Affordable Care Act- How it affects NPs

Specialties NP

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Specializes in ER.

I am applying to NP schools. I am wondering how the Affordable Care Act (ObamaCare) will affect the role of the NP, mainly the FNP.

Will the demand and salaries go up or down?

Thanks

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Not an expert on the politics of healthcare but I think it's easy to assume that if in fact the individual mandate pushes through, there will be a surge in the number of newly insured individuals who would need to seek care from Primary Care Providers (physicians, NP's, and PA's). This would, in theory, lead to a demand for more providers of this type. Primary Care NP's who live in independent practice states will benefit the most in my opinion. However, I have no doubt that physicians in non-independent practice states also recognize that NP's and PA's are necessary to fill this healthcare gap and hopefully become more willing to work collaboratively with more NP's and PA's. As for salaries, the ACA requires insurance companies to reimburse NP's the same rate as physicians though Medicare will continue to reimburse NP's at 85% of physician rate. One can interpret this as a possible salary increase for NP's.

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Not an expert on the politics of healthcare but I think it's easy to assume that if in fact the individual mandate pushes through, there will be a surge in the number of newly insured individuals who would need to seek care from Primary Care Providers (physicians, NP's, and PA's). This would, in theory, lead to a demand for more providers of this type. Primary Care NP's who live in independent practice states will benefit the most in my opinion. However, I have no doubt that physicians in non-independent practice states also recognize that NP's and PA's are necessary to fill this healthcare gap and hopefully become more willing to work collaboratively with more NP's and PA's. As for salaries, the ACA requires insurance companies to reimburse NP's the same rate as physicians though Medicare will continue to reimburse NP's at 85% of physician rate. One can interpret this as a possible salary increase for NP's.

Woah! So an independent practice NP can expect to make closer to the equivalent of what a physician makes? This is interesting. I know I don't plan on going independent when I first graduate, but 5-10 years into practice it feels like it will become a distinct possibility... I am not staying in California for the rest of my career, that's for damn sure!

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Woah! So an independent practice NP can expect to make closer to the equivalent of what a physician makes? This is interesting. I know I don't plan on going independent when I first graduate, but 5-10 years into practice it feels like it will become a distinct possibility... I am not staying in California for the rest of my career, that's for damn sure!

That is in a primary care setting - for what it's worth with the caveat that physicians have long lamented the low income potential in primary care, hence, the lack of interest in the field from medical school graduates.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

One thing about getting into these types of threads is that one should never be too flippant in making comments. I could not find the link that states NP's are required to be reimbursed 100% by insurance companies under ACA! Bummer as I'm not about to read all 974 pages of the ACA to find that information. On that note, I'm taking my initial comment back.

Anyway, what I do know is that:

- NP's are included as Primary Care Providers under this new law

- CNM's who are reimbursed at 65% of physician rate by Medicare will be reimbursed at 100% under ACA. NP's not included in the clause.

- Reimbursement of Primary Care Services will be increased by 5% for Medicare beneficiaries

- Next year, Medicaid reimbursement will increase to match Medicare payments by 100%

- Other incentives for primary care services are built in to ACA

As far as challenges ahead:

- some state NP organizations are expressing concern that some state insurance exchanges (referred as the "marketplace") are not including NP's in the list of PCP's even in independent practice states. However, the "marketplace" is not supposed to be operational until next month so I think it's an early assumption that may not be true.

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What falls under the header of primary care according to ACA? The government classifies psych as primary care for the health service corps, as well as midwifery I believe, so I wonder if only FNPs would benefit from this or also psych NPs/certain other NP specialties.

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Yeah, usually psych is under primary care.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

The definition of Primary Care used currently is the Institute of Medicine's statement in 1996 that states "Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community".

Within the context of Medicine, physicians who are trained and practicing in the field of General Internal Medicine, General Pediatrics, and Family Practice are accepted as Primary Care Providers. It would be assumed that the equivalent of those in the NP field are ANP, PNP-PC, and FNP.

In the context of community-based health care, those who provide women's health (OB-Gyn, WHNP, CNM) and community mental health (Psychiatrists, PMHNP) are sometimes included though by definition, these professionals are not able to offer the broad range of services of primary care.

I'm not sure how ACA and the insurance companies empanel NP's into the PCP list. All I can surmise is that NP's can have a specific taxonomy when they obtain an NPI number. The taxonomy corresponds to the type of NP they are (ANP, ACNP, FNP, etc.). However, some NP's did not specify this taxonomy when they applied for an NPI their number.

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Specializes in ICU, CV-Thoracic Sx, Internal Medicine.

I'm not sure how ACA and the insurance companies empanel NP's into the PCP list. All I can surmise is that NP's can have a specific taxonomy when they obtain an NPI number. The taxonomy corresponds to the type of NP they are (ANP, ACNP, FNP, etc.). However, some NP's did not specify this taxonomy when they applied for an NPI their number.

Juan, you area wealth of knowledge.

You are correct on the taxonomy issue.

However, I believe the commercial insurance part of 100% reimbursement is somewhat more complicated. I don't know if the ACA is partially or fully responsible for NP reimbursement rates through commercial insurers. What I do know is that with the taxonomy not distinguishing what NP specialization one performs, commercial insurers that reimburse at the 100% rate do so without regard to what your specialty is.

I know this because I have my own practice in a non-inde state. (My state requires collaborative practice for those who are wondering how I do this.) It is a specialty practice. But because my NPI taxonomy is general and there is no longer E&M consultant codes, insurers cannot distinguish what service you are rendering. I don't know which payors reimburse at the 100% rate but I can tell you I haven't had many. Still, it's worth mentioning since we're on topic.

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I enjoyed reading your posts. My wife is a NP and I am finishing NP school. She says that most of the hospitals and some practices in metro Detroit are now moving away from PA's from what she is hearing from her friends in both fields as well as seeing in her own hospital. In her own hospital it has turned NP only along with three others in the area in just the last 6 months. Thepractice where she works part time for added hours is replacing all PA's that are leaving with NP's. Supposedly there is some part of the scope of practice and the autonomy that physicians in our area, although they may not like it, are starting to see the advantage of a NP's over a PA. I think it is only going to get harder for PA's to find work other than doing H & P's all day very shortly, at least in Michigan.

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This is a trend that I have also seen in southern states like AL, GA, MS and FL.

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Went to a community health clinic today to turn in some candidate documentation for employment and people were getting off the bus in droves to sign up for insurance! It was almost overwhelming but at least people can get the care that they need now!

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