The Affordable Care Act (ACA) has brought new requirements and new patients. However, it has done little to smooth the state-to-state inconsistencies hampering the delivery of care to patients. One major example is in the high growth trend towards employer health clinics. These onsite or near-site operations bring a high level of access and service to groups of employees whiles enabling employers to have more direct impact on their health benefit costs. National onsite clinic management companies fight a state-by-state regulatory battle as they stage clinics for multi-site employer groups trying to offer uniform services to their employees.
Some of the more glaring regulatory inconsistencies between states is in the regulation of mid-level practitioners. The growth of the patient base nationally is putting pressure on traditional medicine and accelerating the demand for mid-level practitioners like Physician Assistants (PA) and Nurse Practitioners (NP). The U.S. Bureau of Labor Statistics predicts that PA’s will be the second fastest growing health profession in the next decade (after home health aides). Traditionally, mid level practitioners practice under the oversight of a physician and have guidelines defining their scope of practice. This model has worked well for many years and has shown great potential for leveraging current physicians while providing scalability to match patient growth. The problem comes as clinic management groups build models to support employers and discover widely varying requirements state by state.
An area in which we’ve seen significant variability involves the regulation of mid-level practitioner dispensing. As the patient base grows and the need for more mid level practitioners grows along with it, patient access to care becomes more and more dependent on each state’s ability to evolve their regulations to accommodate the expanding scope of mid level practice. Today, some states are moving in the opposite direction of national trends and continue to narrow the scope of practice for these mid level clinicians This is in direct response to special interests seeking to protect their turf and is putting up artificial barriers to patients seeking care. For employer groups seeking to manage their health costs while ensuring a high level of care and access to their employees, the intrastate challenges are daunting and frustrating.
For example, does it makes sense that a Nurse Practitioner is able to write a prescription for an antibiotic yet is not able to provide the medication to a patient in the clinic? How about the Physician Assistant who is able to hand a patient a 30 day supply of a medication as a “sample” yet cannot dispense that same quantity to a patient because it is not defined as a “sample”. Mid level practitioners are able to administer any number of medications within the office and yet some states will not allow them to provide prescription medications at the point of care to treat ailments that fall squarely within their scope of practice. Mid level practitioners are able to dispense medications safely and cost effectively to their patients. States that don’t allow this are only hurting their patients by limiting access and increasing costs; they are missing a huge opportunity to make a difference for their constituents.
As the patient base continues to grow and the pressure to deliver builds on physicians, the need for mid level practitioners will expand. States need to streamline regulations and evolve them more quickly as our country’s healthcare needs change. Not only are some states limiting access to care for their constituents, they are missing economic growth opportunities that are migrating to their neighbors. States with more progressive regulatory leadership will continue to outmaneuver their neighbors in attracting companies seeking to provide innovative care models to their employees. For states with major cities on the borders of more healthcare friendly neighbors, this will be an immediate loss as convenient geographic access allows patients to cross state lines for the care they need.
Variations in state regulations will always exist. As it relates to healthcare, finding a way to streamline the regulatory environment will become more and more critical to giving patients access to truly affordable care and empowering our employers to bring innovative approaches to reducing the cost of care nationally.
