Study: Expand nurses' scope of practice to increase care

Reforming team-based payments and expanding advanced practice nurses’ (APNs) scope-of-practice could help increase primary care access in the United States, according to a policy analysis released in December from the nonprofit, nonpartisan National Institute for Health Care Reform.

Most efforts to improve primary care access focus on increasing the practitioner supply through training, educational loan forgiveness or scholarships, credentialing, and higher payment rates, according to the analysis written by authors Emily R. Carrier, MD, MSCI, senior researcher; Tracy Yee, PhD; and Lucy Stark, a health research assistant, from the Center for Studying Health System Change.

“While existing, longer-term efforts to boost the primary care workforce are necessary, they may be insufficient for some time because a meaningful increase in practitioners will take decades,” the authors wrote.

The Health Resources and Services Administration of the U.S. Department of Health and Human Services estimates an additional 17,722 primary care practitioners are already needed in shortage areas to meet a nationwide target of one provider for every 2,000 patients, the report says.

APNs typically have at least master’s degree in nursing.

The policy analysis examines two other possible approaches to increasing primary care capacity: Expanding state scope-of-practice policies and adopting payment policies to boost productivity through team-based care.

The authors cite capitated payments or case management models that provide additional payments for care management, which may encourage the development of teams that share care responsibilities. These teams potentially can deliver more primary care to more patients than can a physician working alone, but this model may reduce physician satisfaction, and the authors found conflicting evidence that teams increase efficiency.

The authors also suggest broadening state scope-of-practice laws for APNs to expand primary care capacity more rapidly, given that training new primary care physicians takes longer.

Changing these scope-of-practice laws, however, can be highly controversial and time-consuming. Just last year, the Texas legislature rejected several bills opposed by the Texas Academy of Family Physicians that would have granted independent diagnosis and prescriptive authority to advanced practice registered nurses.

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