Post COVID-19 Reimbursement Parity for Nurse Practitioners

Reimbursement parity of nurse practitioners (NPs) and physicians is appropriate now more than ever. Studies have demonstrated that NPs provide the same quality of care as physicians, yet they do not receive the same reimbursement. The rise in full practice authority states, as well as nurse managed clinics and retail clinics, has led to more NPs practicing independently. The COVID-19 pandemic opened a need for NPs to provide a greater amount of care in more settings, and thus led to temporary removals of practice restrictions to increase access to care. This article offers a review of the issues, such as “incident to” billing; direct and indirect reimbursement; and quality of care. We consider MedPAC and reimbursement policy, post COVID-19 policy solutions, and action steps to move forward to seek reimbursement parity. The COVID-19 pandemic serendipitously led to the removal of many restrictions on NP practice, offering an opportunity for NPs to work with MedPAC to achieve full reimbursement for care provided.

First-Line Antibiotic Selection in Outpatient Settings

ABSTRACT Using the 2014 IBM MarketScan commercial database, we compared antibiotic selection for pharyngitis, sinusitis, and acute otitis media in retail clinics, emergency departments, urgent care centers, and offices. Only 50% of visits for these conditions received recommended first-line antibiotics. Improving antibiotic selection for common outpatient conditions is an important stewardship target.

Co-located Retail Clinics and Pharmacies: An Opportunity to Provide More Primary Care

This paper proposes that co-located retail clinics (RCs) and community pharmacies can increase opportunities to provide more accessible, affordable, and patient-friendly primary care services in the United States. RCs are small businesses of about 150–250 square feet with a clientele of about 10–30 patients each day and most frequently staffed by nurse practitioners (NPs). Community pharmacies in the U.S. at ~67,000 far outnumber RCs at ~2800, thereby opening substantial opportunity for growth. Community pharmacies and pharmacists have been working to increase on-site clinical services, but progress has been slowed by the relative isolation from other practitioners. An ideal merged facility based on an integrated platform is proposed. NPs and pharmacists could share functions that fulfill documented consumer preferences and still maintain separate practice domains. Potential benefits include a broader inventory of clinical services including laboratory tests, immunizations, patient education, and physical assessment, as well as better patient access, interprofessional training opportunities, and economies related to the use of resources, day-to-day operations, and performance metrics. Challenges include the availability of sufficient, appropriately trained staff; limitations imposed by scope of practice and other laws; forging of collaborative relationships between NPs and pharmacists; and evidence that the merged operations provide economic benefits beyond those of separate enterprises.