Announcement of Public Workshop, "Examining Health Care Competition" ("Health Care Workshop") Project No. P13-1207
State Practice Restrictions imposed on provider relocation that affects Nurse Practitioners at present, also likely to affect Doctors that sell their practice to a hospital networks in the future. At present, as a Nurse Practitioner, residing in Michigan, and seeking relocation, I have found two things that restrict my ability to compete for jobs in other states that does not occur in other professions. 1 No Central Credentialing Agency. All hiring entities are required to credential new providers. At present I have 6 different entities credentialing me through 6 agencies, before an offer is on the table. Each one of these entities redundantly acquires proof of my degrees, prior employment, and consults with 3-5 references. The costs of redundancy increase the costs of healthcare. The agency that accredited me for my nurse practitioner board certification (ANCC), could be responsible for maintaining a credentialing file on me, with a cost charged to the provider for its maintenance, and for sending it to interested parties. The delay in response of either prior employers or references, generally results in loss of the position applied for. In addition, the inconvenience to the references and employers of having to respond to 6 different requests, each, is asking a bit much. Using a consistent agency, would protect a providers image from inappropriate responses should there be a former hostile employer, as in my case where narcotics diversion was reported to the clinic owner. A provider should have the right to select their credentialing agency, and should also be entitled to a credit report or similar from such agency with the opportunity to correct fallacious information. Allowing potential employers to use any credentialing agency of their choice, scatters my personal identity information all around, placing me at increased risk for identity theft. Not allowing provider input into the selection of the independent credentialing agency, would allow large hospital networks to ruin the reputation of the providers they have bought practices from, restricting their future active competition in the locale they have always worked in as well as in other states . 2 Need for National Licensing (each state does its' own thing at present) Obtaining a nurse practitioner license by endorsement in another state, can take anywhere from the now proposed 5 days in New Mexico (SB 119), to > 8 weeks in Arizona, and other states. National licensing will remove this restriction of where a provider can practice, and ease transition time so that providers can more expeditiously relocate and find employment in other states, and therefore would be able to equally compete for open positions. Since National Provider Identifiers (NPI) are required of most practitioners, this could serve as a national license number. Should the states desire to retain the right to charge fees to research endorsees, they should be charges to access national databases. This way the states will not bemoan the loss of income for requiring multiple licenses of providers but at the same time, will not cause a candidate to suffer endorsement licensure delays costing them the position. Many states under the nursing licensure compact already accept one license from another state that they all have reciprocal agreements with. By the action of the state I reside in, Michigan, we are not part of the nursing licensure compact, making it difficult for Michiganders to equally compete. Each candidate should have as an option on their state license to be placed and monitored in the nursing licensure compact, by requiring the candidate to pay additional fees. Similar programs already exist on Michigan drivers licenses allowing drivers license as a substitute for a passport, by purchasing an 'enhancement' to allow access to Canada and Mexico. These 2 actions, create an arrangement of employer/state servitude and restrict where providers can choose to work.