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The Politics of APN Reimbursement

The following statements summarize the political issues and questions voiced by the particular groups involved in reimbursement:

Politicians are concerned that APN reimbursement would be inflationary. They ask:

"Will APN reimbursement be an added cost to a health care system that already has escalating costs?"
"Will APN reimbursement increase costs by causing over-utilization of health care?"

Physicians are concerned about turf issues. They ask: "Are APN services substitutive or complementary to physician's services?" The American Medical Association has actively lobbied against APN reimbursement. Visit the American Medical Association site for their recent resolution opposing APN reimbursement.

Payers are concerned about cost increases and rising fees. They ask: "Will reimbursement of APNs set a precedent for other non-physician providers who want to be reimbursed?"

Legal Experts are concerned that billing APN services under physician names is fraudulent. They ask: "When legislation exists requiring APN services to be reimbursed by providers at 85% of physician rates, is it fraudulent if a clinic reimburses u nder a physician name in order to obtain 100% rates?"

Nurses are concerned about billing APN services using physician names. That makes APNs "ghost providers" in health care organizations. They ask: "How can consumers choose APN providers when their services are not clearly designated as to volume, type, cost-effectiveness, etc.?" Nurse practitioners not billing become "invisible" in the fiscal reporting of the practice. They and others cannot track their productivity, cost-effectiveness, and patient outcomes.

The general public is concerned about access to care. Despite a booming U.S. economy, the number of uninsured Americans continues to grow and now exceeds 40 million. Furthermore Americans feel that their choice of provider is restricted in the evolving managed care system.