Study: NP scope of practice affects reimbursement, access

So far, 18 states plus the District of Columbia allow nurse practitioners to practice independently of physicians, a trend that proponents say increases access to primary care services while detractors worry compromises patient safety.

One of the most recent states to consider expanding NPs' scope of practice is Nevada. "For the average family, it's going to increase access for people to get care," Matthew Khan, a family practice nurse practitioner in Reno and president of the Nevada Advance Practice Nurses Association, told the Las Vegas Sun. "We are removing a barrier."

Meanwhile, some doctors argue changing the law could lead nurses to perform procedures they're not trained to administer, and independent, nurse-led practices could "fragment" medical care in Nevada, the newspaper reported.

In a similar vein, the American Academy of Family Physicians recently shared these concerns as part of its argument that physicians should be at the helm of medical homes. "Wholesale substitution of nonphysician healthcare providers for physicians is not the solution, especially at a time when primary care practices are being called upon to take on more complex care," Roland Goertz, chair of the AAFP board of directors, said in a statement.

While these opposing positions have been in the spotlight for some time, new research from the Center for Studying Health System Change highlights another wrinkle in the debate: the way scope-of-practice (SOP) laws affect how NPs are paid.

According to interviews conducted with NPs across six states representing a range of legal SOP restrictions--Maryland, Arizona, Michigan, Indiana, Massachusetts and Arkansas--restrictive SOP laws have a ripple effect on payer policies, thus further limiting patient access to services for which NPs are more narrowly reimbursed.

For example, Arkansas' Medicaid program does not pay for streptococcal screens or influenza swabs done by NPs. While the state's SOP laws do not prohibit these activities by NPs, they do not grant them explicitly, leaving these payment restrictions as longstanding Medicaid policies, according to researchers.

This and other forms of NP payment restrictions "might hamper the efficiency of our provider capacity," lead author Tracy Yee told Kaiser Health News. "NPs can be doing more; they could be seeing more patients; they could be reaching communities that are underserved more often."

To learn more:
- see the article from the Las Vegas Sun
- read the research brief from the National Institute for Healthcare Reform
- see the post from Kaiser Health News

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