Nonphysician Clinicians Physician Compensation

What are the real life implications of scope of work restrictions?

Why have a physician do a job when a nurse could do it? Why have a nurse do it if a home health aide could do it? Clearly, the latter group in each sentence is lower cost; however, the former group may provide higher quality care. The balance of who can do what in terms of trading off quality and cost clearly varies by task, but one key issue with scope of work restrictions is that they limit flexibility and individual professional judgement. Consider the case of a seriously ill patient with primary progressive multiple sclerosis as outlined in this Health Affairs article by Michael Ogg:

Nurse practice acts in each state regulate tasks that must be performed by registered nurses
instead of being delegated to agency employed home health aides. Although my state had relaxed its regulations, allowing home health aides to administer medications, MyPACE did not yet permit them to do so. My nurse told me that if I needed twice-daily medications, they might have to put me in a nursing home instead of sending the home nurse twice a day.

Recommending certain specialties provide certain tasks does make sense. But in many situations, mandating that they do so is problematic as it prevents providing creative health care solutions to the patients who need help the most.

In fact, another article in the same issue of Health Affairs by Morgan et al. (2019) found that:

Case-mix-adjusted total care costs were 6–7 percent lower for NP [nurse practitioner] and PA [physician assistant] patients than for physician patients, driven by more use of emergency and inpatient services by the latter. We found that use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs.

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