In early January, the Federal Trade Commission (FTC) issued a letter encouraging state lawmakers to pass House Bill (HB) 100, which would modernize Pennsylvania’s nurse practitioner law.

HB 100, a companion to Senate Bill (SB) 25, enjoys bipartisan support from nearly every healthcare stakeholder.

AARP Pennsylvania, the Hospital & Health System Association of Pennsylvania, the PA Rural Health Association, and many other organizations have endorsed reform. Delaware County support has come from the Greater Philadelphia Business Coalition on Health and Main Line Health.

The letter argues in part that Advanced Registered Nurse Practitioners (ARNPs) and Certified Registered Nurse Practitioners (CRNPs) should be allowed to prescribe pharmaceuticals, like doctors, and to have existing supervision requirements removed that currently prohibit them from prescribing.

Removing the supervisory requirements, the FTC argues, “…has the potential to benefit Pennsylvania consumers by increasing competition among health care providers, which likely would improve access to care, contain costs, and expand innovation in health care delivery.”

The Pennsylvania Coalition of Nurse Practitioners (PCNP) welcomed the letter, which reiterates findings of the National Academy of Medicine and many other nonpartisan organizations. PCNP is the state organization that promotes and protects the practice of over 10,000 certified registered nurse practitioners in Pennsylvania and whose mission is to improve access to care.

“State law should work for our patients, not against them. As this letter makes clear, House Bill 100 will help improve health care quality, increase access and lower costs,” said PCNP President Adele Caruso.

The FTC letter cites a report by Pennsylvania’s Joint State Government Commission, which predicted a shortage of 20,400 primary care physicians by 2020:

 “If certified registered nurse practitioners and physician assistants are fully utilized, their rapidly growing numbers could reduce the physician shortage in 2020 to 6,400 physicians,” said Caruso. “However, this reduction assumes a reorganization of the primary care delivery model in which certified registered nurse practitioners and physician assistants deliver a greater proportion of the services than they do within the current care delivery model.”

Full practice authority legislation would end the mandate and make Pennsylvania a full practice authority state. Currently, 22 states and the District of Columbia are already using full practice authority to expand access to care, especially for underserved rural areas and patients with Medicaid insurance.

Nurse practitioners (NPs), also called certified registered nurse practitioners, and advanced registered nurse practitioners have advanced education, with master’s degrees or doctorates, and are nationally certified in their specialty areas. Among their many services NPs order, perform and interpret diagnostic tests; diagnose and treat acute and chronic conditions such as diabetes, high blood pressure, infections and injuries; prescribe medications and other treatments; and manage a patient’s care. Over 100 studies have proven that NPs provide safe, high-quality health care.

Currently, in order to practice, a NP must secure business contracts, called collaborative agreements, with two physicians. Researchers – including physicians and NPs alike – have proven that this mandate offers no patient health benefits. Instead, research shows that the mandate restricts access to care and correlates with worse patient health outcomes.

“I support it,” said Dr. Letitia O’Kicki, medical director of ChesPenn Health Services, about HB 100. We have three nurse practitioners who work with us and a physician’s assistant so we clearly support it. When you have a number of physicians working at one site there is collaboration. It promotes everyone learning from each other’s patients.”

Caruso, a longtime resident of Delaware County who is currently working at the University of Pennsylvania, lauded the legislation and said it would modernize nursing.

“In Delaware County, the way it helps patients is, it will increase access to care,” Caruso said. “Many practices are empowered when they have NPs in their midst. The practices themselves are more successful in taking care of patients and are fiscally sound when they have NPs with their group. There is also the improved quality of care with NPs. We are well trained. Our outcomes are good and we have a high level of patient satisfaction along with being cost effective.”

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