This month, state legislators in dozens of states are in the height of legislative session. Many of them are considering legislation -- more than 600 bills in all -- designed to improve patient access to primary care, an issue that has reached epidemic proportions as a result of health care provider shortages in states nationwide.
With the rising tide of chronic disease and our aging population, the demand for primary health care is skyrocketing. Fortunately, there are more than 205,000 nurse practitioners in the United States who are educated, clinically trained and ready to deliver timely, high-quality, cost-effective, comprehensive, patient-centered health care. Yet, many states still don't allow Nurse Practitioners (NPs) to practice to the full scope of their education and clinical training.
As of January 2016, there are 6,359 so-called health professional shortage areas in the United States – reflecting the number of communities nationwide that lack adequate access to primary care providers. In the last 18 months alone, this number has grown by nearly 300 communities according to the Department of Health and Human Service's Health Resources and Services Administration (HRSA).
Despite the increasing demand, there remains a disconnect in many states between the high level of care that NPs are prepared to provide patients and the limited level of care outdated state practice laws allow NPs to deliver. On average NPs have more than six years of academic and clinical preparation. NPs assess patients, order and interpret diagnostic tests, make diagnoses, initiate and manage treatment plans – and prescribe medications. All told, NPs manage some 990 million patient visits per year and have practiced successfully and consistently in primary, acute and specialty settings for over half a century.
Many physician organizations have opposed autonomous practice by NPs, arguing that physician supervision is required to deliver quality care. In some cases, physician interests have secured passage of state laws that prevent NPs from practicing outside of a mileage radius of a physician, or require NPs to maintain a contract with a physician before they can provide care.
The impact of these unnecessary NP practice restrictions on patient care is undeniable: of the ten states with the greatest number of health provider shortage areas, nine are located in reduced practice or restricted practice authority states. While primary care shortages climb, every major study on the subject of NP care over the last 40 years —more than 100—has concluded that NPs' patient health outcomes are as good or better than other providers who provide similar health care services. That is why -- despite the pressure -- states are modernizing their health care licensure laws in favor of the national standard for NP licensure.
Currently, more than 40 percent of the states have adopted full practice authority (FPA) licensure and practice laws which authorize NPs to deliver care without the prerequisite of a regulated relationship with a physician. These states recognize that yesterday's outmoded hierarchical care model cannot meet today's or tomorrow's health care needs. This year, states including Massachusetts, Pennsylvania and North Carolina are considering FPA legislation and with good reason.
Within five years of enacting FPA, the number of NPs in Arizona increased by 52 percent, with a 73 percent increase in their representation in rural counties and 48 percent in urban counties. A recent study by Montana State University confirmed what we already know: NPs are more likely than physicians to practice in rural areas.
Full practice authority does more than improve access, it strengthens health care quality for all. It is no surprise that the United Health Foundation's ranking of the healthiest states in America includes 8 FPA states among the top 10. FPA states have lower hospitalization rates and demonstrated improvements in health outcomes for Medicare and Medicaid patients, according to a study published by the University of Missouri in 2014.
Patients want access to the providers of their choice, and two out of three health consumers support legislation to expand access to the services NPs provide. They want legislators to remove scope of practice barriers -- and organizations from the Institute of Medicine, the Bipartisan Policy Center, National Governors Association, Federal Trade Commission to AARP acknowledge that health care providers working at the top of their education can improve health care delivery.
The time is right to fix the chronic condition of primary care shortages that plague our nation. NPs and passage of full practice authority legislation are the right prescription for addressing America's primary care crisis and delivering transformative 21st century health care.
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