States Benefit from Increased Autonomy for Nurses

States that allow Advanced Practice Registered Nurses (APRNs) to practice independently saw an improvement in health outcomes for patients and decreases in costs to Medicare and Medicaid, according to a study by researchers at the Missouri University Sinclair School of Nursing, Nurse.com reports.

The study, “Impact of Nurse Practitioners on Health Outcomes of Medicare and Medicaid Patients,” was published in the November-December issue of Nursing Outlook. Researchers analyzed previous studies with data on Medicare and Medicaid patients and found that states with full practice of nurse practitioners have lower hospitalization rates in all of the groups examined.

An INQRI-funded study, "Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics,” found similar cost savings at retail clinics in states where nurses had more independence. The study, co-led by Joanne Spetz and Stephen Parente, found that visits to nurse-managed retail clinics were associated with lower costs, and the costs were even lower when Nurse Practitioners (NPs) practiced independently. The researchers concluded that eliminating restrictions on NPs’ scope of practice could have a large impact on the cost savings that can be achieved by retail clinics.

Expanding Scope of Practice for NPs could save California nearly $2 Billion

Over the next 10 years, California could improve patients access to health care and save $1.8 billion in medical costs if nurse practitioners (NPs) were allowed to practice to the full extent of their education and training, according to a new report from the Bay Area Council Economic Institute funded by the Robert Wood Johnson Foundation and AARP. INQRI grantee Joanne Spetz contributed to the report.

According to the Council, with 3.3 million more Californians having access to health insurance under the Affordable Care Act, allowing NPs to practice independently from doctors is "one of the most effective steps" the state could take to meet the expected increase in demand for primary care providers, FierceHealthcare reports. Expanding scope of practice would increase the number of NPs practicing by 24 percent and would also allow more currently medically underserved communities to gain access to care.

The report reveals that full practice authority for NPs is associated with lower costs for common procedures and does not decrease quality of care: "In states with limited NP practice authority, the average cost for a preventative care visit can be as much as $16 higher than in states with full practice authority. We estimate scope of practice reform in California would save $1.8 billion in the cost of preventative care visits alone over the first ten years."

• The Council's report is available here.
• A statement on the report from the California Association for Nurse Practitioners is available here.

The INQRI-funded study "Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics” was co-led by Spetz and Stephen Parente.

INQRI in the News

The Healthcare Economist blog provides an analysis of the INQRI-funded study "Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics."

The author notes that allowing Nurse Practitioners (NPs) to practice independently reduces health care costs, compared with requiring supervision by a physician. The study found that “when NPs were allowed to practice independently, the cost savings of retail clinic episodes were even greater than when they could not practice independently.”

The study was co-led by Joanne Spetz and Stephen Parente.

INQRI in the News

HealthLeaders Media highlighted the INQRI program, and the importance of nurses to quality of care, in its recent article “Interdisciplinary Care Starts with Respect for Colleagues.” Managing editor Alexandra Wilson Pecci writes that it is time to upend the hospital hierarchy, where power starts with physicians and flows down to nurses, particularly within interdisciplinary care. “Instead of this top-down hierarchy, I believe all branches of health care should function as equals,” Pecci said. “The responsibilities of nurses, physicians, pharmacists, and other members of the clinical care team are certainly different, but none is more or less important to patient care. All members of the team are needed for their own, particular skills.”

The new INQRI-funded study “Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics,” continues to receive media coverage, most recently on the Reuters Health Globalpost website.  The study is led by Joanne Spetz and Stephen Parente.

INQRI In the News

A new INQRI-funded study, which shows that retail clinics can reduce costs when Nurse Practioners (NPs) practice independently, is making headlines. The study, led by Joanne Spetz and Stephen Parente is in current issue of Health Affairs.

News media and blog coverage has included the Albuquerque Business Journal, which notes that New Mexico allows NPs autonomous practice. The study was also covered in The Lund Report and The Incidental Economist.

Additionally, the INQRI-coordinated study to examine whether public reporting laws are effective in encouraging hospitals to improve nurse staffing levels and improving patient outcomes is also receiving attention, recently being featured on News-Line.com.

INQRI Study Shows Retail Clinics are Convenient, Cost-Effective, Provide Quality Care

A new INQRI-funded study shows that retail clinics can reduce costs when Nurse Practioners (NPs) are allowed to practice independently, potentially by nearly $472 million or more in 2015.

Retail clinics are an increasingly popular option for people who need diagnosis and treatment for common, non-life-threatening conditions. NPs are the primary care providers in these clinics, which are located in a range of settings, including pharmacies, grocery stores and “big box” stores. First established in 2000, there are now more than 1,200 retail clinics nationwide.

The research team for the study was led by Joanne Spetz, professor at the Institute for Health Policy Studies and associate director for Research Strategy at the Center for the Health Professions at the University of California, San Francisco, and Stephen Parente, director of the Medical Industry Leadership Institute at the Carlson School of Business, University of Minnesota. The team compared claims data over a two-week period for 9,503 patients who visited retail and non-retail clinics from 2004 to 2007. Researchers compared costs in states that require NPs to be supervised by or collaborate with physicians, states that allow NPs to practice independently but not prescribe, and states in which NPs are allowed to practice and prescribe independently. The study is in the November issue of Health Affairs.

The researchers found that insurance claims over a two-week period were lower following retail clinic patient visits than after visits to other settings, such as doctor’s offices and emergency departments, for the same conditions. Insurance expenditures for retail patient visits were even lower in states that allow NPs to practice independently. Payments for prescriptions were slightly higher in states where NPs are allowed to prescribe, but that increase in cost was mitigated by the lower cost of an NP practicing independently.

Adjusted to 2013 dollars, the average two-week cost for non-retail clinic visits was $704, for retail clinic visits in states with no NP independence it was $543, and for retail clinic visits in states where NPs have independence in practice, it was $484. The average cost for retail clinic visits in states where NPs had independence in practice and prescribing was $509.

Retail clinics are projected to account for about 10 percent of outpatient primary care visits by 2015. The study’s authors projected that the cost savings realized from using retail clinics at that level would be $2.2 million. The savings would be increased by $810 million if all states allowed NPs to practice independently and by $472 million if NPs were allowed to practice and prescribe independently.

Read the study.