Misguided Child
So this article has been making its way around social media. Alycia Bischof, senior lecturer at the University of Pennsylvania School of Nursing is a poor misguided child. She argues “that given the increased role of NPs (particularly during the pandemic) and their proven ability to provide care comparable to physicians, Congress should allow Medicare to increase the NP reimbursement rate to 100% of the physician pay rate.” So let me see if I understand this, you want 100% the reimbursement with 3% of the training? The article reports “The current Medicare reimbursement policy for nurse practitioners (NPs) allows NPs to directly bill Medicare for services that they perform, but they are reimbursed at only 85% of the physician rate.”
A couple key points and counterpoints from the article:
- proven ability – this research has been debunked as flawed/poor methodology and quality, data manipulation, and incorrect assumptions and conclusions.
- provide care comparable to physicians – hmmm, advance practice nursing from the nursing model is no comparable to the practice of medicine. Apples and oranges.
- The COVID- 19 pandemic serendipitously led to the removal of many restrictions on NP practice, – I’ve said it before and I’ll continue to say it, physician supervision and collaboration is NOT a restriction on practice.
- incentivizing them to practice in primary care settings where there is a shortage – (a) data shows they don’t go rural, and (b) physician shortage is a physician problem that physician need to address – like open more residency positions.
- investigate how full practice authority (FPA) – code for “we want to replace you”
- removal of practice barriers – strawman argument for FPA
As stated earlier, misguided. Look how disingenuous where she writes:
“THIS IS THE TIME FOR NPS TO SEIZE THE OPPORTUNITY TO WORK WITH MEDPAC TO ACHIEVE FULL REIMBURSEMENT FOR CARE PROVIDED.”
NP’s are not doctors. It’s ridiculous to think otherwise. I was in an environment that used them as physician extenders and it worked well. I was attached to one and she practiced in the same pod with exam rooms right next to mine and had access to me anytime for questions and problems. If anyone got admitted to the hospital, I took care of them.
Ok, doing pre-op H and P’s for surgeons for elective stuff on “normally” healthy patients is fine.
I saw 3rd year med students moon-lighting for pay doing that in the early 80’s in Peoria, Illinois. I wasn’t smart enough to do that as a med student and had to use all my time studying. The smart guys and gals did it and got a little pocket change. Likely that can’t be done anymore.
Giving NP’s full unrestricted practice rights is an “E’ffing” mistake. They’ll find that out soon as their malpractice insurance rates will sky rocket and they will have no physician to throw under the bus once they start getting sued for malpractice. Unfortunately, patients will get hurt and the NP specialty will suffer.
Want to do full practice and accept all responsibilities? Go to med school and residency!
Kurt Savegnago, M.D. (retired)