Antitrust Law Daily Wrap Up, ANTITRUST NEWS: FTC staff sees benefits to Massachusetts proposal to remove physician supervision requirements for nurse practitioners, nurse anesthetists, (Jan 23, 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 Massachusetts State Representative Kay Khan, provided comments on Massachusetts House Bill 2009 (H.2009) stating that, as proposed, the elimination of certain supervision requirements currently imposed for nurse practitioners (NPs) and nurse anesthetists (NAs) would likely benefit health care consumers and competition in Massachusetts.

According to the January 17 FTC staff comment, H.2009 would permit NPs and NAs to order tests and therapeutics, and issue written prescriptions, without a supervisory agreement with a Massachusetts physician. It also would permit them to administer and dispense certain controlled substances without such supervisory agreements.

Citing serious physician shortages in some areas of practice and some geographic regions in Massachusetts, the comment noted that excessive supervision requirements can exacerbate provider shortages and access problems, particularly for underserved populations that already lack adequate and cost-effective primary care services. “[W]e encourage the Massachusetts legislature to consider adopting provisions that would permit APRNs [advanced practice registered nurses] to deliver the full range of health care services they are trained and certified to provide,” the staff observed.

The staff comment noted that patient health and safety concerns are of critical importance when a state regulates the scope of practice of health care professionals, and FTC staff defers to Massachusetts on the ultimate health and safety standards that the state may choose to establish. However, the staff recommended that the legislature seek to maintain only those NA and NP supervision requirements that advance patient protection.

Additionally, H.2009 would streamline the regulation of NPs and NAs, and permit NPs and NAs to more fully utilize their education and experience in serving Massachusetts health care consumers. Absent good grounds to continue existing supervision requirements, removing them could “benefit consumers by improving access to care, containing costs, and expanding innovation in health care delivery… Removing unnecessary and burdensome requirements may benefit Massachusetts consumers by increasing competition among health care providers,” the staff comment concluded.

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