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To The Editor,

I was surprised at the level of error and inaccuracy in your recent editorial, “Equal Pay Bill Should Be Dead” related to HB 4101, the payment parity for Nurse Practitioners in Oregon.

First and foremost, I take exception to your claim that services provided by NPs are different from those provided by physicians. Ask the patients of nurse practitioners their opinion. You may be surprised to hear the nearly universal positive regard patients have for their NPs. Some may even say they value their NP more than their MD. This view is supported, in many cases, by decades of research which as revealed that NPs provide care that is equal to or better than physicians on the same service, meaning that not only are the services delivered the same, but the services provided by NPs are often higher in quality. Of course, some services are different based on the different providers’ scope of practice and years of experience and HB 4010 would have no impact on the reimbursement rates for physicians when they provide more complex or intensive care based on their education and experience. Rather, HB 4010 says that when a physician OR an NP provides the identical service, those services should be reimbursed the same way. It is difficult to understand how anyone can argue against equal pay for equivalent services. Even the health insurance providers who oppose HB 4010 understand that there are hundreds of examples of services provided by NPs that are exactly the same as those provided by a physician; this is why these services are given the same insurance codes by those insurance companies.

Additionally, your editorial calls into question the chaos that would ensue if NPs were to suddenly be reimbursed at the same rate as physicians. In fact, most NPs are already paid the same as physicians by private insurance plans. HB 4010 would simply require that this common practice be made the standard. Also, where NPs do not have payment parity, the actual and potential impact on patients is serious. For example, in many rural areas (where NPs provide crucial access for patients), some NPs have restricted their hours, are forced to decline patients covered by some carriers, or are considering leaving the area due to financial pressures on their practices due to decreased reimbursement rates.

Finally, you question the challenges raised by “contracts becoming invalid.” It is absolutely crucial to note that contracts between providers and carriers are not as sacred as asserted by the Bulletin or by Representative Conger. In fact, in most many cases, when an insurance provider decides to reduce rates for NPs, those insurance companies simply mail a notification that payment rates are being reduced. No rationale given, no explanation needed, and no negotiation available.
HB 4010 was designed to be a fix for the current system and there are few professionals more supportive of health care transformation than Oregon’s Nurse Practitioners. In fact, NPs have been actively participating in developing Governor Kitzhaber’s approach. The simple fact is this: Oregon can’t afford to lose the services of NPs any more than it can of physicians and Oregon’s NPs can’t afford to be paid less than physicians for exactly the same services.

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