Katie, sent a message to Mark Bertolini, Chairman and Chief Executive Officer, Aetna Email Address that said:
February 25, 2016
Mark Bertolini
Chairman CEO, AETNA
RE: Wisdom 2.0 APRN reimbursement
Dear Mr. Bertolini
Thank you for your presentation about mindfulness in medicine at Wisdom 2.0 this past weekend. I was inspired by your dedication to cultural shifts within your company and your vision of improving the healthcare system as a whole.
I attended your QA session following the talk and asked about Aetnaâs reimbursement policies for nurse practitioner-run facilities in New Jersey. I recently launched an APRN-run school based health center in Camden, NJ through Rutgers University, and was intimately involved in the policies, procedures, and contract negotiations at our inception. If you recall, I mentioned our center was unable to negotiate a contract with Aetna, which blocked our ability to provide healthcare services to teachers because we are run solely by APRNs. You responded that this was due to New Jersey state practice laws, but after some research I found this is incorrect. There are no 3rd party payer laws in New Jersey related to APRN reimbursement. Furthermore the wording Aetna uses in their contracts with APRNs explicitly states that an MD must be physically present 50% of the time. This wording is more restrictive that any state mandate in the country. I am concerned the conservative wording of Aetnaâs contracts in New Jersey suggests APRNs in various states are facing similar issues with Aetna reimbursement.
As I am sure you are aware, APRNS provide high-quality, cost-effective care to many Americans, particularly the most vulnerable, like students at the Rutgers/LEAP Health and Wellness center in Camden, NJ. Multiple research studies spanning many years quantify both quality and cost of APRNs; preventing our reimbursement directly translates to increased healthcare costs, barriers to healthcare access, and increasing health disparities.
After hearing your presentation and your responses during your QA, I am confident that you are dedicated to various methods of improving our healthcare system. I recognize that as CEO of a large healthcare insurance company, you may be unaware of Aetnaâs contract barriers to APRNs in New Jersey and elsewhere. This is why I am attempting to follow up, as I believe Aetna can make changes to APRN reimbursement, spearheading healthcare reform and acting as our ally at the federal level. What an amazing outcome from Wisdom 2.0!
Thank you again for your continued commitment to mindfulness in medicine. I look forward to seeing changes to Aetna contracts with APRNs in New Jersey, and in all states needing transformation. Please do not hesitate to contact me if I can be of assistance in shedding more light on Aetna contract barriers to APRNs in this country.
In solidarity,
Katie
