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

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.