MA Health Policy Brief on the NP Workforce Supports Less Restrictive Scope of Practice

The Massachusetts Health Policy Commission (HPC) met virtually on May 6, 2020 and as part of the meeting, the Care Delivery Transformation Committee presented its policy brief on The Nurse Practitioner Workforce and Its Role in the Massachusetts Health Care Delivery System.

Copied below are the major conclusions and recommendations which highlight their ongoing support for permanent lifting of scope of practice restrictions.

• Timely access to high quality care is essential to a well-functioning health system that prioritizes prevention and yields positive health outcomes equitably across the population. This is particularly true during the COVID-19 pandemic where health systems and clinician supply are especially strained by caring simultaneously for COVID-19 patients while also managing the health care needs of other patients (some of whom may be delaying care and exacerbating chronic conditions). 
• In contrast to slow growth in the supply of physician PCPs in recent years, the number of NPs has increased rapidly and is expected to continue to increase nationally and in Massachusetts. NPs have the potential to fill gaps in access to care, as shown in the analyses above, often working in underserved areas and with lower income populations. Importantly, several state administrations (including the Baker-Polito Administration in 2019) have proposed or passed legislation with the goal of increasing primary care spending as a proportion of all spending, most notably Rhode Island, which did so in 2010.
• Removal of SOP restrictions, such as those in Massachusetts, has been shown in other states to improve primary care access and health outcomes (through increasing NP supply and allowing NPs to practice more efficiently and effectively). The HPC has recommended eliminating such restrictions in its annual policy recommendations and reinforces that recommendation here. 
• As previously noted, the Baker-Polito Administration and numerous other states have temporarily suspended certain SOP restrictions in light of the COVID-19 pandemic. Restrictive SOP laws could be particularly disruptive during the COVID-19 (and future possible epidemics or pandemics) in which physicians may become ill or be redeployed for other critical duties and thus unable to comply with supervision requirements, leaving NPs legally unable to practice.
• Additionally, the HPC recommends that payers and providers end the practice of “incident to” billing in accordance with MedPAC’s recent recommendation, echoed by numerous experts.16,26 As shown in this report, the practice of “incident to” billing increases health care costs and yet there is no evidence that it increases quality of care. Furthermore, this billing practice obscures accountability for the visit, which can interfere with payment systems that rely on claims data to establish the identity of the provider, as well as the reporting and tracking of quality and performance measures.
• Enacting these recommendations would enable the Commonwealth to make the fullest possible use of valuable provider resources, allowing providers to work at the top of their licenses and improve the quality and value of care in Massachusetts now and in the future.

CLICK HERE to read the full brief.