Managed care company launches program to pay NPs directly...and at the same rate as MDs
Oxford Health Plans has begun a pilot program in New York allowing some members to choose a nurse practitioner as their primary care provider. But more importantly, the 20 NPs at Columbia Presbyterian Medical Center who are participating in the program will be directly reimbursed by Oxford -- and will be reimbursed at the same rate as physicians.
Nursing leaders say this parity is important for two reasons. One, it is the formal recognition by a managed care company of the services provided by advanced practice nurses. Two, because of the financial parity with physicians, employers and patients can not view NPs as a cheaper alternative to physicians.
“Oxford was attracted to the project because of nurses’ training in disease prevention and promotion and our ability to empower people to be active in their own health care,” said Sarah Cook, MEd, RN, one of the NPs participating in the project. The health plan is banking on the nurses’ training in disease prevention and promotion as a way to save money.
The NPs are responsible for patients’ initial diagnosis and, if needed, referral to specialists. The NPs also have hospital admitting privileges and can write prescriptions for most drugs, said Cook, who is a professor of clinical nursing and vice dean at Columbia University School of Nursing.
Based on patients’ outcomes, Oxford may expand the pilot program to more enrollees.
The NPs know they can provide patients with primary care services. What they don’t know is whether patients will be willing to choose an NP instead of a physician to be their primary care provider.
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