FTC in Support of NP Independent Practice

Have you been paying attention to the latest legislative issues affecting nurse practitioners? If not, there’s been a buzz recently about laws regulating nurse practitioner’s ability to practice. As our country faces an aging population and drastic increases in the number of medically insured, we are concurrently experiencing a primary care shortage. Naturally, nurse practitioners have been named as one solution to the problem.

While NPs are perfectly poised to step in and help care for patients in this primary care debacle, some legislators aren’t so sure. Many states prohibit nurse practitioners from practicing independently and don’t plan to change these regulations. Most commonly, they cite patient safety concerns as the rationale. Debate among nursing organizations, physician organizations, and legislators themselves are becoming a bit rote, passing predictable banter back and forth. Last month, however, the Federal Trade Commission released a publication, Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses giving a fresh take on the NP independent practice issue.

Charged with the mission of “preventing unfair methods of competition and unfair or deceptive acts or practices in or affecting commerce”, the Federal Trade Commission takes an economic view of the nurse practitioner independence debate. “Competition is at the core of America’s economy, and vigorous competition among sellers in an open marketplace gives consumers the benefits of lower prices, higher quality products and services, and greater innovation” says the FTC. By limiting nurse practitioner’s scope of practice, competition in the healthcare sector, in this case among medical providers, is compromised the FTC argues. 

When states require that nurse practitioners be supervised by a physician, benefits of competition in the healthcare economy are lost. Collaborative practice agreements required by many states drive up the cost of healthcare. Nurse practitioners must pay physicians for the commitment to supervise their practice which rarely confers much value. These added costs are then passed on to patients and insurers. By removing physician supervision requirements, “the regulatory costs of APRN service provision are lowered” says the FTC.

The FTC also points out that “relaxing the regulatory limits on APRN scope of practice will tend to expand the supply of providers who are willing and able to offer those services at a given price”.  A greater supply of medical providers willing and able to freely offer primary care services keeps costs in check. Allowing nurse practitioners to practice independently not only increases supply of providers but also decreases the cost of overhead for a practicing NP.  Cumulatively, this lowers cost of care for patients. 

By bringing the NP independent practice issue down to basic economics, the FTC makes a strong argument. The publication also addresses commonly cited patient safety concerns, but their fiscal stance puts a fresh twist on the independent practice debate.

If you haven’t read the FTC’s Policy Perspective on Competition and the Regulation of Nurse Practitioners, you should. It makes a surprisingly quick read and will give you insight into how your work as an individual nurse practitioner fits into the healthcare system as a whole.


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