Should Loosening of Scope-of-Practice Rules for NPs, PAs Become Permanent?

Any rollback needs to be based on evidence, say authors

It hasn't gotten as much attention as the telehealth tsunami. But the sudden relaxation of scope-of-practice laws and regulations for nurse practitioners and physician assistants is another way that American healthcare has pivoted because of COVID-19.

For now, though, the rules have been eliminated or modified only on a temporarily basis. In a Health Affairs blog post today, three experts on healthcare workforce issues make a contingent case for the changes becoming permanent.

"If the relaxation of SOP (scope of practic) restrictions catalyzed by COVID-19 has alleviated workforce shortages and allowed HCPs (healthcare professionals) to maximize their potential without compromising health care quality or patient safety, we believe states should not revert to the pre-pandemic state of SOP policy," wrote Alden Yuanhong Lai, Susan M. Skillman, and Bianca K. Frogner.

The trio also argue that if the old rules are put back into place, nurse practitioners and others affected by the reveral may feel they are being treated unfairly and that a sense of unfairness is "profoundly dissatsifying and detrimental to profesional well-being." The trio call on policymakers and regulators to use empirica evidence for making decisiohs about whether to extend the loosening of scope-of-practice rules.

Scope-of-practice is regulated at the state level. Where to draw the line between what doctors and other healthcare professionals can do has been a running battle in state capitals through the country for years as physician groups, by and large, want to limit the scope of practice of nurse practitioners and physician assistants while nurse practitioners and physician assistants tend to push for more autonomy. One argument for broadening the scope of practice is that doing so would help make primary care more accessible. One counterargument is that the quality of care might suffer because of the expertise and training of physicians..

HHS Secretary Alex Azar called on states to relax their rules in late March when it seemed like COVID-19 cases might completely overwhelm healthcare providerss throughout the country rather than in just hotspots. According to Lai and his co-authors, Pennsylvania, Tennessee and Wisconsin responddc by removing the requirement that nurse practitioners work under the supervision of a physician; those states also gave them freer rein to write prescriptions. Michigan broadened the scope of practice for several different kinds of healthcare professionals, including pharmacists. And California didn't eliminate physician supervision but relaxed some of the rules.

Lai and his co-authors are cautious; they say decision on rollbacks of scope-of-practice rules be based on careful evaluation of outcomes. They also say that healthcare leaders need to acknowledged "the trememndous contribution and sacrfices healthcare professionals have made during the pandemic.

aSeveral states, including Pennsylvania, Tennessee and Wisconsinn, temporarily eliminated the requirement that nurse practitioners work under the supervision of physician. Others, like California,

s healthcare system's COVID-19 pivo has been the relaxation of scope-of-practice laws for nurse practitioner and physician ass