Report: Pennsylvania lags in health care due to restrictions on nurse authority

Pennsylvania is out of step with its neighbors and deregulating some health care services could give residents of the commonwealth better access to treatment, a new analysis argues.

The Commonwealth Foundation released a report arguing that Maryland’s effort to grant nurse practitioners full practice authority is a model for Pennsylvania.

Full practice authority, wherein health workers can provide services they were trained for without the oversight of a physician, has been heralded as a way to address high costs and worker shortages.

In Pennsylvania, however, nurse practitioners struggle to work independently.

“Pennsylvania has some of the most restrictive laws governing advanced practice registered nurses,” the report noted.

Were the commonwealth to copy Maryland’s approach of granting full practice authority, the Commonwealth Foundation estimated that it “would increase the number of certified nurse midwives in Pennsylvania by an estimated 26.7%, and the number of NPs by 29.5%.”

That would translate into an extra 1,800 patients getting treated by nurse practitioners every week. If all nurse practitioners would then focus on primary care, full practice authority could “eliminate nearly half of” the state’s health care shortage areas.

For evidence, the Commonwealth Foundation pointed to better health care outcomes in Maryland’s border counties compared to Pennsylvania. After Maryland approved full practice authority, its nurse practitioner density grew and the gap between Maryland and Pennsylvania doubled.

“Laws and regulations matter,” said Elizabeth Stelle, director of policy analysis at the Commonwealth Foundation. “Maryland policies that give full practice authority to nurse practitioners and nurse midwives benefit health care consumers, providing greater access and better health care outcomes. Pennsylvania and other states can address primary care physician shortages by allowing highly trained advanced practice registered nurses to do the jobs they were trained to do.”

Pennsylvania has a “reduced practice” model for nurse practitioners, which requires them to have collaborative practice agreements with at least two doctors. They can diagnose patients, order tests, develop treatment plans, and deliver other health services, but a practice agreement determines what they can do. Doctor oversight is then required to consult with the nurse practitioners and review patient records as well.

Advocates for deregulation argue that such requirements limit health care availability without reason, given that NPs are trained to provide health care. Allowing them more independence, they say, could expand access and lower costs.

Other organizations, such as the Hospital and Healthsystem Association of Pennsylvania, also support greater nurse practitioner practice authority.

“HAP supports full practice authority for nurse practitioners and certified nurse midwives,” HAP Vice President of Strategic Communication Chris Daley said. “Empowering advanced practice professionals to take on an expanded role means more talented health care providers will be caring for patients. Especially during a national health care workforce shortage, we must promote flexibility that increases the number of providers caring for Pennsylvanians and improving care.”

The importance of nurse practitioners is in having more health care workers closer to underserved populations, the Commonwealth Foundation argued.

“Health insurance, whether it is funded by taxpayers or an employer, is not the same as health care,” Stelle said. “An insurance card is no guarantee of convenient access to providers who can take the time to understand your health care needs. If we are serious about convenient and affordable health care for all Pennsylvanians we should allow full practice for NPs immediately.”

Nurse practitioners have lower reimbursement rates for government-funded programs such as Medicaid, which is the “major driver of the cost savings” for nurse practitioners compared to doctor visits, Stelle noted. Preventative medicine also matters, when catching a problem early as minor avoids the cost of treating a problem when it’s major.

Giving more authority to health care workers could be key in attracting more workers, too. In a HAP report on workforce challenges, the top complaint for hospitals was finding qualified workers, along with wage pressures. Letting more nurse practitioners work independently could fill some health care gaps in Pennsylvania while making the system more cost-efficient.

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