Insurer extends primary provider status to nurse practitioners

CareFirst BlueCross BlueShield announced last week that it will include nurse practitioners as independent primary care providers within it's Maryland, Northern Virginia and District of Columbia network.

The move comes in response to projections from the Association of American Medical Colleges that the nation will be short approximately 63,000 doctors across all medical specialties by 2015.

“Federal health care reforms will over the next few years result in more residents or our region being covered by health insurance, and that will increase demand for primary care services, Bruce Edwards, CareFirst senior vice president for networks management, said in a press release.

Health officials estimate that an approximate additional 32 million Americans will be insured by 2014. “Allowing nurse practitioners to practice independently as primary care providers is a logical move to serve our members better,” Edwards added.

The decision is yet another testament to the quality of care that NPs and physician assistants deliver, according to Lisa Stern, APRN, a nurse practitioner at Planned Parenthood Los Angeles and Clinical Advisor blog contributor.

“NPs and physician assistants provide an increasing amount of primary health care, and the care NPs and PAs delivered has been shown time and again to be equivalent in safety and quality to that of primary care MDs,” Stern said.

Previously, CareFirst permitted NPs to participate independently of physicians, but only in medically underserved areas.

“CareFirst's decision follows a pattern that has been true throughout the history of the nurse practitioner movement – a role once designed to serve mainly underserved clients has evolved into a popular model for people of all socioeconomic levels,” Stern said. She expects other insurers will adopt this practice as evidence of positive health outcomes and patient satisfaction becomes available.

Julee Waldrop, DNP, ARNP, an associate professor at the University of Central Florida College of Nursing in Orlando, echoed these sentiments.

“If more BlueCross BlueShield insurance companies were to make the same decision this would remove one of the historic barriers to NPs practicing to the full extent of their education and experience,” Waldrop told The Clinical Advisor.

She explained that the contribution NPs make to nation's health would be more accurately documented once they can independently bill and receive reimbursement from private insurance.

“Even though NPs are required to have individual national provider identification numbers and have been able to be reimbursed by most government health insurance – if at a lower rate ­– most private insurance companies have only provided reimbursement to physicians,” Waldrop said. “NPs saw the patient and provided the care, but the bill went out under the name of a supervising or collaborating physician,” Waldrop said.

Under the revised policy NPs are required to meet CareFirst credentialing criteria, must be certified by an approved National Certification Board and meet all licensing and certifications guidelines for the state in which they practice.

Additionally, independent NPs must attest that they have a written collaborative agreement with a physician in good standing who works in the same specialty and belongs to the same CareFirst provider network.

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