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OP-ED | Easing Restrictions on Nurse Practitioners Will Improve Access to Care

by Nora Duncan, State Director, AARP CT | Apr 17, 2014 11:28am
(4) Comments | Commenting has expired
Posted to: Opinion

With the implementation of the Affordable Care Act and the expansion of Medicaid, more Connecticut residents than ever before have access to some form of health insurance. But insurance coverage doesn’t always guarantee access to care. By passing Senate Bill 36, Connecticut lawmakers can ensure that more Connecticut residents have access to the care they need.

Senate Bill 36 will allow advanced practice registered nurses (APRNs) to practice to the full extent of their education and training after three years of working in collaboration with a physician. The legislation will improve access to care and help hold down rising health care costs by removing outdated barriers, such as burdensome contractual agreements with physicians, that prevent nurse practitioners from providing care to consumers. These barriers often delay care to consumers, especially in rural and urban underserved areas where few physicians are available to enter into these agreements with APRNs. And when care is delayed it not only hurts consumers, it also places added stress on family caregivers, who all too often are overwhelmed with bearing the brunt of providing and overseeing the care of a loved one. It can also add unnecessary costs by requiring payments to doctors for collaboration and take precious time away from patient care.

Nurse practitioners are educated and trained to provide high-quality primary health care. They diagnose and manage patients’ care, prescribe medications and refer patients to specialists. By removing unnecessary supervision provisions, Senate Bill 36 will open the pipeline of nurse practitioners, ensuring consumer access to primary care clinicians when and where they need one and reducing the wait time for care for both consumers and caregivers. Receiving high-quality care in a timely manner will improve consumers’ quality of life, help contain their health care costs as well as drive down the cost of delivering care. Allowing nurse practitioners to practice without unnecessary restrictions will also create more choices for Connecticut residents when selecting providers.

Some physician groups have expressed concerns about the safety of care delivered by nurse practitioners, but fail to provide any evidence to support their claims. In contrast, the Institute of Medicine and the National Governors Association cite decades of convincing evidence demonstrating that nurse practitioners provide safe, effective care whether or not they are supervised by physicians.

Last month, the Federal Trade Commission released a staff paper urging state legislators and policy makers to be mindful when evaluating proposals that limit access to care provided by APRNs. The paper found that “mandatory physician supervision and collaborative practice agreement requirements are likely to impede competition among health care providers and restrict APRNs’ ability to practice independently, leading to decreased access to health care services, higher health care costs, reduced quality of care, and less innovation in health care delivery.”

Across the country, 18 states and the District of Columbia allow APRNs to practice without being contractually tied to a physician. Kentucky will join those states in mid-July, when the legislation they enacted in February takes effect. Thirteen additional states are considering legislation this session to ease restrictions and improve access to care.

AARP Connecticut is deeply appreciative of the primary care and chronic care management provided by all clinicians. We need to be certain, however, that our members and all health care consumers can access a primary care provider when and where they need one. Senate Bill 36 would ensure such access to care. This is a rare opportunity where all evidence points to a pragmatic and cost-effective solution to improving health care. We congratulate the state Senate for advancing S.B. 36 in a bipartisan vote and encourage the House to send this bill to the governor this session.

Nora Duncan is AARP Connecticut’s state director.

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(4) Comments

posted by: Kathy Lauretano | April 18, 2014  5:47pm

Nice sentiments but the reality is we are losing doctors at a frightening rate and it is going to get worse with Obamacare. That is why the term “primary care provider” has become fashionable. It lumps nurse practitioners, nurses and doctors all under one nice sounding umbrella, when in fact there is a difference in the level of education, knowledge, diagnostic skill etc.  Most patients want to have a primary care doctor.  Not a primary care nurse or nurse practitioner.The destruction of our medical care system and the dwindling availability of doctors has destroyed the ability of your members and healthcare consumers to readily access the best care possible since they cannot find a primary care physician.  This shift in the reality of who patients can see when ill or injured does not improve health care.  Nor is it pragmatic and cost effective when it prevents them being seen by a fully trained and licensed medical doctor first for diagnosis and prescribed treatment.  The standards of our healthcare are plummeting fast and the reduced availability of hospitals is next.We are reducing our healthcare across the country to the level that in the past was considered an improvement for the Appalachian Mountain poor. A nurse riding the circuit and a local midwife were a blessing, but a doctor almost unheard of.  Today the problem will be the size of the population in need instead of the primitive and long distances to be traveled.

posted by: Stan Muzyk | April 19, 2014  6:36pm

As an outpatient at the West Haven Veteran Center. in the past few years my primary care needs have been serviced exclusively and very adequately by nurse practitioners.  I am in favor of a legislative vote in favor of allowing nurse practitioners to operate in their own offices independently.

posted by: ASTANVET | April 21, 2014  8:48pm

Just a question, if NP’s have the ability to operate their own office, do they not incur the same liability of a doctors office?  or more??? what would be the cost of the rise in malpractice costs for NP’s to operate independent of a Dr’s license?

posted by: Stan Muzyk | April 24, 2014  7:21pm

@ASTANVET: Aren’t you putting the cart in front of the horse? The APRNs have to be approved by our legislature for separate practices before we should really begin exploring the expense cost factors of operating their offices.