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Nurse Practitioners to Meet Increased Demand for Primary Care

Dec. 21, 2012 – 2:38 p.m.

Governors See Larger Role for Nurse Practitioners

By Jane Norman, CQ HealthBeat Associate Editor

Nurse practitioners could play a more prominent role in health care delivery and states should consider easing laws under which they practice, recommends a new report by the National Governors Association.

The implementation of the health care law (PL 111-148, PL 111-152) in 2014 and its coverage of uninsured people, as well as the aging of the population, will mean an increased need for primary care providers. The NGA said in its report that one way to accomplish that is by fully using the services of nurse practitioners.

“Research suggests that nurse practitioners can perform many primary care services as well as physicians do and achieve equal or higher patient satisfaction rates among their patients,” says the NGA report from its Center for Best Health Practices.

The debate is over what are known as scope-of-practice laws in the states, which define who can practice what type of medicine through licenses and certification. The NGA said its research found wide variation in state laws regarding nurse practitioners, including the extent to which they are allowed to prescribe drugs, operate independently of physicians, and bill insurers and Medicaid.

Some 16 states and the District of Columbia allow nurse practitioners to practice independently of a physician and to diagnose, treat and refer patients as well as prescribe medication. The remaining states require some form of physician involvement, but how much varies from state to state, said the report.

“To better meet the nation’s current and growing need for primary care providers, states may want to consider easing their scope of practice restrictions and modifying their reimbursement policies to encourage greater nurse practitioner involvement in the provision of primary care,” the report says.

It notes that in 2010 the Institute of Medicine criticized states for preventing nurse practitioners from practicing to the full extent of their training. Partly as a result, in 2011 Kaiser Permanente began to discuss advancing nurse practitioners from team members to clinic leaders in certain geographic areas.

A Colorado prenatal clinic was selected to pilot that model, and while it’s too early to compare costs with clinics led by physicians, in other measures the two are indistinguishable, the report says. Kaiser Permanente is planning to expand the nurse-led model.

The IOM report also said that some physician groups were concerned about extending state laws to allow nurse practitioners to practice more broadly, citing worries about patient safety and quality of care, the NGA report said. However, a review by NGA found no studies that raised concerns about the quality of care, and most showed care was comparable to physician-provided care.

Physician groups also may have financial concerns, but a recent analysis found no differences in physician earnings between states that have expanded scope-of-practice laws and those that do not, the NGA report said.

• From CQ Hot Docs: NGA Report on Nurse Practitioners (pdf)

Jane Norman can be reached at

Posted On: 
Dec 27th, 2012