Impact of State Scope of Practice Laws and Other Factors ...

Impact of State Scope of Practice Laws and Other Factors on the Practice and Supply of Primary Care Nurse Practitioners

Final Report

Contract Number: HHSP23320095655WC

November 16, 2015

Prepared for: Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, DC 20201

Prepared by: Westat An Employee-Owned Research Corporation? 1600 Research Boulevard Rockville, Maryland 20850-3129 (301) 251-1500

Table of Contents

Section

Executive Summary..................................................................................................................

Introduction and Context .......................................................................................................

Background ..........................................................................................................

Research Goals ...................................................................................... Project Overview and Approach ........................................................

Methodology .............................................................................................................................

Preliminary Work to Inform Analyses ............................................................

Environmental Scan ............................................................................. Technical Expert Panel ........................................................................

Qualitative Methodology ...................................................................................

Case Study Selection ............................................................................. Case Study Protocol..............................................................................

Quantitative Methodology ................................................................................

Research Questions and Analytic Design.......................................... Data Sources .......................................................................................... Variable Coding..................................................................................... Outcome Measures ............................................................................... Modeling Approaches ..........................................................................

Findings ...............................................................................................................................

Qualitative Findings ...........................................................................................

Care Delivery ......................................................................................... Access to Care ....................................................................................... Supply and Migration ........................................................................... Challenges to NP Practice ................................................................... Cost & Reimbursement Issues............................................................ Conclusion .............................................................................................

Page

1

4

4

5 6

8

8

8 9

10

10 12

13

13 14 16 19 20

22

22

22 25 25 27 28 29

Final Report

iii

Contents (continued)

Section

Quantitative Findings.........................................................................................

NPs Providing Patient Care and Primary Care................................. Working in Patient Care....................................................................... Working in Primary Care .....................................................................

Having a Patient Panel and Hospital Admitting Privileges ..........................

Having a Patient Panel ......................................................................... Hospital Admitting Privileges .............................................................

Percent of Time in Patient Care and Number of Patients Per Week .......................................................................................................

Percent of Time in Patient Care ......................................................... Number of Patients Seen Per Week...................................................

NP Billing and Physician Supervision .............................................................

NP Billing Arrangement ...................................................................... Working Without Physician Supervision...........................................

Working in a Rural Area ....................................................................................

Rural Locations .....................................................................................

Medicare First Visit Claims ............................................................................... Discussion and Conclusions .............................................................................

Policy Implications ...................................................................................................................

Scope of Practice Regulations........................................................................... Organizational Practices .................................................................................... Education and Training ..................................................................................... Billing and Reimbursement ...............................................................................

References ...............................................................................................................................

Page

30

30 30 33

34

34 36

36

37 38

38

38 39

40

41

42 45

49

49 50 51 52

53

Final Report

iv

Contents (continued)

Appendix A B C D

Environmental Scan ...........................................................................................

Case Study Discussion Guide ...........................................................................

Detailed Tables of Quantitative Results..........................................................

Claims Data Request: Counts by State and Claim Type each for 2004, 2008, 2012 .................................................................................................

Page A-1 B-1 C-1

D-1

Table 1 2 3 4 5

Descriptive characteristics of case study states .............................................. 11 State characteristics data sources ...................................................................... 16 State scope of practice in 2004, 2008, and 2012 ............................................ 17 NP Share of Primary Care Workforce, by year .............................................. 20 Dependent variables: NP share of first visit claims and reimbursement .................................................................................................... 42

Final Report

v

Contents (continued)

Figure 1 2

3 4

5 6 7 8 9

Impact of SOP on NP supply...........................................................................

Probabilities of working as an NP in patient care by SOP and rurality ...................................................................................................................

Probability of working in primary care by urban/rural location .................

Having a panel and hospital admitting privileges by rural/urban location .................................................................................................................

Impact of SOP on billing and physician supervision ....................................

Probabilities of no physician supervision by SOP and rurality....................

NP share of first-visit claims billed, by year and SOP ..................................

NP share of first-visit reimbursement, by year and SOP..............................

Change in NP share of first-visit claims billed and reimbursement, 2004-2012, by change in SOP ..............................................

Page 31

32 33

35 39 40 43 44

45

Final Report

vi

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download