The Federal Trade Commission has endorsed a proposal in the Connecticut General Assembly that seeks to cut health care costs by allowing advanced practice registered nurses to operate more freely and without the direct supervision of a doctor.
The bill, sponsored by state Rep. Theresa W. Conroy of Seymour, would remove the requirement that advanced practice registered nurses (APRNs) practice in collaboration with a licensed physician in certain instances where APRNs would diagnose, treat or prescribe medications for patients.
A day prior to a March 20 hearing before the General Assembly Committee on Public Health, the FTC issued an extensive report, which recommends “that the Connecticut legislature seek to ensure that statutory limits on APRNs are no stricter than patient protection requires.”
The report, which was completed by the FTC staff at Conroy”™s request, concluded that the bill ”” absent any safety concerns ”” “appears to be a pro-competitive improvement in the law that would benefit Connecticut health care consumers” by allowing APRNs to “practice to the full extent of their training, education and abilities.”
Meredith Wallace Kazer, an APRN and associate dean of Fairfield University”™s School of Nursing, said studies have repeatedly demonstrated that APRNs have been successful in working independent of doctors.
“It”™s high time that we”™re allowed to function to the extent that we”™re able to,” Kazer said.
In states that allow APRNs to practice independently, “There has been really high patient satisfaction, better access to care, much improved outcomes in the patients who have seen nurse practitioners, and that”™s been demonstrated repeatedly,” Kazer said.
APRNs are licensed by the state Department of Public Health, and under Connecticut law are able to diagnose and treat patients in collaboration with a licensed physician. APRNs also may prescribe, dispense and administer medications in collaboration with a doctor.
Removing the requirement that APRNs practice in concert with a physician “may be beneficial for all patients, and especially for those medically underserved areas or populations where there are shortages of primary care providers,” according to the FTC report.
The FTC, citing a report by the National Governors Association, said there are 39 federally-designated Health Professional Shortage Areas (HPSA) in Connecticut. Currently there are 435,000 Connecticut residents living in a primary care HPSA; with the full implementation of the Affordable Care Act in 2014, that number is likely to increase by 150,000.
While numerous health professionals lined up to speak in support of the bill at the March 20 hearing, state Health Commissioner Jewel Mullen called for patience. She said that the proposed changes represent such a significant shift that they should be subject to a review process mandated under state law.
In prepared testimony, Mullen said APRNs requested a scope review of the proposed changes earlier this year, but that the Department of Public Health could not complete all of the requested reviews due to a lack of available resources.
However, Kazer said time is of the essence.
“I don”™t think we have a lot of time,” she said. “With health care reform changing the insurance availability for patients next year, the need for primary care providers is going to go through the roof.”
According to the FTC report, the bill “is likely to reduce the cost of basic health care services” due to the fact that “APRN care is generally less expensive to patients and payers than physician care, and is often provided in a variety of health care delivery settings.”
