“Initially, the state had thought they would save $600,000 if they paid that 10%-reduced rate to all NP and PA providers,” Kopanos says. “But after hearing the cost shift that would occur, the decreased number of primary care access points patients would have, and the lack of transparency, the legislature decided it was not going to get the state where it needed to go.”
Solutions Welcome
All of this serves to illustrate the oft-repeated but important point that PAs and NPs can make a difference by speaking up and sharing their expertise. This is not limited to Medicaid cutbacks; as Powe points out, a number of provisions in the health care reform legislation are beginning to take form at the state level—accountable care organizations, patient-centered medical homes, and insurance exchanges.
“PAs cannot afford to sit on the sidelines and let other people carry the water for them. They have to come up to the plate and be involved in the commissions, the councils, the meetings—any opportunity they have to get involved,” Powe says. “We think it’s essential for PAs to, whenever possible, take leadership roles and tell their stories about what impact—positive or negative—these issues will have on their ability to provide care to patients. That really is what it’s all about.”
Kopanos echoes those sentiments: “Talk to a legislator. Let them know, ‘on the ground, this is what that cut would look like.’ Or, ‘on the ground, if we could tweak this part of the system, I could be more effective in meeting those care needs.’ Our legislators need that input.”
Connecting with a state professional organization (which probably already has relationships with the relevant parties—policymakers, the governor’s office, and the state Medicaid office) and reading the budget and the related recommendations, which are publicly available, will also help. Most of all, have a constructive alternative to suggest.
“The legislators already know that they’re going to have to make cuts and it’s going to make people unhappy,” Kopanos points out. “They would very much appreciate it if you could bring solutions to the table.”
In Colorado last year, for example, the Colorado Nurses Association made some calculations and discovered that if the across-the-board reimbursement cut was increased to 1.1%—just one-tenth of a percent—the state could save $900,000 (more than its original proposal, without the negative consequences to access and transparency).
“It’s tough times and tough decisions,” Kopanos says. “If you can provide some traction for good ideas, they’re listening.”