Nurses Rap Payment Models Recommended by AMA

A recommendation from the American Medical Association calls for physicians to determine how care teams are paid. The American Association of Nurse Practitioners calls the AMA's link of reimbursements to physician-led teams "anti-competitive."

6 comments on "Nurses Rap Payment Models Recommended by AMA"
Jon Burroughs (11/24/2013 at 9:06 PM)

It is not either/or, it is and. In New Hampshire, nurse practitioners can work independently of physicians but choose to work collaboratively with them due to their interdependent skills and areas of expertise. One is not better than another; each brings different skills and perspectives that are equally valuable to the patient.
Brad Thornton (11/22/2013 at 8:23 AM)

Speaking as a long time nurse and less time Administrator I see mid-level and MD performance comparisons all day long. There is a constant and predictable difference in outcomes and costs in favor of the MD. However, this "clinical" competence does NOT make them a strong leader, nor does it make them effective in their management of staff or mid-levels. My experience says we need some degree of mid-level oversight but, of equal importance in the process, physicians must learn leadership and management
Jeff angel (11/22/2013 at 4:22 AM)

Let me sum up a physician versus mid-level: depth and breadth of training, not to mention rigors of training that weed out the lazy and the ones who cannot think when tired, etc I see unnecessary tests and wrong treatment plans by midlevels nearly everyday. Like it or not, there is a big difference in training. Studies have shown midlevels order more tests/have higher costs. There is nothing wrong with supervision and collaboration. Its better care and nothing but jealousy to not want help!! Lets work together...with appropriate supervision by leaders who have more training.
Luchia (11/21/2013 at 7:18 PM)

Arise!! This has been whispers from behind the scenes for awhile. NPs just woke up and saw it. NPs will lose because they have not been watching. We are being set up by our own profession. Don't blame the physicians. Physicians are protecting their profession as nurses march off thinking they have progressed.
John (11/21/2013 at 3:21 PM)

Why is there such a strong need for the AMA to carve out such defined rules for making sure they stay in control of how health care dollars get paid out. Let the market set the need. If physicians create the best outcomes and provide the best care; patients will find them. Forcing care to exclusively be under physician direction is unfair to the consumer and other capable providers. Why is there such a hesitancy by physicians to recognize that high quality outcomes are achieved by nurses, and nurse practitioners. Additionally, these nurse professionals are just as qualified as MD's to lead care teams. Sometimes it seems the AMA is all about control, money, and fear mongering(if physicians aren't in charge people will die!). Their perspectives and positions are so self serving I have a hard time wanting to see the possibility of reason in their statements.
Mike (11/21/2013 at 6:49 AM)

Sad to say, but physician-led teams do not always function efficiently and safely. As a labor and delivery nurse, I worked side-by-side with certified nurse midwives for many years. When the midwifery profession emerged in the United States it was met with extreme opposition by many obstetricians who claimed the care rendered by nurse midwives would be substandard and denied patients the care of a skilled physician during childbirth. Well today, physician opposition to nurse midwives has died down. There are too many instances where the "team leader" obstetrician absolutely refuses to get out of bed at night or come in on a weekend or holiday to treat an ill woman and her unborn baby. The nurse midwife has to request, cajole, beg, and finally threaten the obstetrician that s/he will call the Chief of Obstetrics in the department . Only then does the nurse midwife get appropriate help for a high-risk woman or a baby who is in trouble. The nurse is often an employee of a physician or physician group. The nurse midwife works the night shifts, weekends, and holidays, and has to repeatedly ask a physician to come in when the woman's problems and the needed treatment exceed the legal bounds of nurse midwife practice. By the time the physician arrives, the patient and her unborn baby may be in big trouble. Obstetricians are very happy to leave nurse midwives alone and in charge - and they are paid much less than their physician counterparts!


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