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New Policy Brief Outlines Burdens of Restrictions on Advanced Practice Professionals

July 05, 2018

A recent policy brief published by The Hamilton Project, an economic policy initiative of the Brookings Institution, provides new insight into the ways that limitations in scope of practice are impacting health care in the United States.

The policy brief—Improving Efficiency in the Health-Care System:  Removing Anticompetitive Barriers for Advanced Practice Registered Nurses and Physician Assistants—advocates for reforms to reduce scope of practice restrictions for advanced practice professionals.

Advanced practice professionals include physician assistants and advanced practice registered nurses (APRN). APRN is an umbrella term for professionals who have at least a bachelor of science degree in nursing and a master of science degree in nursing, and can include nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists.

In its review of recent research, the brief’s authors found that scope of practice restrictions are associated with:

  • Higher costs of care
  • Delays in care and reduced care coordination
  • Increased administrative burden and documentation requirements
  • Barriers to entering advanced practice fields and lower employment of advanced practice professionals

Researchers also suggest that restrictive scope of practice laws could run counter to the spirit of health care innovation efforts, including value-based payment models, Accountable Care Organizations, global budget pilots, and telemedicine programs. 

Reducing scope of practice restrictions, the authors assert, can help bring more advanced practice professionals into the labor market and improve efficiency by allowing professionals to specialize in the services and procedures for which they are best-suited to perform. Additionally, with a higher supply of trained professionals who are qualified to provide the necessary care, patients have more options to access primary care providers, especially in rural areas.

The brief’s comparative analysis shows that Pennsylvania currently lags behind other states in reducing scope of practice restrictions, limiting the practice authority of physician assistants and APRNs.

HAP advocates for efforts to allow advanced practice professionals to practice to the full extent of their education and training in all health care facility settings. This can help hospitals alleviate workforce shortages; deliver timely, high-quality care to patients; and ease burdens on physicians.

HAP supports Senate Bill 25, sponsored by State Senator Camera Bartolotta (R–Beaver), would permit certified nurse practitioners to practice to the full scope of their license without the need for physician supervision after they have worked under such supervision for three years and 3,600 hours. Senate Bill 25 was approved by the Senate on April 26, 2017, and awaits consideration by the state House of Representatives.

For more information, contact Mary Marshall, HAP’s director, workforce and professional development, or Stephanie Watkins, HAP’s vice president, state legislative advocacy.

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