FTC Staff: West Virginia Should Consider the Competitive Impact of Legislation Affecting Advanced Practice Registered Nurses

Federal Trade Commission staff submitted written comments on the competitive impact of a legislative proposal to modify the supervision requirements imposed on Advanced Practice Registered Nurses (APRNs) in West Virginia, permitting some APRNs, under limited conditions, to write prescriptions without a formal agreement with a particular supervising physician. The Bill would also place the regulation of certain APRNs under the authority of the West Virginia Board of Medicine or Board of Osteopathy. The comments are in response to a request from West Virginia State Senator Kent Leonhardt.

As stated in the comment by staff of the FTC’s Office of Policy Planning and its Bureaus of Competition and Economics, undue regulatory restrictions on APRN practice can impose significant competitive costs on patients and third-party payors, and may frustrate the development of innovative and effective models of team-based health care. The proposal “could benefit patients, as it would permit a route to independent prescribing, at least for some APRNs under certain conditions,” but it “raises significant competitive concerns nonetheless, first because of the many conditions and exclusions it would impose on independent APRN prescribing, and second because of the regulatory conflicts of interest that appear to be inherent in the Bill’s requirements of physician permission for and oversight of APRN prescribing.”

The comment further states that “the requirement that an APRN have ‘a recommendation from his or her collaborative physician . . . [to] be permitted to prescribe without a collaborative arrangement,’ raises concerns about professional and financial conflicts of interest.” Additionally, “because the Bill would assign regulatory authority over APRN prescribing to the Boards of Medicine and Osteopathy, it raises concerns about potential biases and conflicts of interest.”

The comment urges the legislature to consider whether these proposed requirements are necessary to assure patient safety, noting that removing unnecessary and burdensome requirements may benefit West Virginia consumers by increasing competition among health care providers.

The staff comment refers to an FTC staff policy paper, issued in March 2014, which analyzes the competitive implications of various types of APRN regulations.

The Commission vote to issue the staff comments was 4-0. (FTC File No. V160005; the staff contact is Daniel J. Gilman, Office of Policy Planning, 202-326-3136.)

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