A quarter of caring for Alaskans: nurse practitioners celebrate their role in the state's health.

• Author: Stomierowski, Peg
• Position: HEALTHCARE

Nurse practitioners in Alaska, as they celebrate a quarter century of independent practice amid a strained primary care system, are studying and working to keep up with growing need among the elderly and others that can't find physicians to diagnose and treat them. Marilyn Walsh Kasmar and other leaders in the field warn that when it comes to coverage and reimbursement boondoggles, things are likely to get worse before they get better.

According to findings of the Alaska Physicians Supply Task Force, which in 2006 projected the anticipated need for physicians in the state for 20 years out, Alaska through 2025 needs about 100 new doctors coming on line each year, reported Jim Jordan, executive director of the Alaska Medical Association. That's in order to come up with a net increase of about 59 new doctors each year, taking into account deaths, retirement and general attrition. Meanwhile, during the last decade, the number of seniors in the state has grown by 48 percent.

A GROWING CRISIS

Take the case of one woman whose daughter helped her navigate the system. The daughter came to a care center seeking a family practice doctor or internist to see her mother. Unfortunately, the older woman hadn't been a patient at the clinic in question before turning 65. "They took me in," she told a nurse practitioner on duty later, "but they told me this was it. I was the last one. They couldn't take any more."

"It's becoming a real crisis," Kasmar, CEO of the Alaska Primary Care Association (PCA), said this fall of the frustrations consumers and families experience in trying to access appropriate services--especially in remote areas amid service-provider frustrations over reimbursement levels, paperwork and oversight requirements.

In cases like these, nurse practitioners may find themselves caught up, as one described, in "making calls, pulling favors, trying anything to find someone who will take them," especially if the clinic they serve isn't accepting Medicare patients.

While her office routinely accepted and was reasonably reimbursed for the care of Medicaid patients, she said, a colleague recalled waiting six months for Medicare re-payment to come through.

It's the bigger issue, explained Lynn Hartz, editor of "Alaska Nurse," who has worked both in solo and medical clinic practice. "Medicare is more fluid," she said. Nurse practitioners may take up to a certain number of patients on Medicare, but there are limits, so who takes Medicare or not can change from week to week.

One nurse practitioner recalls a case in which she realized it was going to cost more in paperwork and mailing costs to pursue reimbursement for her short visit with an 80-year-old woman than the $11 she'd receive if she was successful in pursuing...