Expanding Nurse Practitioner Authority: Effects on Provider Composition, Continuity of Care, and Patient Outcomes in Medicare

• In Event: Implications of Scope of Practice Reform for Advanced Practice Registered Nurses

Abstract

Amid persistent physician shortages over the past decade, states have increasingly adopted scope of practice (SOP) laws that expand nurse practitioners’ (NPs) ability to provide care independently, without requiring physician oversight.  However, a question remains as to how SOP laws affect the composition of practice in a primary care setting. Historically, it has been difficult to properly identify whether a patient sees a physician or nurse practitioner during an office visit due to incident to billing - a phenomenon by which NPs are incentivized to bill under the NPI of a physician due to higher reimbursement rates. Leveraging a novel methodology developed by Patel et al. (2022), I use prescription claims linked to Medicare office visits to identify the primary care provider (NP, physician assistant, or physician) seen by each beneficiary. Employing a staggered difference-in-differences design, I analyze the effects of SOP law changes on continuity of care – how care is split between providers – and the resulting health outcome in preventable emergency department (ED) visits among diabetic Medicare patients. While expanding NP practice authority addresses provider shortages, it may have unintended consequences for care continuity and preventable ED utilization among vulnerable populations. These findings highlight the need to examine care coordination in the changing primary care environment.

Author

• Jessica Lu, Cornell University
  Presenting Author