Virginia’s largest insurance company cut reimbursement rates. Some doctors say primary care will suffer.

One of Virginia’s largest insurance companies is lowering reimbursement rates for nurse practitioners and physician assistants amid the COVID-19 pandemic — a move that many doctors say will hurt already struggling primary care practices.



a person sitting at a table using a laptop: One of Virginia’s largest insurance companies is lowering reimbursement rates for nurse practitioners and physician assistants amid the COVID-19 pandemic — a move that many doctors say will hurt already struggling primary care practices.


© Provided by Richmond-Petersburg WWBT
One of Virginia’s largest insurance companies is lowering reimbursement rates for nurse practitioners and physician assistants amid the COVID-19 pandemic — a move that many doctors say will hurt already struggling primary care practices.

Clark Barrineau, assistant vice president of government affairs for the Medical Society of Virginia, said the group began receiving calls from doctors around the state after they noticed a 15 to 20 percent reduction in the repayment rates that Anthem was offering for nurse practitioners and physician assistants under their supervision.

Previously, the insurance company offered 100 percent reimbursement for the providers — the same rate it pays physicians. But with the reduction, Barrineau said a nurse practitioner or physician assistant who billed $100 worth of services would only receive back around $80 to $85, leading to a significant cut in revenue.

“Our folks are obviously taken aback,” Barrineau said. “This has a workforce impact. You’re forcing people to make staffing decisions because they hired people assuming they would be reimbursed at a certain rate for their work.”

The change also affects nurse practitioners and physician assistants with independent practices. But Virginia offers less autonomy to those providers than many other states, which means that most work under the supervision of a doctor. While nurse practitioners, for example, can open an independent practice after five years of full-time clinical experience, only 782 have registered for licenses in Virginia out of the roughly 8,000 nurses who qualify to work autonomously.

Many of those providers work in primary care settings — including with family doctors, pediatricians, and OB-GYNs — which are also some of the practices most vulnerable to changes in revenue, said Dr. Cynthia Romero, director of the M. Foscue Brock Institute for Community and Global Health at Eastern Virginia Medical School.

“The biggest expense for any small business is personnel,” she added. “And in this case, if the payments for services from nurse practitioners and physician assistants are reduced, I anticipate some of the biggest decisions these practices are going to have to make is who on staff they’re going to have to let go.”

Even before the pandemic, many primary care providers were operating on tighter margins, partially driven by a decline in patient volume. One study found that primary care visits declined between 6 and 25 percent across a range of populations between 2008 and 2016.

But there’s evidence that COVID-19 intensified the problem. A recent Harvard study found that outpatient visits dropped by nearly 60 percent at the end of March. In April, Virginia reported a nearly 50 percent decline in child vaccination rates, largely driven by fears of transmission and confusion over the governor’s stay-at-home order.

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