Nurse Practitioners Stifled by Practice Laws and Payment Policies

Obamacare has opened the floodgates as 40 million new patients become eligible for medical care. But with more doctors choosing to enter specialties and sub fields, the increasing shortage of general practitioners will force millions of patients toward Nurse Practitioners (NPs). Yet significant barriers still remain that prevent NPs from being utilized to their full potential. 

A new policy brief from the National Institute for Health Care Reform, released in February, found that “scope of practice” laws and payment policies severely limit the increased use of NPs. Some laws restrict an NPs ability to prescribe medications, create treatment plans or work without physician oversight. The patchwork of regulations in 25 states call for varying oversight by a physician for a variety of services. In Arkansas, Arizona, Indiana, Maryland, Massachusetts and Michigan, the study revealed that primary care doctors prohibited many NPs from working in more rural areas—locations where providers are often hard to find. 

Study co-author, Tracy Yee noted that the problem often goes beyond scope of practice laws to payment challenges that inhibit NPs to practice. “A misconception is that the solution or silver bullet for expanding provider capacity would be to liberalize scope of practice regulations,” said Yee. “States need to also look at their Medicaid programs because they have control over that.”

Yee noted that while states like Arizona have independent practice laws, NPs can’t get reimbursed, which limits how long they can practice. A possible way around this would be for Medicaid and private payers to allow NPs to be directly reimbursed or identified as preferred providers.

Dr. Tay Kopanos, VP of governmental affairs for the states at the American Association of Nurse Practitioners, indicated the study’s findings affirm what her organization has encountered. “When nursing organizations would go forward to adopt rules and regulations, there has always been this friction point between medicine and nursing,” said Kopanos. She noted that there have been some changes in scope of practice regulations--12 states currently have bills that would allow NPs more practice authority. 

The other ray of hope is that only a scant few states, including Utah and Arkansas, fail to recognize NPs in their Medicaid program. “I am hopeful that there is an awakening that healthcare isn’t owned by one profession,” Kopanos said. “But it is the strength of multiple disciplines providing care for patients in multiple settings that will be good for patients.”

As Obamacare moves millions more into healthcare, nurse practitioners need to become aware of the rules, regulations and Medicare programs in their state. For the latest news affecting NPs in your state, visit AANP’s Legislation/Regulation site. 

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