Health Affairs, 32(7), 1236-1243. We use cookies to help provide and enhance our service and tailor content and ads. Terms and Conditions. For more information, view our Privacy Statement. Retrieved from: http://ldi.upenn.edu/voices/2013/10/03/consumer-preferences-toward-non-physician-providers. Such practices may exacerbate the projected health care “bottleneck,” in which demands for health care outpace the supply of providers—and that, the report argues, is anti-competitive. FTC staffs interest in nursing regulation derives from our expertise in health care competition issues. Dill, M. J., Pankow, S., Erikson, C., & Shipman, S. (2013). (2012). 2013), cert. 19, 2013); Written Testimony from FTC Staff to Subcomm. 111-148, §4105, 2717. In March 2014, the FTC published, To read this article in full you will need to make a payment. By continuing you agree to the, https://doi.org/10.1016/S2155-8256(15)30034-X, Advanced Practice Nurses: Perspectives on Competition and Regulation. It is easy to see how such requirements could present a challenge in some rural or urban communities, where the nearest doctor can be many miles away. 5. That, at least, is the conclusion of the FTC, which released a policy paper making that argument in March entitled Competition and the Regulation of Advanced Practice Nurses. granted, 2014 U.S. LEXIS 1710 (U.S. Mar. (2014). Published by Elsevier Inc. All rights reserved. This commentary originally appeared on the RWJF Human Capital Blog. Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses. The FTC report also contends that excessive supervision and collaboration requirements may undermine access to care. BACKGROUND ON APRNS AND SCOPE OF PRACTICE ISSUES 7 II.A. The FTC’s focus on promoting expanded roles for non-traditional providers in health care is evident from its prior actions and this newly issued policy paper. 26, 2012); Comment from FTC Staff to the Hon. In the past few years, the Federal Trade Commission (FTC) has demonstrated a consistent Users are advised not to take, or refrain from taking, any action based upon the information and materials contained herein without consulting legal counsel engaged for a particular matter. The major question the report tackles is: “Do current SOP laws and regulations impair competition?”  Competition, it argues, is good for the health care market, as it is for the larger economy, because it can spur improved quality and help contain costs. All Rights Reserved. For example, the FTC previously found that a state dentistry board illegally thwarted competition by working to bar non-dentist providers of teeth-whitening goods and services.1 In 2011, the agency issued competition advocacy comments to a pending Tennessee state bill, concluding that the proposed physician-supervision requirements for certain pain-management services would result in reduced access and increased prices.2 Similarly, over the past three years, the FTC has issued comments analyzing the likely competitive effects of proposed changes to advanced practice registered nurses (APRNs) regulations in Massachusetts, Connecticut, West Virginia, Louisiana, Kentucky, Texas and Florida.3 The FTC has now gone beyond a case-by-case approach on these issues, with the issuance on March 7 of a policy paper titled Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses.4, The FTC advocates in its paper for the expansion of APRN scope of practice, cautioning state legislators that “[p]hysician supervision requirements may raise competition concerns because they effectively give one group of health care professionals the ability to restrict access to the market by another, competing group of health care professionals, thereby denying health care consumers the benefits of greater competition.”. (2012). This communication may be considered attorney advertising under the rules of some states. Rodney Ellis & Hon. 4. The position laid out in the 2014 FTC report asserts the opposite; it argues that health care organizations that employ APRNs should have the flexibility to determine their own protocols for the use of APRNs. The FTC report also argues that restrictive collaborative practices turn physicians into “gatekeepers” who control access to the market. March 12‚ 2014. That extensive body of evidence makes it difficult to support the many restrictive SOP regulations that are in place in many states. 22, 2011). on Health of the State of W. Va. Legislature (Sept. 10-12, 2012); Comment from FTC Staff to the Hon. Consumer Preferences Toward Non-Physician Providers. Auerbach, D. I. The FTC report makes a timely entrance into the current debate over how to transform our health care system. Thomas P. Willmott & Hon. Certification and licensure requirements should reflect the types of services APRNs can safely and effectively provide. These protocols should be based on the needs of the consumers and the expertise and skills of providers. 6. 2. FTC Cautions States against Overbroad Regulation of Nurse Practitioners in Continued Effort to Promote Expanded Roles for Non-traditional Providers. First, imposing greater restrictions on APRNs may exacerbate existing provider shortages, particularly for underserved populations. While the authors of the report do not necessarily advocate for a single uniform model or standardization of SOP regulations, they are in favor of less restrictive regulations, particularly in light of the distributional problems in the supply of health care professionals. The FTC identified a set of guiding principles and formulated an analytical framework to assist policymakers when evaluating proposed changes to APRN scope of practice regulations. The information and materials contained herein have been provided as a service by the law firm of Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. © 2015 National Council of State Boards of Nursing, Inc. Health care provider shortages are a real concern, especially for individuals living in primary care deserts. Handwashing to Slow the Coronavirus Pandemic, Disability Inclusion: Shedding Light on an Urgent Health