FTC Staff: Proposed Tennessee Legislation May Reduce Patient Access to Pain Management Services and Increase Prices

Federal Trade Commission staff, in response to a request from Tennessee State Representative Gary Odom, stated that there may be reduced access to pain management services in the state, as well as higher costs for those services, under a bill proposed in the Tennesssee legislature that would require on-site physician supervision of pain management services in some facilities.

Tennessee House Bill 1896 would require physician supervision of pain management services administered by advanced practice nurses (APNs), as well as certified registered nurse anesthetists (CRNAs), who are APNs with specialized training in anesthesia and pain management. The Bill also would limit which physicians may supervise or provide such services. The limitations would apply to health care facilities such as physician and nursing practices but not to facilities such as hospitals and nursing homes.

“Access to pain management services in Tennessee is likely to be compromised by unnecessary limits on the abilities of APNs, CRNAs, doctors, and other health care professionals to provide those services, with no demonstrable safety benefits,” the FTC staff comment stated. CRNAs are key providers of anesthesia and pain management in many rural and underserved areas, and “access problems may be especially acute for elderly patients with chronic pain, as well as rural and low-income Tennesseans.”

The FTC staff also stated that, based upon available evidence, it is not clear that the restrictions proposed in the Bill are necessary to protect patients. “Because the full costs and benefits of the Bill remain uncertain, and because the Bill’s competitive impact may be substantial, especially for rural or underserved Tennessee health care consumers, we recommend that the House investigate the full competitive implications of H.B. 1896 before adopting any of its restrictions. Absent findings that its provisions are likely to ameliorate identifiable safety concerns, we recommend that the Bill be rejected.”

The Commission vote approving the staff comment was 5-0. It was sent on September 28, 2011. (FTC File No. V110011; the staff contact is Daniel Gilman, Office of Policy Planning, 202-326-3136.)

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