledge of an advanced practice role and supervised practice. Professional certification is required for advanced practice with a focus on a certain population. The competencies include: direct clinical practice, holistic perspective, therapeutic partnerships, expert clinical performance, reflective practice, use of evidence, and diverse approaches to health (Hamric et al., 2014, p. 76).

In recent years, there have been increased efforts to improve the state of healthcare in the United States. Despite spending much more than any other high-income countries on healthcare each year, the United States is behind many other countries when it comes to overall health status (Squires & Anderson, 2015). There have been several new policies set forth to improve patient outcomes while also cutting costs. In addition to excess spending, there are also concerns regarding the increased demand for healthcare as the baby boomers continue to age (Song & Ferris, 2018). To address these challenges, officials are working toward utilizing advanced practice nurse practitioners (APRNs) to act as healthcare providers for the growing population of

The APRNs Regulatory Model specializes roles and titles and population foci within a regulatory framework (Hamric, Hanson, Tracy, & O'Grady, 2014). This was implemented to resolve the issue of inconsistent rules, policies and standards of care across states. APN practice is faced with many barriers or obstacles put in place with notion of regulating practice and provision of quality and safe care. This have led to reviewing of the regulations to broaden the spectrum of APN practice as health care is fast evolving. Diverse regulatory criteria like variable accreditation standards, licensing requirements, inconsistent population foci and scopes of practice, represent barriers to optimize APRN function within today’s complex health care system

Advanced Practice Registered Nurse (APRN) has evolved tremendously since it was establish in 1965 to service vulnerable populations, however there are still barriers that must be addressed in order to free APRNs from limitation imposed by state scope of practice (SOP) laws and payers, which disrupts health care financing/costs, access, delivery, and quality patient care. Currently, only one third of the states in the U.S. permit APRNs to fully practice within their scope without limitations (Hain & Fleck, 2014; Yee, Boukus, Cross, and Samuel, 2013).

A current problem in the advanced practice roles is reimbursement for Medicare, which “is set at 85% of the physician rate, a payment disparity that the APRN community has quietly accepted” (Mason, Leavitt & Chaffee, 2014, p. 396). An example of this is evident through ear infection visits in the office. When a patient comes in for otitis media their reimbursement is “15% less than when the same condition is treated by a physician” (Mason, Leavitt & Chaffee, 2014, p. 396). MedPAC an independent advisory commission called The Medicare Advisory Payment Commission has suggested that there should be no payment differentials between providers (Mason, Leavitt & Chaffee, 2014). However, still advanced practicing nurses still do not receive the same amount of reimbursement for the same services rendered.

APRNs are structured by the Consensus Model for APRN Regulation. The model was created by the APRN Consensus Work Group and the National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee. This was developed to provide consistency so that the standards and scope of practice of APRNs will be the same (APRN, 2008).

The role of the advanced practice nurse (APRN) is evolving with the advancement of health care in the United States. The APRN roles consist of nurse practitioner (NP), certified nurse midwife (CNM), certified nurse anesthetist (CRNA), and clinical nurse specialist (CNS)(Chism, 2016). Scope of practice for APRNs is a critical issue when considering access to care. There are a variety of stakeholders that can benefit from collaboration to promote quality, safe and effective health care for the American population that would decrease the incidence of health care disparities. Some of the stakeholders include APRNs, physicians, insurance companies, legislators and patients. APRNs who have a Doctor of Nursing Practice

An Advanced Practice Registered Nurse (APRN) is a master’s, post-master or doctoral prepared nurse with a degree in a nursing specialty and can generally practice without the supervision of a physician. APRNs help meet the demand for primary and specialty healthcare practitioners, especially in rural and other areas underserved by physicians. Hamric (2014) describe advanced practice nursing as a concept, not a role, a set of skills, or a substitution for physicians. Such a conceptual definition provides a stable core understanding for all APN roles, it promotes consistency in practice that can aid others in understanding what this level of nursing entails, and it promotes the achievement of value-added patient