Insurer counts nurses as primary care providers

by Olga Deshchenko, DOTmed News Reporter | November 08, 2010
Nurse practitioners are now able to participate in CareFirst BlueCross BlueShield networks as independent primary care providers, the insurer announced last week.

Previously, NPs were restricted to practicing without physicians only in certain medically underserved regions that lacked primary care doctors. CareFirst's revised policy also opens the doors to NPs practicing as independents before the launch of the insurer's Primary Care Medical Home Program in January 2011.

As the health system braces for an influx of 32 million additional insured patients by 2014, the U.S. is also facing a primary care physician shortage crisis. The Association of American Medical Colleges also projects a national shortage of nearly 63,000 physicians of all specialties by 2015.

"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," said Bruce Edwards, CareFirst senior VP for Networks Management, in prepared remarks.

The evolving role of nurses in health care has been the center of controversy in recent months. In September, two Colorado doctor groups sued the state to keep nurse anesthetists supervised in the OR.

In October, an Institute of Medicine report said nurses should assume leadership roles in the transformation of the health system, while the American Medical Association fired back in disagreement.

Under CareFirst's new policy, NPs will be able to serve as independent primary care providers throughout the insurer's Maryland, Northern Virginia and District of Columbia service regions. They will be required to meet the company's credentialing criteria, be certified by the appropriate National Certification Board and meet all of the licensing guidelines as set by the state in which the NP wishes to practice.

Additionally, "the NP must attest that they have a written collaborative agreement with a physician of the same specialty who is a member in good standing of the same CareFirst provider networks as the NP," according to the company's release.

With headquarters in Owings Mills, Maryland, CareFirst is the largest health care insurer in the mid-Atlantic region, serving approximately 3.4 million people.