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CareFirst opens provider network to nurse practitioners

Anticipating a surge of newly-covered customers swamping general care physicians, CareFirst BlueCross BlueShield said Thursday that it was opening its health care provider networks to nurse practitioners.

Nurse practitioners are registered nurses with a graduate degree in advanced practice nursing. Under state law, they are allowed to provide a broad range of medical services such as prescribing medication and ordering lab work and x-rays without physician supervision.

The change means nurse practitioners will be able to bill the insurer and be considered a primary care network provider.

“This does open up the job prospects for nurse practitioners,” said Sandra Nettina, a nurse practitioner and president of the Nurse Practitioner Association of Maryland. “With this, nurse practitioners will really be able to go out and work for a small practice on their own, or as a satellite location.”

CareFirst officials said the decision was “logical” due to the coming increase in the number of people seeking primary care treatment under federal health care reform.

“Federal health care reforms will over the next few years result in more residents of our region being covered by health insurance, and that will increase demand for primary care services,” Bruce Edwards, CareFirst’s senior vice president for networks management, said in a statement.

According to the Association of American Medical Colleges, there will be 32 million additional Americans getting health care coverage due to health care reform, which will lead to an estimated shortage of 63,000 doctors across all specialties in 2015.

Nurse practitioners had been allowed to participate in the networks before Thursday, but only in underserved areas with limited access to primary care physicians. Nurse practitioners participating in the network will have to meet CareFirst credentialing criteria and must attest that they have a written collaborative agreement with a physician of the same specialty who is also in the CareFirst provider network on file with the state.

Jane Kapustin, a nurse practitioner and associate professor and assistant dean for the master’s program at the University of Maryland School of Nursing, said nurse practitioners are willing to go to where they’re needed, often to areas lacking in primary care options. And, being able to bill CareFirst could encourage nurse practitioners to go into business for themselves.

“It’s thrilling news,” she said. “This is big news for nurse practitioners in Maryland. If we can now open our own businesses, think of the underserved people who will now have access to primary care.”

According to the American Academy of Nurse Practitioners, as of 2010, there are about 140,000 practicing nurse practitioners in the U.S. The academy said about 600 million visits are made annually to nurse practitioners. In Maryland, there are about 3,500 nursing practitioners, according to the Nurse Practitioner Association of Maryland.

One comment

  1. It’s about time that we allow this and alternative medicine to enter hte main stream. What is really wrong with health care in this country is the absolute lack of preventative medicine, focus on nutrition and excercise, and taking the “call center HMO caregiver” out of the decision process.

    We can provide affordable health care to all if the corporations and special interests could be removed from the equation and doctors and nursess allowed to do their jobs (with recertificaiton and continuing education and licensing).