Posted on Mar 18, 2019

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Trump Administration: Ease Scope of Practice Laws

Easing scope-of-practice laws and streamlining graduate medical education (GME) funding would make U.S. healthcare more competitive and efficient.

"Reduced competition among clinicians leads to higher prices for healthcare services, and reduces choice... Government policies have reduced competition by restricting the available supply of providers and restricting the range of services they offer,” said a senior administration official.

Although scope-of-practice (SOP) laws may be justified in cases where there is substantial risk of consumer harm, "Oftentimes, too, SOP restrictions limit provider entry and ability to practice in ways that do not address demonstrable or substantial risks to consumer health and safety," according to the report. "When this happens, these undue restrictions are likely to reduce healthcare competition and harm consumers -- including patients, and taxpayers more generally."

"For example, advanced practice registered nurses (APRNs), physician assistants (PAs), pharmacists, optometrists, and other highly trained professionals can safely and effectively provide some of the same healthcare services as physicians, in addition to providing complementary services," the report continued. It made the following recommendations:

• States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice at the top of their license, utilizing their full skill set.

• The federal government and states should consider accompanying legislative and administrative proposals to allow non-physician and non-dentist providers to be paid directly for their services where evidence supports that the provider can safely and effectively provide that care.

• States should consider eliminating requirements for rigid collaborative practice and supervision agreements between physicians and dentists and their care extenders (e.g., physician assistants, hygienists) that are not justified by legitimate health and safety concerns.

Currently, "there is likely an inadequate supply of physicians in the United States," the report noted. “Moreover, there is an uneven distribution in physician supply (both geographically and across specialties). To address this problem, "as requested in the FY 2019 President's Budget, the federal government should more efficiently spend taxpayer resources by streamlining federal Health and Human Services spending on graduate medical education into a single graduate medical education grant program," the report authors suggested. "The new grant program would be funded out of the Treasury and jointly operated by the administrators of [the Centers for Medicare & Medicaid Services] and HRSA [the Health Resources and Services Administration]. This proposal is estimated to save $48.1 billion between 2019 and 2028."

The report also called for HRSA to continue its work on assessing physician supply, and to assess the agency's workforce development programs and identify gaps between existing programs and future workforce needs.



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