Law eases billing woes for advanced practice nurses
Law eases billing woes for advanced practice nurses
Nurse practitioners, midwives rate high
The new Medicare reform package contains a stunning advance for nurse practitioners and clinical nurse specialists: They now receive direct Medicare reimbursement at 85% of the local physician payment rate. The provision is part of the larger Medicare agreement passed by Congress and the White House as part of the budget reconciliation process in July. What’s more, patients rave about the extra attention they receive from nurse practitioners and nurse midwives and the longer appointment times. Consider these professionals a pipeline to customer satisfaction and superior care outcomes, women’s health experts advise.
Medicaid and Medicare traditionally have reimbursed for nurse practitioner and nurse midwife services. Under Medicare, however, the old law directly reimbursed nurse practitioners only in long-term care facilities or rural areas. Otherwise they were covered only if they provided care while a physician was on the site. For example, if a nurse practitioner saw someone in an inner-city satellite clinic, and the physician was a block away at headquarters, Medicare wouldn’t pay, explains Susan Wysocki, RNC, NP, president and chief executive officer of the Washington, DC-based National Association of Nurse Practitioners in Reproductive Health.
The new law authorizes direct Medicare reimbursement to nurse practitioners and clinical nurse specialists regardless of location, association with, or supervision by a physician.
"Nurse midwives are better positioned with Medicaid," explains Karen Fennell, RN, MS, senior policy analyst with the American College of Nurse-Midwives in Washington, DC.
She says 40% of the nurse midwives’ clients nationwide are Medicaid covered. Current federal statues require states to offer women the right to choose nurse midwifery for prenatal care and birthing services, she adds. "There’s real growth in states’ coverage of midwifery services through freestanding birth centers, because they’re cheaper than hospitals," Fennell says. (For more details, see Women’s Health Center Management, January 1997, p. 10.) A recent study from the University of Michigan in Ann Arbor backs up her statement. It reports that average hospital birth fees are $5,427, while birthing centers average $4296.1
Dealing with managed care
Medicare often sets precedents for the private marketplace, Fennell notes. A College of Nurse- Midwives survey of managed care plans found that many approved nurse-midwife maternity care but excluded family planning and gynecological care. Over half of the plans did not list midwives on their provider panels.
In short, Fennell says, "managed care is still a concern to our members." That concern prompted the college to create a handbook on marketing to managed care companies, which describes negotiation skills and capitation formulas. The college also conducts workshops on the issue. (See source box, p. 116, for details.)
In another proactive move, the College of Nurse-Midwives is forming a national preferred provider organization. Fennell anticipates that the strength of numbers will give midwives an excellent negotiating position with insurers.
Nurse midwives attend to the whole woman, recognizing that even 20% compliance with healthy self-care is better than none.
"We get good birth outcomes because we feel that if we can reduce smoking in pregnant women just a little, it will make a difference," Fennell insists. "Our success stems from teaching and patient interaction, not throwing drugs at our patients’ problems." (See graph, p. 116, for a glimpse at the growth in births attended by nurse midwives in the last 20 years.)
"We spend more time with our patients, but it costs less," notes Elisa Patterson, MS, of Women First, a private midwifery practice in Loveland, CO. For example, the Women First C-section rates run between 9% and 10%, compared with 20% for surrounding the Loveland area, Patterson says. The University of Michigan study reports that nurse-midwife attended births resulted in a 7% perineal laceration rate, compared with 23% among obstetricians.
The commitment to holistic care translates into a nurturing health environment for consumers, and they respond like plants to sunshine. Patterson says, "Most of our ladies would tell you they like the personalized care. We listen to them and spend a little more time with everyone."
Thanks to patient satisfaction with nurse practitioners and midwives, business at the Winona (MN) Center for Women’s Health has quadrupled in fewer than five years, says the center’s coordinator, Ann Olson, RNC, MA. Its market reach hasn’t changed, she says, and the area has gone from 5% to 40% managed care coverage in the past two years. Women’s Health started with one full-time nurse practitioner; now it has four.
"We’re all booked two months in advance for first-time routine appointments," Olson says.
Reference
1. Oakley D, Murray ME, Murtland T, et al. Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives. Obstet Gynecol 1996; 88:823-829. ß
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