DNP 840 Topic 4 Discussion Question One
DNP 840 Topic 4 Discussion Question One
What are two bills or laws that influence the doctorally prepared nurse? How do these bills or laws influence doctorally prepared nurses specifically and on nursing practice in general?
Despite the original report in 2010, we still struggle against some of the same barriers. In some states, the battle to practice within the scope-of-practice regulations becomes further impeded by archaic hospital bylaws. Nurse practitioners with the same educational
preparation and national certification may face a host of restrictions when relocating from one state to another, thus limiting their scope of practice (Safriet, 2011). Variations in the scope-of-practice regulations across states have an indirect impact on patient care, as the degree of physician supervision may affect practice opportunities and payer polices for NPs (Yee et al., 2013).
Further research looks promising in regard to health-care costs. One such study in 2013 “was inconclusive for total health-care spending” (Martsolf et al., 2015). However, it did show that prices appear to go down slightly while utilization increases due to improvements in access to care. Spending in nine states that grant NPs full prescriptive authority does seem to increase slightly for some services, such as office visits, but acute coronary syndrome (ACS)-related emergency visits tend to drop.
Nurse practitioner independence might reorient spending toward higher-value services. If, as the studies suggest, full practice authority of NPs leads to more office-based primary care visits and checkups and fewer ACS emergency visits, then value per dollar spent should increase. There is not enough evidence to know the answer definitively. It does appear that restrictive laws could, in some states, force NPs to pay a significant share of practice revenues to their collaborating physicians.
Federal regulations place additional barriers on NP practice despite some small victories. The Balanced Budget Act of 1997 included the Primary Care Health Practitioner Incentive Act, perhaps the most important payment reform to affect NPs. Although the Primary Care Health Practitioner Incentive Act allowed for NPs to bill for services, one of the remaining challenges is the continued existence of the two-level fee structure. Nurse practitioners can receive 100% reimbursement for incident to services, but they cannot do so independently, thereby placing another barrier for the formation of independent practices and access to health care.
Many arguments against full practice cite safety as a concern. Evidence regarding the impact of NPs compared with physicians (MDs) on health-care quality, safety, and effectiveness has been systematically reviewed by Stanik-Hutt et al. (2013). Data from 37 of 27,993 articles published from 1990 to 2009 were summarized into 11 aggregated outcomes. According to the authors, “Outcomes for NPs compared to MDs (or teams without NPs) are comparable or better for all 11 outcomes reviewed”.