Instructions: Respond by extending, refuting/correcting, or adding additional nuance. Response must be constructive, grammatically correct, in current APA style, and use academic literature. Must  be at least 300 words. Advanced practice registered nurses are knowledgeable, educated, well trained and able to provide a plethora of services to patients. That being said, there are several barriers that have hindered the progress of advanced practice nursing including federal policies, outdated insurance reimbursement practices and institutional practices and culture within the workplace (Altman, 2016).   Although progress has been made, there are still numerous federal policies that prevent APRN’s from practicing to the full extent of their training and education. In 2018, Congress issued legislation that made it possible for nurse practitioners (NPs) to oversee pulmonary and cardiac rehabilitation beginning in 2024, however NPs are still not able to order pulmonary and cardiac rehabilitation for their Medicare patients (AANP, 2021). Nurse Practitioners are both capable and qualified to provide these services, however this barrier only services to harm patients as it causes delays in treatment. Secondly, although (NPs) provide full range of care to individuals affected by Diabetes, they are still required to involve a physician when a patient requires therapeutic shoes. The NP must send the patient to a physician to confirm the need for the shoes, and the physician then must be tasked with being the provider treating the diabetic’s condition moving forward. Again, this causes major delays within the healthcare system and affects the overall health of the patient (AANP, 2011). Additionally, while NPs work as providers for hospice patients and are able to conduct assessments as well as establish and review care plans, they are prohibited from certifying eligibility for hospice programs. Once again, a physician is required, and additional costs are incurred. Currently, the American Association of Nurse Practitioners is calling on Congress to change many federal laws, including authorizing NPs to order cardiac and pulmonary rehabilitation services for Medicare patients, allowing for NPs to issue therapeutic shoes to diabetics without involving a physician and authorizing NPs to certify Medicare patients for Hospice Care (AANP, 2011).  Historically, reimbursement for NP services has been scattered and confusing to say the least. In 1990, APRN direct reimbursement by Medicare was available only in rural areas and skilled nursing facilities. It was not until 1997 that direct reimbursement was made possible in all clinical settings as well as locations, however the rate was 85% of that of a physician. (Journal of Wound, Ostomy and Continence Nursing, 2012). This can be a huge issue, as NPs working in their own offices receive 15% less reimbursement than a physician’s office would. Furthermore, there is so much variability in Medicaid reimbursement b.

1. Instructions: Respond by extending, refuting/correcting, or
adding additional nuance. Response must be constructive,
grammatically correct, in current APA style, and use academic
literature. Must be at least 300 words.
Advanced practice registered nurses are knowledgeable,
educated, well trained and able to provide a plethora of services
to patients. That being said, there are several barriers that have
hindered the progress of advanced practice nursing including
federal policies, outdated insurance reimbursement practices
and institutional practices and culture within the workplace
(Altman, 2016).
Although progress has been made, there are still numerous
federal policies that prevent APRN’s from practicing to the full
extent of their training and education. In 2018, Congress issued
legislation that made it possible for nurse practitioners (NPs) to
oversee pulmonary and cardiac rehabilitation beginning in 2024,
however NPs are still not able to order pulmonary and cardiac
rehabilitation for their Medicare patients (AANP, 2021). Nurse
Practitioners are both capable and qualified to provide these
services, however this barrier only services to harm patients as
it causes delays in treatment. Secondly, although (NPs) provide
full range of care to individuals affected by Diabetes, they are
still required to involve a physician when a patient requires
therapeutic shoes. The NP must send the patient to a physician
to confirm the need for the shoes, and the physician then must
be tasked with being the provider treating the diabetic’s
condition moving forward. Again, this causes major delays
within the healthcare system and affects the overall health of
the patient (AANP, 2011). Additionally, while NPs work as
providers for hospice patients and are able to conduct
assessments as well as establish and review care plans, they are
prohibited from certifying eligibility for hospice programs.

2. Once again, a physician is required, and additional costs are
incurred. Currently, the American Association of Nurse
Practitioners is calling on Congress to change many federal
laws, including authorizing NPs to order cardiac and pulmonary
rehabilitation services for Medicare patients, allowing for NPs
to issue therapeutic shoes to diabetics without involving a
physician and authorizing NPs to certify Medicare patients for
Hospice Care (AANP, 2011).
Historically, reimbursement for NP services has been scattered
and confusing to say the least. In 1990, APRN direct
reimbursement by Medicare was available only in rural areas
and skilled nursing facilities. It was not until 1997 that direct
reimbursement was made possible in all clinical settings as well
as locations, however the rate was 85% of that of a physician.
(Journal of Wound, Ostomy and Continence Nursing, 2012).
This can be a huge issue, as NPs working in their own offices
receive 15% less reimbursement than a physician’s office
would. Furthermore, there is so much variability in Medicaid
reimbursement between different states at a time when nurse
practitioners are expected to take care of record numbers of
patients utilizing Medicaid. Medicaid tends to follow federal
guidelines as it relates to reimbursement, therefore the problem
with a reduction in payment to nurse practitioners for service
charges that are already exceptionally low is extremely
significant (Edmunds, 2014). To combat this, nurse
practitioners are bringing this to the federal level, and asking
that NPs be reimbursed at the same rate as physicians when
caring for Medicaid patients.
Another barrier to the progress of advanced practice nursing is
the culture of many settings where physicians and NPs interact
on a daily basis. Although NPs possess the specific skillsets to
diagnose, prescribe and treat, there is often physician
opposition to independent NP practice, which is free from
oversight or supervision (Schirle, et.al, 2018). There is also a

3. major lack of understanding of the NPs role, and lack of
recognition on a professional level. Studies have shown that
NPs report lower job strain and increased job satisfaction when
given higher levels of autonomy rather than being
micromanaged (Schirle, et. al,2018). To manage this widespread
issue, relationships between NPs and physicians should be
improved and there should be more education provided as to the
scope of the NPs role. Further, the NP should be treated with
respect and professionally recognized for the services that they
provide on a daily basis. Lastly, an appropriate amount of
autonomy should exist for NPs to utilize their knowledge,
educations and skillsets. By doing this, job satisfaction and
productivity is increased, and patients are cared for by an NP
that feels valued in the workplace.
References
AANP Federal Policy Priorities
. American Association of Nurse Practitioners. (2021).
https://www.aanp.org/advocacy/federal/federal-issue-
briefs/aanp-federal-policy-priorities.
Altman, S. H. (2016, February 22).
Removing Barriers to Practice and Care
. Assessing Progress on the Institute of Medicine Report The
Future of Nursing.
https://www.ncbi.nlm.nih.gov/books/NBK350160/.
Edmunds, M. W. (2014). Important NP Issues.
The Journal for Nurse Practitioners
,
10
(9). https://doi.org/https://www.npjournal.org/article/S1555-
4155(14)00615-1/fulltext.
Reimbursement of Advanced Practice Registered Nurse Services

4. A Fact Sheet. (2012).
Journal of Wound, Ostomy and Continence Nursing
,
39
(2), 7–16.
https://journals.lww.com/jwocnonline/fulltext/2012/03001/reim
bursement_of_advanced_practice_registered.4.aspx.
Schirle, L., Norful, A. A., Rudner, N., & Poghosyan, L. (2018,
December).
Organizational facilitators and barriers to optimal APRN
practice: An integrative review
. Health care management review.
https://pubmed.ncbi.nlm.nih.gov/32865939/.
Instructions: Respond by extending, refuting/correcting, or
adding additional nuance. Response must be constructive,
grammatically correct, in current APA style, and use academic
literature. Must be at least 300 words.