1. Potera, Carol


Changing scope-of-practice laws is one approach.


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A new report to the president from three government agencies recommends policy moves to promote competition and consumer choice in health care. Among the recommendations are that states do away with certificate-of-need laws, expand scope of practice for allied health professionals, and scale back mandates for health care coverage. The authors posit that these measures will help to deliver high-quality care at lower prices through greater choice, competition, and consumer-directed health care spending.


The report, Reforming America's Healthcare System Through Choice and Competition ( was prepared by staff of the U.S. Department of Health and Human Services, Department of the Treasury, and Department of Labor in conjunction with the Federal Trade Commission. It supports the expansion of independent practice for advance practice registered nurses (APRNs), physician assistants, pharmacists, optometrists, and other allied health professionals providing services comparable to those provided by physicians.


Slightly more than half of states require APRNs to work under physician supervision, which raises the cost of APRN services. Expanding their scope of practice to the top of their licenses would benefit consumers, especially in poor and rural areas, the authors contend. "When state regulators impose excessive entry barriers and undue restrictions on [scope of practice] for particular types of providers, they often are not responding to legitimate consumer protection concerns," the report states, adding that such restrictions are "an easy, state-sanctioned opportunity [for professionals with overlapping skill sets] to insulate themselves from competition." Moreover, by limiting the services of competent health professionals, these practice restrictions harm consumers, patients, and taxpayers. Among measures to limit such harm, the report recommends that states allow interstate licensing compacts so health care providers can practice in multiple states and offer telemedicine services across state lines.


In addition to scope-of-practice regulation, states vary widely in how their Medicaid programs reimburse allied health professionals. In some states, these providers can bill Medicaid directly; in others, they must bill under a supervising physician's number. For patients to maximally benefit from better scope-of-practice regulation, all providers should be authorized to bill and be paid independently, the authors write.-Carol Potera