💫New research💫 I'm excited to share my paper on the effects of nurse practitioner scope of practice laws in primary care, newly published in Health Economics. Check it out here: doi.org/10.1002/hec.44…

Nurse practitioners (NPs) are an integral, rapidly-growing part of the primary care workforce and are shown to provide safe, high-quality, & cost-effective primary care.

However, in many states, scope of practice (SOP) laws & regs restrict NPs from practicing to the full extent of their training & ability, requiring them to practice with physician oversight.

I examine the effects of relaxing SOP laws (i.e., removing requirements for physician oversight) on NPs’ day-to-day autonomy, workload & allocation of patients to NPs vs. physicians, & the provision of low-value services at primary care practices.

Historically, these things have been hard to study b/c NP-provided services are often billed under physician ID’s (i.e., “incident-to billing”), meaning they are attributed to physicians rather than NPs in traditional claims datasets (e.g., Medicare claims).

I use claims & EHR data from @athenahealth that circumvent this issue by recording both the rendering & billing clinicians for all services, enabling a novel, granular look at NP-provided services at a national sample of primary care practices from 2011-2017.

I find evidence that NPs have more autonomy after SOP restrictions are removed – specifically, NPs bill independently, rather than incident-to a supervising physician, more often.

I also find no evidence that removing SOP restrictions changes patient volume, the complexity of patients that NPs see, nor how often low-value services are provided.

Independent billing by NPs is cost-saving, since NP services are billed at ~85% of the physician rate (vs. 100% when services are billed incident-to a supervision physician), & it increases transparency of claims data by reflecting who actually provided the care.

What does this mean? Many others have found no evidence that removing SOP restrictions adversely affects patient health outcomes…

…My findings further suggest that removing SOP restrictions enables NPs to practice with more autonomy, without otherwise affecting the actual delivery of care at primary care practices.

A key priority for future research will be to examine the longer-term effects of SOP laws on primary care access, quality, & costs, as I was limited to a relatively short “post” period in most states.

MANY thanks to my dissertation advisors @EGolberstein & @HNeprash & committee members @Ateevm & @abrah042; to @athenahealth for their amazing data; to @AHRQNews & @urbaninstitute for their instrumental support; & to many others for their helpful feedback & suggestions!💫


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