Rethink pay cut for dedicated medical professionals

This cut was initiated according to the lobbying powerhouse Virginia Association of Health Plans in response to legislated independent practice

Recently there was little fanfare after an article was published highlighting Virginia’s largest insurance company’s decision to lower reimbursement rates for nurse practitioners (NPs) and physician assistants (PAs) by 15-20%. Anthem had been reimbursing for medical services based on the service provided, not the service provider, meaning it paid 100% reimbursement for physicians, nurse practitioners and physician assistants.

This cut was initiated according to the lobbying powerhouse for insurers, Virginia Association of Health Plans, in response to legislated independent practice stating, if these providers want to practice independently, they should expect less than physician pay, because “they’re not doctors.” It also claimed it had been generous to “pay them more over the crisis period.” Anthem further stated it is “ensuring charges are paid at appropriate levels based on education and accreditation.”

Charges should be paid on the basis of service provided, not on supposed temporary generosity. Supplies, equipment and all matters of overhead are the same irrespective of provider title. If insurers want to ensure charges are paid at appropriate levels, tie them to measures like outcomes and satisfaction.

Secondly, NPs and PAs are well aware they are not physicians, nor do they want to be, or they would have pursued that path. Thirdly, less than 13% of all NPs have autonomous practice, and yet Anthem believes it appropriate to penalize the remaining 87%. Finally, like it or not, some of these non-physician practitioners have, in fact, doctorate degrees, are all accredited through national board certification and still they do not want to be physicians.

As working nurse practitioners on the front lines of clinical care and state legislators, we find this “they’re not doctors” language offensive, disrespectful and frankly a part of the larger attempts to oppress our presence in the health care arena and delegitimize our value by ascribing fewer dollars to our work. We believe the insurer is seeking to balance their checkbooks on our backs which is not in the best interest of our patients nor their health.

The timing of this could not be more devastating. As demonstrated by the governor’s executive orders, to rally “all hands on deck,” NPs and PAs have been part of the solution to the lack of workforce during this pandemic.

They continue to fill the gaps and alleviate the shortages in primary care and other specialty care areas, while many health care clinics see fewer patients and experience revenue cuts of as much 50%. Many of these clinics already struggling to stay afloat due to reduced hours or pay cuts now further risk destabilization so insurers can profit.

And though today it is Anthem, this sets precedent for others to follow. Health care practices hire and staff clinics and long-term care facilities based on pre-established reimbursement rates; reducing this rate will force many practices to reduce staffing during an already critical period with exceptional demands on health care providers. Legislators and consumers should not stand for this.

It is common knowledge thatnurse practitioners and physician assistants provide quality, effective patient-centered care to wide ranges of patients with excellent outcomes, and are often recognized as the “value-added” providers in the physician practices where most work. To suggest this work is only 80-85% as valuable and significant as physicians is demeaning and unacceptable.

As nurse practitioners, we simply ask that we be recognized for our contribution to providing impactful and effective health care for our patients. As legislators who represent both political parties, we believe in equal pay for equal work. We ask Anthem to reconsider this cut in pay for some of the most important providers of health care in our communities, especially at a time when our services are needed the most.

Del. Dawn M. Adams DNP, is a board-certified adult nurse practitioner and a Democrat who represents the 68th District, which includes parts of Richmond, Chesterfield and Henrico. Sen. Jen A. Kiggans, MSN, is a board-certified adult-geriatric nurse practitioner and a Republican who represents the 7th District, which includes parts of Virginia Beach and Norfolk.