Scope-of-practice laws put patients in the crosshairs

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Allowing nurses to do primary care reduced costs for diabetes treatment 20% in urban areas and about 10% in rural areas

New research appears to have found the proverbial "free lunch" economists have long been searching for.

States that grant nurse practitioners "full practice authority" -- that authorize them to provide care independently, without the supervision of a physician or other provider -- reduce total healthcare costs for people with diabetes by 20% in urban areas and drive down rural usage of advanced medical services by people with diabetes by about 10%.

And there doesn't appear to be a trade-off. The study found that full practice authority had no effect on primary care claims, the number of high blood-sugar tests, or diabetic debridements -- common procedures for people with the condition.

In other words, states can dramatically reduce healthcare costs without sacrificing the quality of care simply by deregulating their healthcare labor markets. And it doesn't cost a dime of taxpayer money.

What are they waiting for? Nearly half of states still maintain some level of restriction on the "scope of practice" for nurse practitioners.

Obviously, some advanced diagnostic and treatment decisions and procedures can only be handled by doctors. But nurse practitioners undergo rigorous training programs that enable them to provide most primary care services -- and identify when a consultation with an M.D. is advisable. They're just as adept as doctors at diagnosing common diseases and prescribing widely used drugs.

In fact, this new study on people with diabetes is only the latest to show that allowing qualified nurse practitioners full practice authority results in better care for patients -- at lower cost.

Alterio Felines

Physician time is limited and they are in short supply

A 2018 study published in the journal Medical Care found that Medicare enrollees treated by nurse practitioners had lower rates of hospital admissions, readmissions, and inappropriate emergency department use compared with those treated by physicians. The study also found that the cost of nurse practitioner care was between 11% and 29% lower than care provided by doctors, even after controlling for patients' severity of illness and other factors.

Perhaps that's because physician time is limited. Doctors spend 4.5 hours a day on electronic medical records, according to a 2022 study. They may be inclined to spend their scarce clinical time on patients in dire need of care. That could give them less time for patients with chronic conditions like Type 2 diabetes, whose management requires careful monitoring over time.

Doctors are also in short supply. Last year, nearly two-thirds of rural areas faced a shortage of primary care physicians, according to a report published by the federal Health Resources and Services Administration. More than 15% of Americans -- about 46 million people -- live in rural areas. But only 10% of doctors practice in these communities.

Nurse practitioners can close much of this gap. Allowing them to do so would also let doctors reserve more of their time for the complex clinical situations they have been uniquely trained for.

There's no good reason to preserve outmoded scope-of-practice laws that artificially constrain the supply of health care -- and hurt patients and drive up costs in the process. Nurse practitioners are highly trained. It's time to let them practice to the full extent of their capabilities.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. This piece originally appeared in the Richmond Times-Dispatch.