Antitrust Law Daily Wrap Up, ANTITRUST NEWS: FTC staff comments on Missouri House bill to change physician supervision requirements for advanced practice nurses, (May 9, 2014)

By Linda O’Brien, J.D., LL.M.

The staff of the FTC’s Office of Policy Planning, Bureau of Competition, and Bureau of Economics, in response to a request from the Missouri House of Representatives, provided comments today on the on legislative proposals that would remove or change requirements for “collaborative practice arrangements” between Missouri physicians and Advanced Practice Registered Nurses (APRNs).

The FTC staff comment noted the critical importance of patient health and safety, and deferred to state legislators to determine the optimal balance of policy priorities, and define the appropriate scope of practice for APRNs and other health care providers. At the same time, the staff observed that undue regulatory restrictions on APRN practice can impose significant competitive costs on health care consumers and other payors.

In responding to Missouri House Bills 1481 and 1491, the FTC staff comment noted that the bills would curtail costly barriers to competition – barriers that may “deter procompetitive innovation in health care delivery, to the ultimate detriment of Missouri health care consumers, as well as both public and private third-party payors.”

As stated in the comment, HB 1491 would, in part, allow APRNs to assess and diagnose patients, and order diagnostic and therapeutic tests and procedures, without a collaborative practice arrangement with a particular physician, as is now required in Missouri. HB 1481 would allow physicians and APRNs to collaborate electronically, replacing current law that requires their offices to be physically nearby.

The staff comment referred to an FTC staff policy paper, entitled “Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses”, issued in March, which analyzes the competitive implications of various types of APRN regulations, including the mandatory collaborative practice arrangements now required under Missouri law. According to the policy paper, these types of rigid statutory requirements can “increase health care costs and prices,” needlessly constrain innovation in health care delivery,” and “exacerbate well-documented provider shortages.” The policy paper also cites research suggesting that these types of mandates do not appear necessary to promote coordination among health care providers or to assure that care is safe and effective.

The staff comment urged state legislators to avoid restrictions on APRN practice that do not 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 . . .within the scope of their training, licensure, certification, and current practice.”

The Commission vote to issue the staff policy paper was 5-0.

News: Antitrust FederalTradeCommissionNews