Who is better educated the Nurse Practitioner or the Physician.
If you ask me, the answer is neither. They are both educated in their particular field of study.
NP’s are educated with a nursing background, physicians with a medical background.
Nurses are better at caring for people with compassion, understanding and empathy regardless of their illness. Physicians are more educated concerning the pathophysiology of human illness.
NP’s have specific areas of specialty training such as family, pediatrics, adult or anesthesiology. Physicians got to residency training to be orthopedist, surgeons or family practitioners.
Regardless of which educational background is taken to become the primary care provider both nurse practitioners and physicians have the education to provide that care.
24 March 2010
22 March 2010
Equal Pay for Equal Health Care Services
Equal Pay for Equal Health Care Services
I have an issue today that I am addressing in my office. Regular business as usual, of course.
There is a small local insurance company that wouldn't have anything to do with me 2-3 years ago. Recently someone came in and asked if we would take their insurance. My billing manager said, “no we don't take that insurance,” so I got on the phone, for the heck of it, called the contact at that insurance and said, “are you ready to accept nurse practitioners as primary care providers?”
“Sure,” they said and we discussed reimbursement. He said, “my understanding is that nurse practitioners are paid 15% less than physicians, according to Medicare guidelines, we pay 120% of Medicare, so we will pay you 105% of Medicare.” I said send me a contract and we'll see what we can do.
I was actually more excited that they were actually accepting nurse practitioners and not concerned with actual reimbursement that I didn't fully negotiate as I should had. I admit this has happened a lot, especially when first trying to get contracts at all. I accepted and I bet you accepted whatever was offered, pleased simply to be getting any contract.
After further thought, I sent him the following email:
Mr. H,
Why do suppose that you would reimburse a nurse practitioner at a lesser rate than a physician?
Surely you expect the same quality of care to be provided. I as a primary care practitioner will provide for your members, everything you would expect from any of your physician providers, including acute and chronic illness care, general physicals, referrals etc, etc.
Some would even argue that nurse practitioners are a favored health care provider due to their nursing background and their ability to educate and be more personal with patients.
I appreciate your willingness to accept me as a primary care provider. Please consider reimbursing me equal to a physician at 120% of Medicare reimbursement.
Thank you.
Jeff Guillory Jr. RN, FNP
I got no response to this email and did not accept the proposal for 105% of Medicare that he sent me.
So after a couple of weeks I tried again sending the following email:
Dear Mr. H,
I appreciate your willingness to accepting the health care services of the NP Health Clinic; PLLC for your managed care members. It would indeed be our pleasure to provide your members with high quality primary care services.
I do have a problem with the reimbursement rates being based on Medicare reimbursements, however. Considering the drop in Medicare rates of 21.2% that are planned, we need to rethink our reimbursement rate in order to make this a win-win situation for G_______, G_________ participants and the NP Health Clinic, PLLC.
As you know and we have discussed you typically reimburse physicians at 120% of Medicare rates. G________ asks and expects the NP Health Clinic, PLLC to provide the exact same services that require the same skill, effort and responsibility of our physician cohort. Your confidence in our ability to provide these services is appreciated.
Considering the fact that Medicare is an unstable base in which to plan reimbursement please reconsider the reimbursement rate for the NP Health Clinic, PLLC. We will be happy to accept reimbursement at 120% of the Medicare rate of 2009. Seeing that Medicare is rapidly changing we should base our rates on a past rate and leave it as such, and not be affected by Medicare changes.
I appreciate you understanding and consideration and will look forward to accepting your new managed care agreement.
Sincerely,
Jeff Guillory Jr. RN, FNP
I quickly got a response as below:
Mr. Guillory,
Mr. H has elevated this provider agreement to me for resolution.
I have reviewed the agreement for your group and it is in line with typical reimbursements for these services. G_________ utilizes the CMS reimbursement methodology as a basis for payments to providers. We are willing to use the 2009 Medicare tables as a basis for this agreement on a go forward basis, however the conversion factor will need to remain at $38.00 as stated in the agreement.
Thank you,
Mr. B
Here lies the problem. Medicare has set a precedent for all insurances to follow. One hundred percent for physicians and 85% for nurse practitioners.
Of course this is against the law, but who cares Medicare did it. The Equal Pay Act of 1963 states that those who use the same skill, effort and responsibility are entitled to equal pay. But this company wants to pay me 15% less because Medicare is doing it.
We must stand up for our rights. Equal pay for equal health care services. I will keep you informed.
I have an issue today that I am addressing in my office. Regular business as usual, of course.
There is a small local insurance company that wouldn't have anything to do with me 2-3 years ago. Recently someone came in and asked if we would take their insurance. My billing manager said, “no we don't take that insurance,” so I got on the phone, for the heck of it, called the contact at that insurance and said, “are you ready to accept nurse practitioners as primary care providers?”
