Antitrust Law Daily Wrap Up, ANTITRUST NEWS: FTC staff raises competition concerns over Missouri Nurse Practice Act bill, (Apr 22, 2015)

By Greg Hammond, J.D.

The staffs of the FTC Office of Policy Planning, Bureau of Economics, and Bureau of Competition have issued a letter to Missouri representative Jeanne Kirkton, in response to an invitation for comments on Missouri House Bill 633, which would amend the state’s Nurse Practice Act. The bill, while removing some constraints, will impose other constraints on collaborative practice arrangements between physicians and Advance Practice Registered Nurses (APRNs), the FTC staff wrote.

Two amendments could potentially make arrangements between APRNs and collaborating physicians less burdensome, according to the letter, including: (1) a revised supervision period that would last up to one month, as agreed upon by the APRN and the collaborating physician; and (2) allowing collaborating physicians to perform chart reviews off-site. Both of these changes could reduce costs of collaboration and could mitigate some challenges APRNs face in securing collaborative arrangements, the staff noted.

“These benefits, however, may not be realized because of new costs potentially imposed by the bill,” the letter stated. Specifically, the bill contains a new provision that requires collaborating physicians to be available for consultation in person or electronically if an APRN provides services for conditions other than acute, self-limiting, or well defined problems. In addition, a patient’s chart must be reviewed and approved or modified by a collaborating physician or other physician designated in the collaborative agreement for new or significantly changed conditions other than acute, self-limiting, or well defined problems. These changes may limit the number of physicians willing to collaborate.

It is also unclear whether new provisions would replace or supplement existing ones, which could also result in fewer physicians who would be willing to collaborate with APRNs. For example, there is uncertainty in whether the regulations would still require collaborating physicians to visit the APRN clinic at least every two weeks to review records, provide consultations, and be available to see patients, or whether the collaborating physician must provide a follow-up evaluation and visit within two weeks after the patient’s encounter with an APRN for certain new or significantly changed conditions.

“As currently drafted, HB663 may lower the costs of these arrangements by facilitating electronic collaboration,” the letter stated. “However, the bill retains a mandatory collaborative practice structure that FTC staff have identified as raising possible competitive issues. Additionally, the potential benefits of electronic collaboration may go unrealized unless the new statutory provision explicitly supersede, rather than supplement, more onerous regulations that currently require in-person collaboration.”

The FTC staff therefore recommends that the Missouri legislature “review the current statutory and regulatory requirements to determine whether HB633 will—or should—supplant more restrictive regulations, and whether the bill is appropriately tailored to address any legitimate and substantiated health and safety concerns.”

News: Antitrust FederalTradeCommissionNews