How is the attestation statement in Maryland affecting you? Have you had trouble finding a physician for your attestation. Read this article by David Weldon, contributing editor at Healthcare Finance News
"Last fall, New Mexico Gov. Susana Martinez announced that she was pushing for a statewide nurse practitioner recruitment campaign. Martinez was counting on New Mexico’s lack of physician oversight contract requirements to be a big recruiting plus – especially since nurse practitioners in neighboring Texas often paid enormous fees to their supervising physicians.
Characterizing the situation at the time, an article in the New York Times called it “moving time for nurses who don’t need doctors.”
The jury is still out on whether New Mexico has been able to lure many much-desired nurse practitioners. But the unfortunate reality for some NPs who wish to operate a clinic or healthcare facility on their own is that moving could indeed be their best option.
The reason: in states that require an NP to have an oversight contract with a supervising physician, the amount of fees can sometimes be cost prohibitive. And in the event that the supervisory physician retires, relocates, or opts out of the agreement for any reason, the NP is left in the lurch – unable to exercise primary care authority.
The physician is in?
Physician oversight agreements do exactly what the term implies – provide a formal contract between a fully licensed physician and a nurse practitioner that enables the NP to provide specified primary care services. Any limitations and restrictions on that care are spelled out in each contract, and regulations differ by state. The prescribing of various drugs is also specified or prohibited under the contract.
Physician oversight fees can be quite high, and the fees not only vary from state to state, but from contract to contract, said Susan Lynch, CEO and vice chairman of the Florida Association of Nurse Practitioners. There are no state regulations that mandate what contract fees are, Lynch said. Contract fees are arranged between the physician and the NP and are usually based on market conditions and a sense of fairness. NPs have no recourse if they feel the contract fees are unfair.
“It is left to the practitioner and to the physician to work out,” Lynch said, and many times NPs feel like what they get in return for the money they pay physicians is negligible.
“I know of two nurse practitioners in our state that had to pay $50,000 a year for a physician to sign their contracts,” Lynch said. In return, “they basically got a signature” rather than the collaborative relationship they were paying for.
Such a situation is becoming more common, Lynch said, leading to more frustration for NPs and helping to spur the push by nurse practitioners to get rid of physician oversight requirements altogether.
The fight for independence
Nineteen states and the District of Columbia have recently passed laws allowing NPs to provide primary care without physician oversight, and other states are examining the issue, said Taynin (Tay) Kopanos, vice president of state government affairs at the American Association of Nurse Practitioners.
The issue of costly oversight fees is not what’s behind the push for independence Kopanos said. NPs believe they are being hemmed in by physician oversight regulations that are not allowing them to practice to the full scope of their training and education.
[See also: Nurse practitioners hemmed in by scope of practice laws and payment policies.]
National physician organizations have opposed the loss of oversight not because physicians would be losing out on the money they get from oversight contracts, but because NPs, they argue, do not have enough training to practice and prescribe independently.
“The American Academy of Family Physicians does not support independent practice for nurse practitioners,” said Perry Pugno, who just retired as vice president for medical education at the AAFP. “They are members of the ‘medical home’ team, but should work under the supervision of a physician to be maximally effective and efficient.”
With factors such as the national drive to lower cost of care, the aging population putting added burdens on an overwhelmed primary care physician workforce and other repercussions of the Affordable Care Act, the impact of physician opposition may lessen over time, especially as states continue to grapple with tight budgets.
Bills opening up nurse practitioner scope of practice laws are awaiting action in Massachusetts, New Jersey and Pennsylvania. Kopanos said another 10 states are expected to have the issue come up for review next year."