Nurse Practitioner Independence Save

A JAMA Viewpoint article reports on a March 2025 Nurse Practitioner (NP) Entrepreneurship Summit in Boston in March 2025 identifying barriers and opportunities to NP-owned medical practices.

Despite the impressive occupational growth rate of NPs (46%), only 3% of NPs own practices, but this is expected to grow as the NP workforce grows.  NP practices vary in scope but involve office visits, telehealth, home-based care, and remote monitoring – all to improve access and outcomes. Yet NPs will face many of the same challenges as other independently owned physician practices.

Challenges to NP Practice Ownership

• Primarily financial and policy barriers, which may require NPs to engage in financial risks and legal battles over credentialing and outdated payer policies.
• Next most impactful is the 15% reimbursement gap imposed by Medicare. This is based on differences in the cost and duration between physician and NP training. (Lower NP reimbursement underlines reduced NP salaries, and possibly lower overall practice revenue, even though practice overheads remain high)
• Despite the growth of independent NPs, half of all states require formal agreements with collaborating physicians, which will increase costs and administration.
• Some insurers still preclude NPs from being considered primary care clinicians.
• Most hospitals do not grant admitting privileges to NPs (despite the significant decline in physicians who admit to or round at hospitals).
• NP credentialing and reimbursement depends less on licensure and training and more so on administrative discretion of payers and local health systems.

Future Options for NP Independence

• More innovation in the private sector.
• Enablement firms (or Management Services Organizations [MSOs]) are recruiting and establishing aggregated NP-owned practice networks.  They potentially avoid the downside risk to NPs and address the administrative, operational, credentialing and regulatory challenges faced by NP owners.
  • These become aligned with accountable care organizations (ACOs), hospital systems and other local payers who value NP provided care.

The authors recommend supporting, sustaining and scaling NP primary care services – they did not address NP independent care for the subspecialties, such as rheumatology. Future challenges include difficult credentialing processes, how federal policymakers will manage the 15% payment differential disproportionately affects NP owners, and if state and local policymakers will remove supervision mandates to recognize the value that NP provided services and NP-owned practices in our communities.