FTC Staff: Proposed Missouri Legislation May Reduce Patient Access to Pain Management Services and Increase Prices

Federal Trade Commission staff, in response to a request from Missouri State Representative Jeanne Kirkton, stated that a bill proposed in the Missouri legislature to regulate providers of pain management services contains restrictions that are likely to raise costs, limit access, and reduce choices for Missouri patients.

Missouri House Bill 1399 would allow only physicians to treat acute and chronic pain with injections around the spine or spinal cord that are guided by imaging technology, such as ultrasound or fluoroscopy. The prohibition would apply to certified registered nurse anesthetists (CRNAs), who are advanced practice nurses with specialized training in anesthesia and pain treatment. The bill would prohibit CRNAs from providing some treatments that they currently provide to patients.

"In some areas of Missouri, no alternative providers, such as anesthesiologists or board-certified physician pain specialists, appear to be available," the FTC staff comment stated.
"Shortages of physicians in Missouri exist now and are projected to increase. By restricting the provision of services by CRNAs, the Bill could exacerbate problems of access to care, especially for rural and other underserved populations. It may also impede price and non-price competition among providers of pain management services and increase costs to Missouri citizens."

The FTC staff comment also stated, "Higher out-of-pocket prices, more limited hours, and reduced distribution of services throughout the state all may tend to reduce access to pain treatment," and expressed concern that restrictions on CRNAs "may limit not only physician-CRNA collaborations, but also the ability of health care providers to develop, test, and implement the most efficient teams of pain management professionals."

The staff comment recommended that the Missouri House of Representatives "examine whether the broad prohibition in HB 1399 is necessary for patient safety. . . . In particular, we recommend that you investigate whether there is evidence that current CRNA practice is harmful to patients and, if so, whether the Bill is tailored to address those health and safety concerns."

The Commission vote approving the staff comment was 4-0. It was sent to Missouri State Representative Jeanne Kirkton, on March 27, 2012. A copy of the letter can be found on the FTC's website and as a link to this press release. (FTC File No. V120002; the staff contact is Daniel J. Gilman, Office of Policy Planning, 202-326-3136.)