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A Comparison of Changes in the Professional Practice of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives:  1992 and 2000

This page: Appendix A.  Project Advisory Committee | Appendix B.  Professional Organizations | Appendix C.  Original Index Calculations

Appendix A.

Project Advisory Committee

Richard A. Cooper, MD
Director, Health Policy Institute
Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226

Antonio Furino, PhD
Professor of Economic and Director
Center for Health Economics and Policy
University of Texas, HSC at San Antonio
7703 Floyd Curl Drive, Mail Code 7907
San Antonio, TX 78229-3900

Tim Henderson
Director, Primary Care Resource Center
National Conference of State Legislatures
444 North Capitol Street, Suite 515
Washington, DC 20001

L. Gary Hart, PhD
Director, WWAMI Health Workforce Center
Roosevelt Way, NE  Suite 308
University of Washington
Seattle, WA 98195-4795

Thomas R. Konrad, PhD
Director, Program on Health Professions
Sheps Center for Health Services
725 Airport Road, CB 7590, Suite 210
Chapel Hill, NC 27599-7165

Linda Lacey
Associate Director
North Carolina Center for Nursing
222 North Person Street
Raleigh, NC 27601

Kevin Marvelle
VP, Data Systems and Analysis
American Academy of Physician Assistants
950 North Washington Street
Alexandria, VA 22314-1552

Eileen T. O’Grady, PhD, RN, NP
Policy Liaison
American College of Nurse Practitioners
503 Capitol Court, NE, #300
Washington, DC 20002

Joyce Roberts, CNM, PhD
President
American College of Nurse-Midwives (ACNM)
818 Connecticut Avenue, NW  Suite 900
Washington, DC 20006

Hollis Russinof, MUPP
Center Manager and Policy Analyst
Illinois Center for Health Workforce Studies
850 West Jackson Blvd, Suite 400
Chicago, IL  60607

Edward Sekscenski
Health Care Financing Administration
Susan Skillman
Deputy Director, WWAMI Health Workforce Center
Roosevelt Way, NE  Suite 308
University of Washington
Seattle, WA 98195-4795

Joanne Spetz
Research Fellow
Center for the Health Professions
545 Edinburgh Street
San Mateo, CA  94402

Staff

Edward S. Salsberg
Executive Director
Center for Health Workforce Studies
School of Public Health, University at Albany
One University Place, Suite 200
Rensselaer, NY 12144-3456

Paul Wing
Deputy Director
Center for Health Workforce Studies
School of Public Health, University at Albany
One University Place, Suite 200
Rensselaer, NY 12144-3456

Margaret Langelier
Senior Research Associate
Center for Health Workforce Studies
School of Public Health, University at Albany
One University Place, Suite 200
Rensselaer, NY 12144-3456

Emily Slocum
Graduate Research Assistant
Center for Health Workforce Studies
School of Public Health, University at Albany
One University Place, Suite 200
Rensselaer, NY 12144-3456

HRSA Project Officer

Louis A. Kuta
Economist and Project Officer
National Center for Health Workforce Analysis
Health Resources and Services Administration
5600 Fishers Lane, Suite 8-55
Rockville, MD 20857

Appendix B.  Professional Organizations

This appendix lists the professional organizations related to NPs, PAs, and CNMs contacted as part of this study.

Professional Organizations

The professional organizations that credential and represent Nurse Practitioners, Certified Nurse Midwives and Physician Assistants are:

Nurse Practitioners

Nurse Midwives

  • American College of Nurse Midwives
  • American College of Nurse Midwives (ACNM) Certification Council Inc. (ACC)
  • ACNM Division of Accreditation for CNMs and CMs
  • North American Registry of Midwives (NARM) for CPMs
  • American College of Nurse-Midwives Certification Council
Physician Assistants
  • American Academy of Physician Assistants

Appendix C.  Original Index Calculations

This appendix contains a table that documents the detailed calculations used to compute the practice environment indices for the three professions for each of the 50 States plus the District of Columbia. It includes the following subsections:

  • NPs
  • PAs
  • CNMs

NPs

The original practice environment index developed by Sekscenski et al for 1992 was based on a number of specific criteria and point allocations reflecting the then current practice environment for the profession. The specific criteria and point allocations used in creating the index are presented below.

Legal Status (Maximum = 20)

License or Title Recognition = 6.

Practice Defined by the Board of Nursing = 7.

No Supervision by Physician = 7.

Reimbursement (Maximum = 40)

Mandated Payment = 20. [This was understood to mean any required payment to Nurse Practitioners by Medicare, Medicaid, Workers Compensation, or private payer.]

Services Covered = 0 – 10. [Particularly favorable environments were awarded 10 points, while somewhat favorable environments were awarded 5 points]

Medicaid % Pay = 0 – 10. [This was computed by multiplying the percent of physician reimbursement rate x 10. Thus NP reimbursement at 80 percent of physician rate received a score of 8.]

