Limits on Use of Nurse Practitioners

The primary problem in health spending in the United States is exorbitant growth in unit prices for services and products.  One obvious way to help lower those unit prices, and therefore overall spending, would be to substitute lower-cost providers.  But physicians have fought fiercely to protect their turf by limiting the scope of practice for non-physicians, through restrictive state laws and regulations.  An article in Health Affairs describes the current situation.   (HA Article)    A nurse practitioner is typically a registered nurse who has earned an advance degree.  They are extensively trained and capable of handling most, if not all, of the tasks of a primary care physician, and in some cases, a specialist.  They often are used in group medical practices as adjuncts to physicians, but their ability to practice with physician “supervision” often doesn’t exist.

The Health Affairs article details various types of limitations on nurse practitioners.  As of 2012, only 18 states allow nurse practitioners to diagnose and treat patients and prescribe medication without physician involvement.  Physicians attempt to justify these restrictions by quality concerns.  There is absolutely zero credible evidence that nurse practitioners have higher error rates or worse patient satisfaction than physicians.  In fact, given all the quality concerns, doctors might want to get their own house in order before criticizing other professionals.  In addition to the regulatory limitations, even where a nurse practitioner may be allowed to provide services without “supervision”, there may be reimbursement restrictions.  This is ludicrous, particularly when payers, especially government payers, should be the most concerned with constraining spending growth.  There is a great deal of concern about the adequacy of the supply of primary care providers, particularly when the reform law fully kicks in and there is an anticipated wave of new patients in the system.  Removing limits on scope of practice and reimbursement for nurse practitioners and other alternative providers to physicians would both help provide greater access and lower spending.