Equity Issue, It’s Time to Connect Rural Health Equity with Community and Economic Development, Data Maps the Impact of Where a Child Grows Up, Creative Communities Are Addressing Social Isolation, Why We Must Turn Up the Heat on Tobacco Products, http://www.ftc.gov/system/files/documents/reports/policy-perspectives-competition-regulation-advanced-practice-nurses/140307aprnpolicypaper.pdf, http://www.aafp.org/dam/AAFP/documents/about_us/initiatives/AAFP-PCMHWhitePaper.pdf, http://ldi.upenn.edu/voices/2013/10/03/consumer-preferences-toward-non-physician-providers. The report also argues that while SOP policies may be intended as a form of consumer protection, they may have the opposite effect. : New forecasts and implications for healthcare delivery. The FTC paper, Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses, notes the potential benefits of improved competition in the provision of primary healthcare services. 20, 2012); Comment from FTC Staff to the Hon. APRN scope of practice limitations should be narrowly tailored to address well-founded health and safety concerns. States with the least restrictive regulations experienced the largest increase in patients seen by nurse practitioners. By continuing you agree to the Use of Cookies. House of Representatives (Apr. Advanced practice nursing roles are developing globally, and opportunities for advanced practice nursing are expanding worldwide due to the need for expert nursing care at an advanced level of practice. Neither transmission nor receipt of such information and materials will create an attorney-client relationship between the sender and receiver. Jama, 300(10), 1154-1164. While the ACA defers to states to determine if APRNs can lead health care teams, based on state SOP regulations and laws, it states that they should not be prevented from leading primary care teams. INTEREST AND EXPERIENCE OF THE FTC 5 II. That, at least, is the conclusion of the FTC, which released a policy paper making that argument in March entitled Competition and the Regulation of Advanced Practice Nurses. Retrieved from: http://www.aafp.org/dam/AAFP/documents/about_us/initiatives/AAFP-PCMHWhitePaper.pdf. The American Academy of Family Physicians recently recommended that patient-centered medical homes be led by physicians6. of Dental Examiners v. FTC, 717 F.3d 359 (4th Cir. Because unnecessary restrictions on APRN practice have the potential to undermine competition in the health care market and impede consumer access to care. Gilman, D.J., Koslov, T.I. The FTC identified several potential competitive harms that may result from certain APRN scope or practice restrictions that limit APRNs’ access to the marketplace, consequently depriving health care consumers of the benefits of competition among different types of health care providers. You are free to change your mind and to stop receiving emails from us by contacting us at we will send these communications to you only if you choose to receive them by checking this box. By signing up, you agree to the Robert Wood Johnson Foundation level of support for advanced practice nurses based on its emphasis on market competition. Sign up here to receive periodic e-mails notifying you of new publications, news, and events in your areas of interest. Tags: Health Leadership Development, Nurses and Nursing, Nursing. These individuals (many of whom are low-income and on Medicaid) are among the 65 million people living in areas that lack sufficient numbers of health care providers. Staff members cite research suggesting that APRNs provide safe and effective care within the scope of their training, certification and licensure. (2013, October 3). The Federal Trade Commission (FTC) created quite a stir when it released a recent report in support of expanded scope-of-practice (SOP) regulations for advanced practice registered nurses (APRNs)1. Additionally, “scope of practice” rules define the types of services APRNs are authorized to provide and the extent to which they are permitted to practice without direct physician supervision. Why after all, would the FTC—an agency charged with protecting consumers—take an interest in the regulatory woes of nurses? Are the regulations narrowly tailored to serve the state’s policy priorities. © 2001–2018 Robert Wood Johnson Foundation. Patient-centered medical homes for example, are a fixture of the ACA. Nova Science Publishers ISBN-13: 978-1633216259, DOI: https://doi.org/10.1016/S2155-8256(15)30034-X. These regulations differ from state to state, often with no clear safety or quality data to support them. The Federal Trade Commission (FTC) has a well-established role in promoting competition in the health care industry through enforcement, study and advocacy. Patient Protection and Affordable Care Act, Pub. Copyright © 2014 Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. The enclosed 2014 FTC staff policy paper, Policy Perspectives: Competition and the Regulation of Advanced Practice Registered Nurses ("Policy Paper"), analyzes the Other states limit the number of NPs physicians can supervise. By continuing to use this site, you are agreeing to our use of cookies. Some states, for instance, require that NPs practice within a certain distance of a collaborating physician. / Second, excessive supervision requirements may increase health care costs and prices, as such requirements will result in costs being imposed on the supervising physician as well as the supervised APRN. Will the regulation significantly impede competition? Will the NP workforce grow in the future? Advanced Practice Registered Nurses 7 II.B. The FTC cited expert bodies as recommending that access problems be addressed, in part, by increased reliance on APRNs. Most states recognize APRNs as a distinct category of nursing professionals who have been trained to provide a broad range of services, including the diagnosis and treatment of acute and chronic illnesses. Health Affairs, 32(6), 1135-1142. Furthermore, prior results do not guarantee a similar outcome. 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