Loosening scope of practice rules could improve care and costs, report argues
Policymakers and lawmakers could improve healthcare productivity, lower costs and reduce administrative burdens if advanced practice registered nurses and physician assistants didn't face “anticompetitive barriers,” according to a new report from The Hamilton Project.
The issue involves scope of practice (SOP) laws that restrict APRNs and PAs. If state and federal policymakers moved to a fully authorized SOP for those providers, healthcare would see more innovation, freer labor markets and better cost-effective and productive care, the report authors argue.
Making changes to SOP laws could also get PAs and advanced practice nurses into the field more quickly, they said.
The Hamilton Project, an economic policy center, said SOP requirements, which differ by state, limit labor efficiencies and increase costs, while not improving care. Midlevel providers have long been debating physicians regarding these restrictions, but fears of an upcoming provider shortage could result in a strong push toward giving nurses and PAs more freedom to practice at the top of their licenses.
The report suggested ways to reduce SOP restrictions, including cutting supervisory agreements, eliminating formal collaborative practice agreements and protocols, enabling advanced practice providers to prescribe medicines based on their training and education and cutting advanced practice provider-to-physician ratio requirements.
Co-authors E. Kathleen Adams from Emory University and Sara Markowitz from Emory University and the National Bureau of Economic Research said the changes could improve efficiency, reduce shortages and lower avoidable costs, such as those in emergency rooms and ambulatory care.
The report is far from the first to promote reducing restrictive SOP laws. A recent study in Health Affairs said NPs can help fill the gap connected to physician shortages. The Association of American Medical Colleges estimates a shortfall of as many as 105,000 doctors by 2030. Primary care alone could see a shortage of 43,000.
The Health Affairs report found that NPs represented a quarter of the provider workforce in 2016 compared to about 18% in 2008. That was most pronounced in states with full SOP laws, while the fastest growth came in states with reduced and restricted SOP laws.
Meanwhile, nurses across the country are pushing for better working conditions and more respect of what they bring to healthcare. SOP laws affect both of those issues. The American Nurses Association supports legislative and regulatory changes for SOP “with the aim of removing practice barriers for nurses and improving access to care.”
However, the American Medical Association opposes what it calls "inappropriate scope of practice expansion.” The AMA’s Resolution 214 adopted last year calls for a national strategy to oppose legislative efforts that allow nonphysician practitioners to practice independent of a physician.