Access to care based on state nurse practitioner practice regulation: Secondary data analysis results in the Medicare population

Abstract

Purpose To examine access to care in the Medicare population based on state nurse practitioner (NP) practice regulation. Data sources Secondary data analysis of the Medicare Current Beneficiary Survey Access to Care 2011 dataset. Items used to measure access to care were usual source of care, appointment waiting times, and difficulties encountered. States were designated as full, reduced, or restricted NP practice based on data from the American Association of Nurse Practitioners State Regulatory Map. Conclusions Self‐reported usual source of care (N = 1,496,251) was not significantly affected by state regulation (p > .05); however, these results were based on only 3% of the sample answering the question. Significant differences were seen in sites for care across state groups (N = 41,650,566, p ≤ .01). Participants in reduced (B = −1.86) and restricted (B = −2.82) states reported lower waiting times than those in full practice states (N = 371,166, p < .01). Participants in reduced practice states had 67% lower odds of having trouble accessing care than participants in full practice states (N = 5,568,495, p = .01). More participants in restricted and reduced states reported cost as a difficulty (N = 1180, p = .03). Implications for practice Access to care based on state NP practice regulation is an important area of study because of the changing nature of health care and the growing support for full practice. This study examined access to care in states with different levels of NP practice regulation, but did not directly measure outcomes in individuals based on NP care. Additional research is needed to examine the impact of state regulation in different patient populations (self‐insured, Medicaid, uninsured), and changes in access to care over time as state regulations change.

Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study

“…To date, several studies investigated the impact of various regulatory barriers on NP role in care delivery and patients’ access to care (Barnes et al, 2016, Cross and Kelly, 2015, Graves et al, 2016). In contrast, comparatively little research has focused on the organizational structures in health care settings employing NPs and how organizations utilize NPs in care delivery as primary care providers with their own patient panel within the same federal and state regulatory environment.…”

Effects of Regulation and Payment Policies on Nurse Practitioners’ Clinical Practices

“…Richards and Polsky (2016) found improved access to care for Medicaid beneficiaries in practices that both employed more providers, including NPs and physician assistants (PAs), and were located in states with the least restrictive SOP. In one study, a sample of Medicare beneficiaries reported shorter wait times for appointments and less difficulty accessing care in states with more restrictive NP SOP regulations (Cross & Kelly, 2015). …”

Offers of appointments with nurse practitioners if a requested physician is unavailable

“…Despite this, there is a growing shortage of primary care physicians that is expected to worsen due to an aging population, the rising prevalence of chronic diseases, and the expansion of coverage under the Affordable Care Act (U.S. Department of Health and Human Services [USDHHS], ). One proposed solution is to better integrate nurse practitioners (NPs) and physician assistants (PAs) into the primary care workforce (Cassidy, ; Cross & Kelly, ; USDHHS, ; Van Vleet & Paradise, ), but the appropriate role of NPs in primary care remains the subject of debate. While the majority of NPs favor greater scope of practice for their profession, they face resistance from some physicians (American Academy of Family Physicians [AAFP], ; Donelan, DesRoches, Dittus, & Buerhaus, ).…”