Independence
2. Supreme Court
to Hear Precedent-Setting Case with Implications for Midwifery Advocacy
3. Oral Arguments
in Hobby Lobby Case to Begin Soon
4. New Tool from
the Guttmacher Institute
5. Consumer-Oriented
APRN Advocacy Video
1.
FTC Issues Policy Paper Endorsing APRN Independence
The Federal Trade
Commission (FTC) has issued a "Policy
Perspective: Competition and the Regulation of Advance Practice Nurses,"
that strongly endorses independent practice for APRNs. The document is
very clearly aimed at state lawmakers and makes several pointed
recommendations. It should be reviewed by ACNM affiliates advocating for
full practice authority in their states and talking points should be drawn from
it for use in those efforts.
In the introduction to the document the FTC states that:
FTC staff has consistently urged state legislators to avoid imposing
restrictions on APRN scope of practice unless those restrictions are necessary
to address well-founded patient safety concerns.
Based on substantial evidence and experience, expert bodies have concluded that
ARPNs are safe and effective as independent providers of many health care
services within the scope of their training, licensure, certification, and
current practice. Therefore, new or extended layers of mandatory
physician supervision may not be justified.
Further, the FTC says that "Effective collaboration between APRNs and
physicians does not necessarily require any physician supervision, much less
any particular model of physician supervision." The FTC goes on to urge
state legislators and policymakers to consider the following principles when
evaluating proposed changes to APRN scope of practice:
- Consumer
access to safe and effective health care is of critical importance.
- Licensure
and scope of practice regulations can help to ensure that health care
consumers (patients) receive treatment from properly trained
professionals. APRN certification and state
licensure requirements should reflect the types of services that APRNs can
safely and effectively provide, based on their education, training, and
experience.
- Health
care quality itself can be a locus of competition, and a lack of
competition - not just regulatory failures - can have serious health and
safety consequences. More generally, competition among health care
providers yields important consumer benefits, as it tends to reduce costs,
improve quality, and promote innovation and access to care.
- Potential
competitive effects can be especially striking where there are primary
care shortages, as in medically underserved areas or with medically
underserved populations. When APRNs are free from undue supervision
requirements and other undue practice restrictions, they can more
efficiently fulfill unmet health care needs.
- APRNs
typically collaborate with other health care practitioners. Effective
collaboration between APRNs and physicians can come in many forms. It does
not always require direct physician supervision of APRNs or some
particular, fixed model of team-based care.
- APRN scope
of practice limitations should be narrowly tailored to address
well-founded health and safety concerns, and should not be more
restrictive than patient protection requires. Otherwise, such limits can
deny health care consumers the benefits of competition, without providing
significant countervailing benefits.
- To promote
competition in health care markets, it may be important to scrutinize
relevant safety and quality evidence to determine whether or where
legitimate safety concerns exist and, if so, whether physician supervision
requirements or other regulatory interventions are likely to address them.
That type of scrutiny can be applied not just to the general question
whether the State requires physician supervision or collaborative practice
agreements, but to the particular terms of those requirements as they are
sometimes applied to, for example, APRN diagnosis of patient illnesses or
other health conditions, APRN ordering of diagnostic tests or procedures,
and APRN prescribing of medicines.
to releasing this Policy Perspective, the FTC will be holding a workshop on
March 20-21 to discuss competition in health care. ACNM staff will attend
and submit comments addressing the issues raised during that event.
2. Supreme Court
to Hear Precedent-Setting Case with Implications for Midwifery Advocacy
The Supreme Court has announced
that it will review the decision of the North Carolina Board of Dental
Examiners vs. FTC. The suit originally arose when the State Board of Dental
Examiners tried to prevent non-dentists from offering teeth-whitening services,
arguing that this service should only be performed by dentists. The FTC
intervened to block the dental board in the name of fair competition. It argued
that the board, composed mostly of practicing dentists chosen by their peers,
functioned more as a trade association than an arm of state government. The
board and its "market participants" - who also whitened teeth - acted
without the state oversight and authorization that might have otherwise given
it immunity from federal antitrust laws, according to the FTC. A federal administrative
judge ruled in the FTC's favor in 2011, and the US Court of Appeals for the
Fourth Circuit upheld its decision in May 2013.
ACNM and other advanced practice nursing organizations considered these rulings
to be a victory with far-reaching implications for the role of medical boards
versus nursing boards in the regulation of advanced practice nurses. The
Supreme Court's decision on the matter will likely have reverberations at the
state level. The Court has not yet announced when arguments will begin in
the case.
3. Oral Arguments
in Hobby Lobby Case to Begin Soon
On March 25, the Supreme Court will begin to hear arguments in Sebelius v.
Hobby Lobby, Inc., a much publicized case challenging the mandate for
employer-sponsored contraceptive coverage as called for within the Affordable
Care Act. A key question before the Court is whether a corporation is akin to
an individual whose religious beliefs and rights can be violated by this
provision. Interested members can find more information on the case here.
4. New Tool from
the Guttmacher Institute
The Guttmacher Institute has created a new online tool that allows users to
create customized tables with data on the contraceptive needs and services
within a given county or groups of counties in a state. All data included in
the new tool are for 2010, the most recent year available.
Among the key data points that can be downloaded into tables proposed changes
to APRN scope of practice are:
- women in need of contraceptive services (i.e., women aged 13-44 who are sexually active and able to become pregnant, but do not wish to become pregnant) by age, race/ethnicity and income;
- women in need of publicly funded contraceptive services (i.e., those in need of contraception and also either younger than age 20, or age 20 and older with an income below 250% of the federal poverty level);
- number of publicly funded clinics and the numbers of clients served, overall or among clinics receiving Title X funding.
The
tool can be found here. Once
a table has been created, it can be downloaded in Excel format.
5. Consumer-Oriented APRN Advocacy Video
Members may be interested in reviewing an APRN advocacy video aimed at
consumers and produced my My Health Care Ohio, "an online resource to help
Ohioans understand their healthcare options so they can make informed decisions
about what's best for them." The video may be accessed here.
Should you have questions about any of these issues, please contact Jesse
Bushman, ACNM's Director of Advocacy and Government Affairs at [email protected] or
240-485-1843.
Don't forget to register
for ACNM's 2014 annual conference. Details are available at the conference website.
