Health Affairs

Nurse Practitioners And Primary Care

Bethesda, MD --A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines policy proposals that would allow nurse practitioners to practice to their full potential--and the extent to which the medical profession, policy makers, and patients are supportive of that effort.

Currently, about 55 million Americans live in areas with shortages of primary health professionals, a situation that may grow worse as the Affordable Care Act increases access to insurance coverage and the population ages and chronic illness increases in prevalence.

In nineteen US jurisdictions (eighteen states plus the District of Columbia), nurse practitioners--registered nurses who have also completed a postgraduate nursing degree--are allowed to diagnose and treat patients and prescribe medications without a physician's involvement. These practitioners and their capabilities help to fill the void left by the current shortage in some parts of the country of primary care physicians. There is also a growing body of research showing that patients value access to consistent care from one particular provider, whether a nurse or a physician.

• What's the debate? The brief discusses the main bone of contention: stringent "scope-of-practice" laws, which require nurse practitioners in thirty-two states to practice care under supervision of a physician, and thus restrict them from practicing on their own. It examines the current opposition by some physician groups to expanding nurse practitioners' roles and also sheds light on the 2010 Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, which recommends changes of state and federal laws to allow nurse practitioners to practice to the full extent of their education and training.
  
  
• What are the financial considerations? At the present time, Medicare reimbursements to nurse practitioners for the same services are 85 percent of those made to physicians. Although the Medicare Payment Advisory Commission found that there was no analytic foundation for this difference, revising the payment structure could increase overall Medicare spending if increased payment rates are not offset by savings in other areas.
  
  
• What's next? At the moment, many state legislatures are considering changes to licensure and scope-of-practice requirements for nurse practitioners. The lawmakers will have to weigh concerns from physicians about patient safety to discern whether those concerns have any validity--the evidence to date suggests that they don't--or primarily represent a concern about competition.

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at www.healthaffairs.org. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.