Nurse practitioners & reimbursement.

Nursing's Agenda for Health Care Reform (1991) embraces primary health care as the focus of a restructured health care system. As part of this reformed system, consumers would access the most cost-effective providers in community-based settings. Removal of financial and regulatory barriers that limit consumer access to providers, such as lack of direct reimbursement by Medicare for nurse practitioners, should be eliminated according to this plan. Senate bills S2103 and S2104 have been recently introduced to the U.S. Senate mandating reimbursement for services provided by nurse practitioners, clinical nurse specialists, nurse midwives, and physician assistants at 97% of physician payment. The aim of this global legislation is to eliminate the current piecemeal mechanisms for nurse practitioner reimbursement and remove financial disincentives. Case examples presented in this article illustrate how obstacles to reimbursement limit access to care for consumers. Quality of care, opportunities for autonomous practice, and control of nursing practice issues have been highlighted as well by the case format. It is intended that these cases would be useful to support changes in patterns of nurse practitioner reimbursement.