Throughout the country, nurse practitioners (NPs) are playing a key role in delivering primary care services. NPs are registered nurses trained at the graduate level, with a specialization in primary care, acute care or psychiatric/mental health nursing, sometimes with a focus on pediatrics, adult/gerontology or women’s health.
With the Affordable Care Act expanding insurance coverage in 2014, NPs will continue to be in high demand in a variety of settings. However, state scope-of-practice laws are putting limits on practice opportunities for NPs and may influence payer policies, according to a recent report from the Center for Studying Health System Change (HSC) for the nonpartisan National Institute for Health Care Reform (NIHCR).
According to the study, state scope-of-practice laws vary widely in the level of physician oversight required for nurse practitioners, with some of the eight states surveyed allowing NPs to practice independently, and others limiting their authority to diagnose, treat and prescribe medications to patients without supervision. For example, Arizona allows NPs to practice independently, while Arkansas requires direct physician supervision of NP diagnoses, treatment and prescribing.
States with more restrictive scope-of-practice laws were associated with more challenging environments for NPs to bill public and private payers, order certain tests, and establish independent primary care practices, according to the study. “Scope-of-practice laws in and of themselves don’t appear to limit what primary care services patients can receive from nurse practitioners, but requirements for documented physician supervision do appear to impact where and how NPs can practice,” said Tracy Yee, Ph.D., coauthor of the study, “Primary Care Workforce Shortages: Nurse Practitioner Scope-of-Practice Laws and Payment Policies.”
Many NP respondents reported that payer policies had more of an impact than scope-of-practice laws on how and where they can practice. Payers determine what services NPs are paid for, their payment rates, whether NPs are designated as primary care providers and assigned their own patient panels, and whether NPs can be paid directly. Restrictive scope-of-practice laws, in conjunction with strict payer policies, reportedly limit NPs to working as employees of physician practices, hospitals or other entities rather than in their own independent practices.