May 05, 2014

Bay Area Council Economic Institute Analysis Finds Granting Full Practice Authority for Nurse Practitioners Increases Access and Controls Costs

Expanding the patient services that licensed nurse practitioners can provide would help California address a serious and growing shortage of primary care physicians, according to a new analysis by the Bay Area Council Economic Institute. The analysis shows that granting full practice authority to nurse practitioners in California would boost the supply of nurse practitioners throughout the state by 24 percent, with the largest increases in high-need areas such as the Central Valley and the Inland Empire.

California ranks 23rd among states in the number of primary care physicians per 100,000 residents. With 2.5 million previously uninsured Californians expected to gain coverage by next year, according to the California Healthcare Foundation, the demand for primary healthcare services will only grow. The white paper—Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost—finds that allowing nurse practitioners to practice to the full extent of their education and training could save the state $1.8 billion on preventative care visits alone over 10 years while increasing the number of preventative care visits by 2 million per year.

“Access to primary care is critical for properly managing and preventing chronic conditions,” said Sean Randolph, President and CEO of the Bay Area Council Economic Institute. “The prevalence and mismanagement of chronic conditions is one of the biggest drivers of healthcare cost increases. Allowing nurse practitioners to deliver primary care services with full practice authority is an important reform that will benefit consumers, businesses, and healthcare purchasers across the board.”

The scope of activities a nurse practitioner (NP) can perform—regulated by the state in which they are licensed—is often widely debated by the medical community, patients, and policy makers. When this report was written, 17 states and the District of Columbia permitted NPs to diagnose, treat and prescribe medications without physician oversight. Eight states allowed them to diagnose and treat, but required physician supervision for the prescribing of medications. In the state of California, NPs cannot diagnose, treat patients or prescribe medications without a signed collaborative practice agreement and Standardized Procedures.

“Our analysis makes a strong argument for allowing nurse practitioners to provide the healthcare services they were trained and licensed for,” said Micah Weinberg, PhD, Senior Fellow with the Bay Area Council Economic Institute. “While no single policy change will be a panacea for the critical cost and access issues facing California, this reform could be an important first step to bring down some of the barriers that are keeping healthcare costs artificially high.”

The white paper was funded by a research grant from the Robert Wood Johnson Foundation and AARP.

Read the Spotlight paper.

Read the Technical Appendix.