Prescriptive Authority (Maximum = 40)

Full Authority = 40. [This was defined as prescriptive authority for Schedule II-V controlled substances and legend drugs.]

Partial Authority = 10 – 30. [Schedule III-V and legend drugs was valued at 30 points. Schedule IV-V and legend drugs was valued at 20 points. Legend drugs only was awarded 10 points.]

No Authority = 0.

The details of the point allocations for each of the fifty States and the District of Columbia can be found below.

Table C-1 Professional Practice Index Scoring Criteria Original Scoring System for NPs for 2000
Scoring Category Score Optimal Score AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN
Legal Status
License or Title Recognition
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
Practice Defined by Board of Nursing
7
7
7
7
7
7
7
7
7
7
7
7
7
7
7
No Supervision by Physician
7
7
7
7
7
7
7
7
7
7
7
7
7
7
7
7
Subtotals Legal
20
13
20
20
20
20
20
20
20
13
20
13
13
20
20
20
Reimbursement
Mandate Payment
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Services Covered
0-10
10
10
5
10
10
10
10
10
10
10
10
7
10
Medicaid % Pay x 10
10
10
10
8
6
8
10
10
10
10
8
9
7.5
8.5
10
8.5
Subtotals Reimbursement
40
20
33
36
28
20
40
40
40
20
38
29
37.5
38.5
37
38.5
Prescriptive Authority
Full Authority
40
40
40
40
40
40
40
40
40
40
Partial Authority
1-39
10
30
30
10
10
10
30
No Authority
0
Subtotals Prescriptive Authority
40
10
40
40
30
30
40
40
40
40
10
10
10
40
30
40
TOTAL
100
43
93
96
78
70
100
100
100
73
68
52
60.5
98.5
87
98.5
 
Table C-1, continued Professional Practice Index Scoring Criteria Original Scoring System for NPs for 2000
Scoring Category Score Optimal Score IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH
Legal Status
License or Title Recognition
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
Practice Defined by Board of Nursing
7
7
7
7
7
7
7
7
7
7
7
7
7
7
7
No Supervision by Physician
7
7
7
7
7
7
7
7
7
7
7
7
7
7
Subtotals Legal
20
20
20
20
14
20
13
6
13
20
20
20
20
13
20
20
Reimbursement
Mandate Payment
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Services Covered
0-10
10
10
7
10
10
10
10
10
10
10
10
10
10
0
10
10
Medicaid % Pay x 10
10
10
8
8
7.5
8
10
10
10
10
9
9
10
8.5
10
8
10
Subtotals Reimbursement
40
38
35
37.5
38
40
40
40
40
39
39
40
38.5
30
38
40
Prescriptive Authority
Full Authority
40
40
40
40
40
40
40
Partial Authority
1-39
35
10
10
30
10
10
10
35
10
35
No Authority
0
Subtotals Prescriptive Authority
40
40
35
10
10
30
40
40
10
40
10
10
40
35
10
35
TOTAL
100
98
90
67.5
62
90
93
86
63
99
69
70
98.5
78
68
95
 
Table C-1, continued Professional Practice Index Scoring Criteria Original Scoring System for NPs for 2000
Scoring Category Score Optimal Score NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT
Legal Status
License or Title Recognition
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
Practice defined by Board of Nursing
7
7
7
7
7
7
7
7
7
7
7
7
7
No Supervision by Physician
7
7
7
7
7
7
7
7
7
7
7
7
7
Subtotals Legal
20
20
20
13
13
20
20
13
20
6
20
13
13
7
20
20
Reimbursement
Mandate Payment
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Services Covered
0-10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
Medicaid % Pay x 10
10
10
9.5
9
10
10
8
10
9
10
10
8
8
9
10
7
10
Subtotals Reimbursement
40
39.5
39
40
40
38
40
19
40
40
38
28
39
40
37
40
Prescriptive Authority
Full Authority
40
40
40
40
40
40
40
40
40
40
40
Partial Authority
1-39
20
35
30
30
10
10
No Authority
0
Subtotals Prescriptive Authority
40
20
40
40
35
40
30
30
40
40
40
10
40
40
10
40
TOTAL
100
79.5
99
93
88
98
90
62
100
86
98
51
92
87
67
100
 
Table C-1, continued Professional Practice Index Scoring Criteria Original Scoring System for NPs for 2000
Scoring Category Score Optimal Score VT VA WA WV WI WY  
Legal Status
License or Title Recognition
6
6
6
6
6
6
  
Practice Defined by Board of Nursing
7
7
7
7
7
7
7
No Supervision by Physician
7
7
7
7
7
7
7
Subtotals Legal
20
20
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