Announcement of Public Workshop, "Examining Health Care Competition" ("Health Care Workshop") Project No. P13-1207
I am a student at Columbia University. However, this comment to the Federal Trade Commission reflects my own personal opinions. This is not representative of the views of Columbia University or the Trustees of Columbia University, Retail clinics (RTCs), largely staffed by nurse practitioners (NPs), treat a narrowly defined scope of conditions and represent a promising model for providing cost-effective and quality care. The number of RTCs is expected to grow within the coming years. Health policy experts have suggested that RTCs may be able to ease the effects of the shortage of primary care doctors that is expected to worsen with the implementation of the Affordable Care Act (ACA). Yet, the geographic distribution of RTCs does not reflect this need. State regulations that limit the operation of RTCs and competition may be at fault. Three methods of RTC regulations are restrictive scope of guidelines for NPs, bans on the corporate practice of medicine, and bans on the establishment of RTCs in places where tobacco and alcohol are sold. Easing scope of practice regulations for NPs represents the best method of addressing this problem.States should broaden their scope of practice regulations for NPs. Scope of practice regulations can be defined broadly to include prescriptive authority, physician oversight, conditions nurse practitioners can treat, as well as compensation frameworks within Medicare and Medicaid. Scope of practice guidelines vary widely among states. Currently, 24 states allow nurse practitioners to practice independently while other states require nurse practitioners to be supervised by a physician. Many of the current scope of practice restrictions are outdated and have come under scrutiny. An Institute of Medicine (IOM) panel recommended expanding the scope of practice of nurse practitioners to reflect the breadth of their medical knowledge. The IOM stated that various state "regimes" restrict advanced practice of nurses "for reasons that are not related to their ability, education or training, or safety concerns, but to the political decisions of the state in which they work." Furthermore, to address this shortage of primary care physicians, the National Governors Associations recommended in 2012 that states broaden their scope of practice for nurse practitioners. Lastly, in March 2014, the FTC recently published a policy paper on scope of practice guidelines and warned state regulators that leading health policy experts agree that an expansion of scope of practice for nurse practitioners, broadly defined above, is central to addressing a scarcity of primary care doctors. The FTC concurs, "Based on our extensive knowledge of health care markets, economic principles, and competition theory, the FTC staff reach the same conclusion: expanded APRN scope of practice is good for competition and American consumers." Indeed, research indicates that utilization of NPs to the scope of their ability would not only mitigate the shortage, but would also reduce state expenses on health care significantly. An expansion would lower the cost of market entry for RTCs and could encourage proliferation of RTCs in geographically underserved areas. A unique opportunity exists for RTCs to assume more responsibility for providing primary health care in the era of the ACA and burgeoning health care costs. Legislators must act to ease restrictions on NPs and allow them to treat more complex conditions, without burdensome oversight requirements so that their constituents can benefit, too.