Third Party Payment for Nonphysician Health Practitioners

Impact of the Rural Health Clinics Services Bill: A projection

“…34,54,55 One of the dangers, recognized by both the proponents and opponents of the bill, is independent practice by the midlevel practioner. 18,19,22 This appears to be a much greater possibility for nurse practitioners than for PAs. Such a possibility could endanger not only the aims of the Rural Health Clinics Bill but the NP movement as a whole through backlash from the state legislatures.…”

Independent reimbursement from third-party payers to nurse-midwives

“…The reimbursement controversy centers on three interrelated issues: (1) how much should be reimbursed, (2) what services should be covered, and (3) who controls the process of reimbursement. All of these factors affect the quality and scope of the services offered and the independence of the professionals providing those services.…”

“…Advocates of equivalent reimbursement argue that consumers pay for services, not providers. Equivalent reimbursement encourages physicians and institutions to employ certified nurse‐midwives, since they would realize a greater profit on services which cost less to produce 2 . This alternative does little to directly lower health costs, but may indirectly do so by stimulating competition between providers and by supporting practitioners whose style of practice is less expensive.…”

“…If one accepts the assumption that reimbursement should reflect the costs of providing services, then nurse‐midwives, who receive less training and lower salaries, should be paid less for their services than physicians. Though this alternative may directly reduce the cost of care, thereby increasing the attractiveness of reimbursing nurse‐midwifery services to administrators of third‐party payers and government officials, it implies that “cut‐rate” midwifery care is of lower quality–which may lessen its appeal to consumers 4 . In addition, lower allowable fees may decrease the economic incentive that institutions have to hire nurse‐midwives.…”

“…Public health agencies, which employ 13.8% of all CNMs, and hospitals, which employ 45.6%, 5 depend on funding from public programs. According to Fox, 100% of the Medicaid rate might equal the cost of nurse practitioner or physician assistant care, but only meet 60–80% of the usual MD fee 6 . Thus, while public institutions may “break even” by utilizing nonphysician practitioners under equivalent reimbursement, this may not occur if reimbursement falls below that received by physicians.…”