FTC Staff: Missouri Should Consider Changing Physician Supervision Requirements for Advanced Practice Registered Nurses

Federal Trade Commission staff submitted written comments regarding the competitive impact of a legislative proposal to modify the collaborative practice arrangements that are imposed on Advanced Practice Registered Nurses (APRNs) in the state and that limit the services they can provide. The comments are in response to a request from Missouri State Representative Jeanne Kirkton.

According to the comment by staff of the FTC’s Office of Policy Planning, Bureau of Competition, and Bureau of Economics, Missouri House Bill 633 would amend Missouri’s Nurse Practice Act to remove some, and impose other, constraints on collaborative practice arrangements between physicians and APRNs. For example, while the bill would permit offsite review of charts, it may impose additional recordkeeping responsibilities for APRNs, as well as additional consultation and chart review responsibilities for collaborating physicians. It also retains the state’s current mandatory collaboration structure, but according to the staff comment, such restrictions on APRNs “do not appear to be justified by health and safety concerns.”

Missouri law requires APRNs to have a collaborative practice arrangement with a specific physician in order to assess and diagnose patients, and to order diagnostic and therapeutic tests and procedures.

As stated in the comment, the FTC staff encourages the legislature to “scrutinize claimed health and safety justifications for its current supervision and collaboration requirements, review carefully whether any claims of potential patient harm are adequately substantiated and well founded, and evaluate whether the collaboration requirements are warranted.”

“If APRNs and other health care professionals are permitted to practice to the extent of their education, training, and abilities, the state could benefit from enhanced competition, including potentially lower costs and greater patient access to care. If the current restrictions are already greater than patient protection requires, we urge the legislature to adopt a bill that removes, rather than increases, oversight requirements that could further limit the provision of health care services by APRNs and, perhaps, other members of health care delivery teams.”

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, including the mandatory collaborative practice arrangements now required under Missouri law. According to the policy paper, these types of rigid statutory requirements can increase health care costs and prices, needlessly constrain innovation in health care delivery, and exacerbate well-documented provider shortages. The policy paper also cites research suggesting that these types of mandates do not appear necessary to promote coordination among health care providers or to assure that care is safe and effective.

The Commission vote to issue the staff comments was 5-0. (FTC File No. V150002; the staff contact is Patricia Schultheiss, Office of Policy Planning, 202-326-2877).

The FTC’s Office of Policy Planning works with the Commission and its staff to develop long-range competition and consumer policy initiatives, consistent with the FTC’s unique mission to conduct research and engage in advocacy on issues that affect competition, consumers, and the U.S. economy. The Office of Policy Planning submits advocacy filings; conducts research and studies; organizes public workshops; issues reports; and advises staff on cases raising new or complex policy and legal issues. To reach the Office of Policy Planning, send an e-mail to opp@ftc.gov. Like the FTC on Facebook, follow us on Twitter, read our blogs, and subscribe to press releases for the latest FTC news and resources.