The state’s health care lag due to limitations on the authority of the nurse | News, Sports, Work


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Pennsylvania is lagging behind its neighbors, and deregulating some health services could give the commonwealth’s residents better access to treatment, a new analysis claims.

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

Full practice authority, where health workers can provide services they have been trained to do without a doctor’s supervision, has been touted as a way to tackle 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,” noted in the report.

If the Commonwealth were to copy Maryland’s approach of granting full powers to practice, the Commonwealth Foundation felt that “will increase the number of certified nurse midwives in Pennsylvania by approximately 26.7% and the number of NPs by 29.5%.”

This would mean an additional 1,800 patients treated by nurse practitioners each week. If all nurse practitioners then focused on primary care, the full scope of practice could “eliminate almost half of” the health care shortage areas of the state.

As evidence, the Commonwealth Foundation pointed to better health outcomes in Maryland’s border counties compared to Pennsylvania. After Maryland approved full practice authority, the density of nurse practitioners increased and the gap between Maryland and Pennsylvania doubled.

“Laws and regulations matter,” said Elizabeth Stell, director of policy analysis at the Commonwealth Foundation. “Maryland’s policies that grant full practice authority to nurses and nurse-midwives benefit health care consumers by providing greater access and better health care outcomes.” Pennsylvania and other states can address the shortage of primary care physicians by allowing highly qualified advanced practice registered nurses to do the work they were trained to do.

Pennsylvania has “reduced practice” model for nurse practitioners that requires them to have collaborative practice agreements with at least two physicians. They can diagnose patients, order tests, develop treatment plans, and provide other health care services, but the practice agreement determines what they can do. Physician supervision is then required to consult with nurse practitioners and review patient records.

Advocates of deregulation argue that such requirements restrict access to health care 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 Pennsylvania Association of Hospitals and Health Systems, also support greater authority for nurse practitioners.

“HAP maintains full nurse practitioner and certified nurse midwifery credentials,” HAP Vice President of Strategic Communications Chris Daley said. “Empowering advanced practice professionals to take on an expanded role means more talented healthcare providers will be caring for patients. Especially during a time of national health care workforce shortages, we must promote flexibility that increases the number of providers who care for Pennsylvanians and improves care.

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

“Health insurance, whether taxpayer-funded or employer-funded, is not the same as health care,” 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 must allow full NP practice immediately.”

Nurse practitioners have lower reimbursement rates for government-funded programs like Medicaid, which is “a key driver of cost savings” for nurse practitioners compared to doctor visits, Stele noted. Preventive medicine also matters where catching a problem early as a minor one avoids the cost of treating a problem when it is serious.

Empowering health workers can also be key to attracting more workers. In a HAP report on workforce challenges, the biggest complaint for hospitals is finding skilled workers, along with wage pressures. Letting more nurse practitioners work independently could fill some gaps in Pennsylvania health care while making the system more cost-effective.

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