Throughout the heated North Carolina Medicaid expansion debate, one word was repeated time and again: supply. Opponents of expansion cited the health care professional shortage as a serious concern that would be exacerbated if over 600,000 individuals were added to the Medicaid rolls. Thankfully, there are some policy reforms that can help alleviate the health-care provider shortage, particularly the SAVE Act.
The SAVE Act is a bipartisan bill that would remove North Carolina’s outdated requirements for advanced practice registered nurses (APRNs) to enter supervision agreements with physicians. Because the physicians can be in a different facility or even reside outside of North Carolina, the agreements operate as supervision in name only.
The SAVE Act could potentially make its biggest impact on supply in primary care by granting nurse practitioners (NPs) full practice authority. According to the U.S. Health Resources and Services Administration (HRSA), North Carolina has 222 designated primary care Health Professional Shortage Areas, with almost 3 million people living in areas without enough providers. To meet the shortage, North Carolina would need 497 more primary-care providers.
NPs are a type of advanced practice registered nurse. They are registered nurses who also hold graduate degrees in nursing. Graduate nursing degrees include advanced coursework and clinical hours. NPs must pass national licensing exams and answer to their professional review boards. The degree of expertise they hold allows them to diagnose and treat patients, to include prescribing medication. They tend to focus on primary care.
When it comes to physician supply, North Carolina is doing better than most. However, care is not evenly distributed. Physician shortage areas are especially acute in rural parts of the state. Although the number of primary care physicians isn’t keeping up with rural needs, the number of NPs more than doubled from 2010-2017, up to 190,000 nationwide. The Medical Care Research and Review journal finds that growth is most significant in rural and underserved areas.
Best of all, more than 80% of NPs are certified in primary care. NPs can provide a safe and cost-effective solution to a looming shortage of family doctors, especially in rural and poor areas. Primary care providers are the first provider a patient turns to when problems arise. Primary care services cover a large majority of personal health care needs.
But North Carolina law conditions NPs’ ability to practice on whether a physician will sign off on “supervising” them. Allowing NPs to practice to the full extent of their training is not a radical idea. More than half of states and the District of Columbia allow NPs to provide healthcare, including prescribing medications, without physician oversight. North Carolina should join these other states in recognizing the value of full practice authority.
In states where NPs are fully utilized, they work without an overseeing physician and meet the unmet needs of the poor, rural and other underserved communities. Academic studies showing positive health outcomes with NPs are possible because some states already grant them full authority to practice.
The Health Services Research journal found that patients reassigned from physicians to NPs “experienced similar outcomes and incurred less utilization at comparable cost relative to [medical doctor] patients.”
A study by University of Minnesota professor Morris Kleiner in the Journal of Law and Economics found that insurance had to pay 3-16% more for well-child visits in states restricting NPs, with “no evidence that the changes in regulatory policy are reflected in outcomes that might be connected to the quality and safety of health services.”
Yet another study found that parents rated their children’s health better in states that allow NPs to practice independently. Another report showed that diabetics got better and less-costly care after states reformed their laws.
Granting highly qualified NPs full practice authority is a commonsense reform. It allows NPs to work independently and saves the health care system money. NPs are cheaper than doctors, and the health care system saves money by detecting and treating medical problems sooner rather than later. It also won’t cost state taxpayers a dime.
Reduced cost, increase access to care, and consumer choice are reasons to relax the regulations on nurse practitioners. Why isn’t North Carolina doing it?