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The ACA provides for a massive coverage expansion, which will drive an estimated 30 million new insured individuals into primary care and other health care services over the next five years. While states are busily building health insurance Exchanges and planning Medicaid expansions, many are thinking forward about smart workforce deployment. Some 170 scope-of-practice bills have been introduced in 39 states, according to the National Conference of State Legislatures (NCSL). Training new physicians is not necessarily timely, practical, or cost-effective. Instead, expanding what mid-level practitioners like nurse practitioners and physician assistants can do in a medical setting may be more expeditious.
Other innovative ideas that states are exploring include:
- Increase number of community health workers – Florida lawmakers have proposed creating the Community Health Worker Task Force. The workers would leverage community volunteers who would provide basic services and connect individuals to clinics.
- Let out-of-state doctors practice – New York and New Mexico are considering allowing doctors with out-of-state licenses to practice inside the state. Limitations include that the service would have to be voluntary, which seems illogical given the reason for loosening up practice laws is due to increasing health insurance. Directing clinicians to underserved areas is a good idea, but restricting reimbursement will not address historical access barriers.
- Authorize pharmacists to give vaccinations to children – Maine wants to make it easier for kids to get vaccinations, permitting pharmacists to give shots to adults and children under proposed law. Basic, public health and prevention necessitates these common sense moves.
- Allow midwives more authority – Indiana and New Mexico are both considering revising and expanding regulations on midwifery practice. Midwives play an integral role in the care and delivery of babies in many states.
- Allow NPs to write treatment plans for physical therapists – Florida wants to let nurse practitioners assign people to physical therapy. Physical therapists would be authorized to follow treatment plans outlined by not only doctors but also NPs.
- Let mid-level practitioners declare death – New Jersey and New York have suggested devolving authority to physician assistants and NPs. NJ is considering letting nurse practitioners determine the cause of death and sign a death certificate if a doctor isn’t available. NY has proposed allowing physician assistants, writing the order under the supervision of a physician, to issue a death certificate.
