Abbey Haslam: Cutting red tape on Pa.’s nurse practitioners
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Expanding health care access has been a major political issue in recent decades — first, during the Clinton health care plan of the 1990s, and then through Obamacare and the subsequent rapid expansion of Medicaid.
Yet, despite the major focus on expanding access to care, millions of Americans live in areas designated by the U.S. Department of Health and Human Services as medically underserved. These areas, often rural, have low patient-to-doctor ratios, forcing patients to travel long distances, face long wait times or go without care.
Simply put, these massive health care initiatives did not increase the supply of providers to meet demand.
Even worse, many Pennsylvanians are at risk because of inadequate health care access. According to the Centers for Disease Control and Prevention, rural residents are more likely to die prematurely from America’s five leading causes of death than urban residents. This sobering trend should resonate with Pennsylvania lawmakers because more than one in four Pennsylvanians live in rural areas.
But thankfully, there is another option for expanding access to health care: licensing reform for advanced practice registered nurses (APRNs). Today’s nurse practitioners (NPs) are more than capable of providing primary care treatment. They are APRNs holding specialized master’s degrees, competent to develop patient-treatment plans.
But Pennsylvania’s licensing regulations limit NPs by requiring expensive physician collaboration contracts. A treating NP must have two doctors’ approval to provide basic primary patient care. Even if patients never speak with a doctor, NPs pay, on average, $1,048 a month for these state-required contracts.
This government red tape, at best, discourages NPs from moving to the commonwealth and, at worst, decreases access to primary care.
Twenty-seven states and the District of Columbia already embrace full practice authority for NPs, meaning these states allow providers to practice independently at the top of their licenses.
Unsurprisingly, NPs favor working in these states. For example, the number of Maryland NPs skyrocketed after the state adopted full practice authority and implemented licensing reform in 2015. And estimates suggest that if Pennsylvania were to follow suit, the number of NPs here would increase by nearly 30%.
About 14% of Pennsylvania’s population lives in a medically underserved area, and nearly every county in the state suffers from an insufficient supply of primary care providers. So, more NPs coming to Pennsylvania would be welcome news to many of these communities. And luckily for us, NPs are already more likely to practice in medically underserved areas than their physician counterparts.
A new report from the Commonwealth Foundation estimated that granting full practice authority would increase patient access by more than 100 visits per NP each year. And more patients receiving primary care means fewer trips to the emergency department and better overall patient health.
Furthermore, the report finds that full practice authority increases NP self-employment and full-time work. These changes translate into increased wages for NPs — upwards of $3,000 — while leaving physicians’ earnings statistically untouched.
The increased independence and earning potential created by full practice authority offer year-over-year incentives and benefits for NPs in the state, unlike the short-term tax credit for new nurses proposed by Gov. Josh Shapiro.
Moreover, Shapiro’s incentive program is unnecessary and redundant; taxpayers already support programs like the National Health Service Corps Loan Repayment Program and the Pennsylvania Primary Care Loan Repayment Program to provide financial incentives to providers practicing in areas most impacted by health profession shortages.
Instead of creating new taxpayer-funded incentives, we should grant full practice authority to NPs. These licensing reforms are desperately needed and long overdue — especially in underserved communities like Armstrong, Bedford and Cambria counties. In many cases, APRNs are already here and doing the work, but the state government restricts them from practicing at their full potential.
The good news is there is legislation proposed to cut this red tape. Senate Bill 25 would empower more than 16,000 Pennsylvania NPs to provide primary care and mitigate the provider shortage.
Shapiro and our state lawmakers should embrace full practice authority for NPs. This simple reform would empower these health care professionals to practice at their full potential and serve more patients while attracting more NPs to move to and better serve the Keystone State.
Abbey Haslam is director of government affairs at the Commonwealth Foundation.