Grandfather clause for DNP?

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I was reading an article about the U of Utah starting a DNP program here and it stated that: "Current nurse practitioners, nurse anesthetists, clinical nurse specialists and nurse midwives, who all hold advanced nurse-practice degrees, would be grandfathered in."

Is this correct? What is the state of the union with regard to grandfathering current APNs into a DNP?

Thanks to all those who respond...

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except you could likely get away with paying a non-DNP less.

I have been an RN since 1978 and an NP since 1988 (GNP) and 1998 (FNP) - in other words, I'm highly experienced. Currently I own my own practice. I get paid based on reimbursement from the insurance companies as well as from private pay individuals.

You post implies that a DNP will be paid higher. While it may be true that some employers will pay a bit more, the truth is, with the current reimbursement structure, I doubt that DNP's will get more money from Medicare, DSHS, Blue Cross, etc.

BarbaraNP

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Specializes in Education, FP, LNC, Forensics, ED, OB.
I have been an RN since 1978 and an NP since 1988 (GNP) and 1998 (FNP) - in other words, I'm highly experienced. Currently I own my own practice. I get paid based on reimbursement from the insurance companies as well as from private pay individuals.

You post implies that a DNP will be paid higher. While it may be true that some employers will pay a bit more, the truth is, with the current reimbursement structure, I doubt that DNP's will get more money from Medicare, DSHS, Blue Cross, etc.

BarbaraNP

I agree with you, Barbara. With the current structure, there will be no differences. But, I'm pretty sure that would change in the future. As it stands now, the NP must possess MSN; the ones still in practice with ADNs/Diplomas cannot collect like MSN. I forsee this changing like it did when MSN became mandatory and if one does not possess DNP, the reimbursement will be vastly different......

Just my observations over the years.

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I have been an RN since 1978 and an NP since 1988 (GNP) and 1998 (FNP) - in other words, I'm highly experienced. Currently I own my own practice. I get paid based on reimbursement from the insurance companies as well as from private pay individuals.

You post implies that a DNP will be paid higher. While it may be true that some employers will pay a bit more, the truth is, with the current reimbursement structure, I doubt that DNP's will get more money from Medicare, DSHS, Blue Cross, etc.

BarbaraNP

You must live/work in a state different from my own. In my state, all APNs must work in collaboration/consultation with a physician, so I'm not sure if owning one's own practice would fly here.

I don't know if a DNP will get paid more then a current MSN, but I wonder if a non-DNP will get paid less in the future, when comparing 2 candidates with equal experience. I am talking, of course, about those states in which an APN must "rely" on a physician to be hired (not an independent practitioner such as yourself). The extra schooling/more debt/"higher" degree, etc all factoring in, it seems as though the DNP may have the upper hand in negotiations over an MSN. Perhaps I'm wrong.

But the purpose of the degree is to advance the profession, so it stands to reason that something must come out of it, as it is clearly not a broader scope of practice as compared to non-DNPs...that much I have gleaned from other posts. As you have pointed out, there is not much more a DNP would give you, as you have tons of experience AND you already own your own practice.

It may be, though, that APNs of the future are going to be "forced" to go through the extra school/personal sacrifice to get the DNP for no monetary gains over current MSNs, which is unfair. And you know there are going to be differences in opinion b/w MSNs and DNPs for a few decades to come with regard to compensation...there will be about 30 years or so of overlap before the grandfathered MSNs retire for one reason or another. Regardless of the reason for pursuing a DNP, I have a hard time believing that those who go for it would be happy with equal compensation. Perhaps I am wrong.

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I agree with you, Barbara. With the current structure, there will be no differences. But, I'm pretty sure that would change in the future. As it stands now, the NP must possess MSN; the ones still in practice with ADNs/Diplomas cannot collect like MSN. I forsee this changing like it did when MSN became mandatory and if one does not possess DNP, the reimbursement will be vastly different......

Just my observations over the years.

Actually I don't think this is completely accurate. There are still a number of NPs that are practicing without any degree. Depending on what source you use the percentage of NPs that do not have an MSN may be as high as 10%. These NPs if they received UPINs before the balanced budget act are fully able to bill Medicare (and other insurance) at the same rate that those who have an MSN. A number of NPs that did not receive their UPIN were not able to later and can no longer bill Medicare. They also cannot get a NPI so they will not be able to bill other insurances.

