ANA: Require in-network nurses for health exchanges

Job satisfaction high among nurse practitioners
Job satisfaction high among nurse practitioners

The American Nurses Association (ANA) is recommending the Centers for Medicare and Medicaid Services (CMS) require a minimum number of advance practice registered nurses (APRNs) be included in health insurance networks to be eligible for state exchanges. 

"As many more millions of uninsured or underinsured seek primary care services through these exchanges, they will need access to qualified primary care providers. That will not happen if private insurers continue to exclude or restrict APRNs from their provider networks," ANA President Karen A. Daley, PhD, RN, FAAN, said in a press release.

The proposed minimum would be set equal to 10% of the APRNs who independently bill Medicare Part B in a given state. Health plans failing to reach the 10% quota would be ineligible for the exchange system.

Currently, about 100,000 APRNs nationwide are qualified and enrolled as independent Medicare providers and bill Medicare for services provided to Medicare patients under their own National Provider Identifier.

More than 250,000 APRNs – nurse practitioners, certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists – are licensed nationally.

“This standard is easy to monitor and enforce, and easy to understand and meet for health insurance plans that are serious about addressing the real burden of patient access to primary care,” Daley said.

Health insurance exchanges, a key provision of the Affordable Care Act, are designed to encourage competitive online marketplaces and will begin open enrollment October 1, 2013. Both individuals and small businesses will be able to pick and choose from a variety of plans ranging in cost and scope. Insurance obtained through the exchanges is scheduled to become effective January 1, 2014.

In 2011, more than 10 million Medicare Part B patients received $2.4 billion worth of care from 100,585 APRNS nationwide. Under the ANA's proposal, Hawaii would be required to include the least number of APRNs at 16, whereas Florida would be required to include the most at 654.

While the recommendation is likely to be denounced by many territorial doctors who feel that APRNs do not have the qualifications for such a responsibility, the ANA feels that nurses have the necessary skills, but are being hamstrung by insurers who overlook them in favor of physicians.

“Findings from several decades of research consistently demonstrate that APRNs provide safe, quality care with comparable patient outcomes to physicians and even higher patient satisfaction rates,” Daley said.

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