“Sure,” they said and we discussed reimbursement. He said, “my understanding is that nurse practitioners are paid 15% less than physicians, according to Medicare guidelines, we pay 120% of Medicare, so we will pay you 105% of Medicare.” I said send me a contract and we'll see what we can do.
I was actually more excited that they were actually accepting nurse practitioners and not concerned with actual reimbursement that I didn't fully negotiate as I should had. I admit this has happened a lot, especially when first trying to get contracts at all. I accepted and I bet you accepted whatever was offered, pleased simply to be getting any contract.
After further thought, I sent him the following email:
Mr. H,
Why do suppose that you would reimburse a nurse practitioner at a lesser rate than a physician?
Surely you expect the same quality of care to be provided. I as a primary care practitioner will provide for your members, everything you would expect from any of your physician providers, including acute and chronic illness care, general physicals, referrals etc, etc.
Some would even argue that nurse practitioners are a favored health care provider due to their nursing background and their ability to educate and be more personal with patients.
I appreciate your willingness to accept me as a primary care provider. Please consider reimbursing me equal to a physician at 120% of Medicare reimbursement.
Thank you.
Jeff Guillory Jr. RN, FNP
I got no response to this email and did not accept the proposal for 105% of Medicare that he sent me.
So after a couple of weeks I tried again sending the following email:
Dear Mr. H,
I appreciate your willingness to accepting the health care services of the NP Health Clinic; PLLC for your managed care members. It would indeed be our pleasure to provide your members with high quality primary care services.
I do have a problem with the reimbursement rates being based on Medicare reimbursements, however. Considering the drop in Medicare rates of 21.2% that are planned, we need to rethink our reimbursement rate in order to make this a win-win situation for G_______, G_________ participants and the NP Health Clinic, PLLC.
As you know and we have discussed you typically reimburse physicians at 120% of Medicare rates. G________ asks and expects the NP Health Clinic, PLLC to provide the exact same services that require the same skill, effort and responsibility of our physician cohort. Your confidence in our ability to provide these services is appreciated.
Considering the fact that Medicare is an unstable base in which to plan reimbursement please reconsider the reimbursement rate for the NP Health Clinic, PLLC. We will be happy to accept reimbursement at 120% of the Medicare rate of 2009. Seeing that Medicare is rapidly changing we should base our rates on a past rate and leave it as such, and not be affected by Medicare changes.
I appreciate you understanding and consideration and will look forward to accepting your new managed care agreement.
Sincerely,
Jeff Guillory Jr. RN, FNP
I quickly got a response as below:
Mr. Guillory,
Mr. H has elevated this provider agreement to me for resolution.
I have reviewed the agreement for your group and it is in line with typical reimbursements for these services. G_________ utilizes the CMS reimbursement methodology as a basis for payments to providers. We are willing to use the 2009 Medicare tables as a basis for this agreement on a go forward basis, however the conversion factor will need to remain at $38.00 as stated in the agreement.
Thank you,
Mr. B
Here lies the problem. Medicare has set a precedent for all insurances to follow. One hundred percent for physicians and 85% for nurse practitioners.
Of course this is against the law, but who cares Medicare did it. The Equal Pay Act of 1963 states that those who use the same skill, effort and responsibility are entitled to equal pay. But this company wants to pay me 15% less because Medicare is doing it.
We must stand up for our rights. Equal pay for equal health care services. I will keep you informed.
21 March 2010
Introduction
Let me introduce myself. My name is Jeff Guillory Jr. I have been a nurse practitioner now for 10 years. I graduated from McNeese State University in 1999. I opened the NP Health Clinic, PLLC four years ago. My practice is doing pretty well, I employ five full time employees including myself, one part time receptionist and one part time nurse practitioner.
I am struggling on a daily basis with the physician controlled medical industry, including collaberative agreements and getting paid only 85% of what I'm worth.
Most nurse practitioners, I understand, do not see or have any problems with their careers because they get paid well and enjoy theirs jobs. I however, being owner and operator of my own clinic, am painfully aware of the injustice that NP's suffer in this industry.
The intent of this blog is to allow me to voice my frustrations and to make all who read this blog understand what I am going through as a nurse practitioner in a physician controlled world. Also I wish to give others in my situation a place to voice their own opinions and share ideas to help us all better our predicament.
I am struggling on a daily basis with the physician controlled medical industry, including collaberative agreements and getting paid only 85% of what I'm worth.
Most nurse practitioners, I understand, do not see or have any problems with their careers because they get paid well and enjoy theirs jobs. I however, being owner and operator of my own clinic, am painfully aware of the injustice that NP's suffer in this industry.
The intent of this blog is to allow me to voice my frustrations and to make all who read this blog understand what I am going through as a nurse practitioner in a physician controlled world. Also I wish to give others in my situation a place to voice their own opinions and share ideas to help us all better our predicament.
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