The issue with a DNP receiving more from insurance is that the money has to come from somewhere. This has been a problem with different medical specialties. In these cases the medical profession is unlikely to want to give up money for the NP pot of money. One possibility is to pay DNPs a higher percentage of the physician payment while paying non DNP NPs less. That would probably not sit well with the majority of NPs and Medicare has never paid different rates within a class of providers (as far as I know).

Addressing the OP, presumably non-DNPs will continue to be able to practice. However, in a manner similar to what happened with the MSN you may be restricted in changing states or even jobs if credentialling is involved (a situation that has definitely changed since 1997). One thing to remember is that any changes will require changes not only in the Medicare payment schedule but also individual state nursing acts. Both of these are politically difficult.

David Carpenter, PA-C

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You must live/work in a state different from my own. In my state, all APNs must work in collaboration/consultation with a physician, so I'm not sure if owning one's own practice would fly here.

Even in states that require consultation/collaboration, there's nothing to necessarily keep an NP from owning/operating a practice -- I know several NPs (in my state, which requires consultation/collaboration) who own independent private practices and hire a physician to meet the consultation/collaboration requirement.

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I can answer that, forpath. No, it doesn't matter at all. You are obviously gathering information for your future. Glad to see this. Keep on asking questions. You should be well-informed before making decisions about this.

You're right, it doesn't matter, but it's interesting. I think the poster is a med student, resident, or new physician.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
Actually I don't think this is completely accurate. There are still a number of NPs that are practicing without any degree. Depending on what source you use the percentage of NPs that do not have an MSN may be as high as 10%. These NPs if they received UPINs before the balanced budget act are fully able to bill Medicare (and other insurance) at the same rate that those who have an MSN. A number of NPs that did not receive their UPIN were not able to later and can no longer bill Medicare. They also cannot get a NPI so they will not be able to bill other insurances.

You missed my point and sorry if I was unclear.

Yes, there are still NPs practicing w/o MSN.

One possibility is to pay DNPs a higher percentage of the physician payment while paying non DNP NPs less.

This is exactly what I foresee happening.

Addressing the OP, presumably non-DNPs will continue to be able to practice. However, in a manner similar to what happened with the MSN you may be restricted in changing states or even jobs if credentialling is involved (a situation that has definitely changed since 1997). One thing to remember is that any changes will require changes not only in the Medicare payment schedule but also individual state nursing acts. Both of these are politically difficult.

This is the point I'm trying to make as well. You just said it better than I.

It will be much the same way as when MSN became mandatory. The ones with MSN now will be penalized in some form in the future if they do not have DNP. Just like it is now with the ones currently in practice w/o MSN.

BON will adjust accordingly.

If I were thinking about an NP program now, I would obtain DNP w/o question............

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Even in states that require consultation/collaboration, there's nothing to necessarily keep an NP from owning/operating a practice -- I know several NPs (in my state, which requires consultation/collaboration) who own independent private practices and hire a physician to meet the consultation/collaboration requirement.

I did not know that...interesting. Thank you.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
Even in states that require consultation/collaboration, there's nothing to necessarily keep an NP from owning/operating a practice -- I know several NPs (in my state, which requires consultation/collaboration) who own independent private practices and hire a physician to meet the consultation/collaboration requirement.

Correct. Most states require collaboration but that does not preclude setting up own practice. Same thing goes for my state as well.

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You're right, it doesn't matter, but it's interesting. I think the poster is a med student, resident, or new physician.

Keep trying. Also, how exactly are a resident and a "new physician" different?

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Specializes in Education, FP, LNC, Forensics, ED, OB.

I'm going to ask that we not personalize the conversation. Please keep discussion on topic w/o interjecting critique of other's creds.

I think we as professionals, whether nurse or physician, can discuss the grandfather clause in a professional/civil manner.

One thing I do respectfully ask is if members are here soley to place the APN specialty in a negative light, please take it to another board.........it will not be tolerated here.

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In Philadelphia PA, I know of 2 NP owned house call practices where they hire MD for consultation + collaborave role....its happening more than you think around the country.

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