Nurse practitioner reimbursement.

The Rural Health Clinics Act demonstrates the current trend in reimbursement of nurse practitioners: Congress intends to move slowly and continuously with mid-level practitioner reimbursement, limiting NP practice first to rural underserved areas, and reimbursing at a cost-related rate to avoid unnecessarily inflating costs. The Act's recognition of the NP as a reimbursable provider of traditional medical services, needing only indirect supervision, is important, especially with regard to the mandatory Medicaid coverage of "rural health clinic services." All states which do not explicitly prohibit NPs have been affected by this mandate, precipitating state legislative efforts to more clearly define NP scope of practice. There is still a need to clarify the ambiguity surrounding NP Medicaid reimbursement policies; Medicaid plans are frequently not well coordinated with nurse practice statutes. Altering third-party payor practices to permit reimbursement for services of nurse practitioners would alleviate some of the current restrictions on NP practice. However, medical society opposition also plays a significant role in such restriction. Antitrust courts, free of the tremendous lobbying power of medical interest groups, may be able to provide remedies which will facilitate greater competition and innovation in the health care industry. Legal test cases are necessary to begin contesting obstacles to the implementation of the Rural Health Clinic Services Act. The aggregate surplus of physicians projected for 1990 will continue to be an issue in the development of new financial programs concerning NP services. Demonstration projects which utilize various reimbursement strategies should evaluate the effect on health manpower of reimbursement for medical services provided by nurse practitioners.