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Value-Based Care News

Do Nurse Practitioners Increase Healthcare Spending Rates?

Increasing the scope of practice for nurse practitioners may not have a uniformly positive impact on healthcare spending rates.

By Catherine Sampson

- While the use of independent nurse practitioners (NPs) is often seen as an important way to drive down healthcare spending rates, a new report from researchers at the University of California San Francisco indicates that the positive impact of NPs on care costs may be minimal.

Increasing the scope of practice for nurse practitioners can lead to an increase in total costs.

Granting NPs independent scope of practice was associated with a small increase in healthcare costs of between one and four percent.

This slight increase was attributed to the fact that more patients were able to obtain access to care by getting certain types of healthcare services from nurse practitioners rather than physicians.

At the same time, researchers noticed that there was a small decrease between one and four percent in prices for primary care services in states that implemented independent nurse practitioner scope of practice laws between 2008 and 2012 compared to states that did not implement these regulations.

In sum, on one hand, total costs went up slightly. On the other hand, the price of primary care services decreased as a result of regulation because nurse practitioners are typically less expensive than doctors. Overall, researchers noted that the impacts on prices and costs were still limited.

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If independent scopes of practice increase the number of nurse practitioners, prices should go down, researchers argued. In states with independent scope of practice, nurse practitioners might provide a greater share of services. This leads to reduced costs because nurse practitioners are typically less expensive than physicians.

Overall, researchers came to the conclusion that independent nurse practitioner scope of practice can potentially lead to a reduction in prices as a result of increased nurse practitioner supply as well as changes in service provisions between practitioner and physicians.

Additionally, the report, which uses data from the Health Care Cost Institute, observed that the passage of a new law that allows nurse practitioners to prescribe medication did not actually lead to changes in medication adherence.

The researchers hypothesized that nurse practitioner scope of practice still might be important for other patient or provider behaviors or outcomes. Previous research implied that independent scope of practice for nurse practitioners can positively impact healthcare outcomes. However, medication adherence is affected by various factors and might not be as responsive to changes in regulation.

States that were able to successfully introduce independent nurse practitioners scope of practice were able to increase the amount of routine check-ups. They were also able to lower the body mass index and “achieve a lower rate of ER admission for conditions that are sensitive to ambulatory care,” researchers said.

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Nurse practitioners scope of practice laws specifically strive to create a legal framework that controls the delivery of medical services that nurses provide. According to the American Association of Nurse Practitioners, nurse practice laws and regulations vary from state to state.

State scope of practice regulations are supposed to determine whether a physician is required to be involved in the nurse practitioner’s care of patients. Also, nurse practitioner’s ability to diagnose illness and prescribe medications is regulated as a result of these laws.

“Understanding how these laws affect outcomes, costs of care and utilization is important for the implementation of the ACA [Accountable Care Act] because they could directly affect access to care services and medications, thereby potentially impact the quality and cost of health care,” the report said.

The researchers believed that states should carefully consider the potential impacts that changing nurse practitioners scope of practice have on access to care, prices and health outcomes.

Other researchers, such as experts from George Mason University, share this viewpoint as well. “State policymakers (and taxpayers) interested in reducing the cost of care for citizens on Medicaid should consider relaxing restrictions on nurse practitioners and physician assistants,” according to a study from George Mason University.

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“The body of research on this topic suggests that allowing nurse practitioners and physician assistants broader scope of practice has little impact on the quality of care delivered, increases access to health care, and also potentially reduces the cost of providing healthcare to patients,” the study said.

By 2012, 18 states had set up independent scope of practice for nurse practitioners, researchers said.

Between 2008 to 2012, researchers noted that the following five states implemented independent scope of practice laws: Hawaii, Colorado, Nevada, Vermont and Maryland.  They examined data from these states as well as data from states that did not implement independent scope of practice laws.

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