Jun 21, 2018

Scope-of-Practice Restrictions an Impediment to Lower Health Care Costs

Post by Freedom Partners

Why is health care so expensive in the United States? Our country allocates more of its gross domestic product to health care than any other developed nation. So, why are Americans getting less value for such a massive investment?

A study by the Brookings Institution found that one of the biggest drivers of sky-high costs in health care is the lack of competition. Legal barriers, like state-imposed scope-of-practice restrictions, limit productivity levels of health care professionals, leaving consumers with fewer options and unaffordable costs. They restrict the duties some practitioners can perform, even if they are qualified to do more.

What Are Scope-of-Practice Laws and Why Do They Exist?

SOP restrictions limit the ability of advanced health care professionals, like nurse practitioners and physician assistants, to practice on the level for which they were trained. Levels of restriction vary by state, but generally they:

  • Require unnecessary supervision agreements.
  • Require multiple practitioners to collaborate on duties that may not require that many people.
  • Forbid advanced practice providers from giving out prescriptions, despite being trained to do so.
  • Require an arbitrary ratio of advanced practice provides to physicians.

These laws are determined by state legislatures, often influenced by information given by practitioner advocacy groups. But, as the study explains, that information is often based on two common misperceptions about SOP regulations:

  1. Physicians would lose, and advanced practice registered nurses would gain, if SOP barriers were lifted.
  2. SOP restrictions are necessary to protect the public health.

“Research indicates that the capacity of the health care system can expand, benefiting a wide range of stakeholders,” the study says, discrediting the first myth. “The academic research shows no difference in a variety of health outcomes when comparing fully authorized SOP to restrictive SOP laws,” it continues, addressing the second.

SOP limits create artificial barriers and hurt employment and mobility of resources while costing consumers more money. Why not lower them?

Benefits of No Barriers

Lowering SOP barriers would allow practitioners to work to their full ability, helping patients to receive care at costs they can actually afford.

Increasing efficiency and productivity — at a cost equal to or less than current cost — could provide much-needed relief for patients paying high deductibles. Medicare enrollees could see a savings increase. Patients would pay less for services.

Lower transaction and overall costs would also be made possible, research shows. Offices using advanced practice providers more regularly saw lower labor costs. Another recent study found that lowering restrictions on nurse practitioners working in emergency rooms would result in an estimated national savings of $543 million.

Facilities could hire more practitioners. New facilities could open their doors to serve more of the public faster. And, with reduced administrative duties, providers could have more time to spend one-on-one with patients.

The list goes on.

All these benefits can’t be achieved in one fell swoop, however. Since state laws determine scope of practice, they vary widely. A new report, “The US Health Provider Workforce” by the Mercatus Center gives the landscape:

“In the battle over scope of practice, there is a modest trend toward expanded roles for [nurse practitioners] and [physician assistants]. Geographically, much of the western United States plus most of New England allow NPs a full scope of practice, meaning they can prescribe, diagnose, and treat patients without physician oversight. Parts of the Atlantic coast and Midwest allow a reduced scope of practice, meaning [nurse practitioners] need physician oversight to prescribe medications. The remainder of the United States, roughly the Southeast plus Texas and California, have the most restrictive practice laws.”

State by state, legislators should fully authorize advanced practice providers to practice on the level that their education, training and experience allows them.

Americans deserve the best-quality health care possible for the best-possible price. SOP restrictions are unnecessary impediment.

Policymakers should support proposals that will increase efficiency, encourage competition and empower health care providers to serve patients to the best of their abilities.