Some states have benefited from a boom in convenient care clinics, which provide quick access to basic health care services for lower costs. A simple law change to expand the scope of practice for nurse practitioners would help fix Texas’ broken health care delivery system by providing more primary care options and allowing these clinics to thrive in both urban and rural areas.
Currently, Texas is among the top five most heavily regulated states regarding the scope of practice for nurse practitioners. In a majority of states, nurse practitioners must enter into a collaborative practice agreement with at least one physician in order to practice or to prescribe medication.
Moderately regulated states have supervisory requirements with a physician and, in many cases, limit the number of nurse practitioners with whom a physician can supervise and collaborate. But Texas’ rules go several steps further and impose limits on the distance between a collaborating or supervising physician’s primary practice and any satellite practice managed by nurse practitioners.
Texas statute prohibits physicians from collaborating with no more than three nurse practitioners at a time, requires physicians to work at the same site as the practitioner 20 percent of the time, requires a physician to review 10 percent of a practitioner’s charts every 10 days, and dictates that the physician’s primary site must not be more than 60 miles away from any worksites of collaborating nurse practitioners.
Almost 90 percent of rural Texas counties are designated as “medically underserved” and lack access to a primary care provider. Unduly strict scope-of-practice rules are a main cause of this problem; easing these requirements would allow more nurse practitioners to fill the void and provide basic medical services in these areas.
Although some stringent rules are relaxed when a nurse practitioner is practicing in a medically underserved area, the regulations are still more onerous than those of many states. Both rural and urban communities are literally paying for this shortage in care as health care costs continue to rise. A simple law change can make health care more efficient and less costly.
Texas is not the only state to attempt to deregulate its practice barriers to nurse practitioners. According to the American College of Nurse Practitioners, 22 states and the District of Columbia allow practitioners to treat patients without supervision, and 28 allow them to do so with documented physician involvement.
While the number of general-practice doctors declines nationwide, the need for access to qualified health care providers is growing.
According to José E. Camacho, executive director of the Texas Association of Community Health Centers, “Our clinics throughout Texas are on the front lines of providing care, and many are struggling to deal with patient demand because primary care providers are scarce. Healthcare that is delayed means healthcare that is denied. And in many parts of our state, people are being forced to wait months for basic preventative care – or simply go without.”
At retail health clinics, a walk-in patient is usually seen within 20 minutes. These clinics accept the majority of insurance plans and for the uninsured, fees tend to be under $60, much cheaper than emergency room fees and high insurance premiums. Allowing patients to be treated for common or minor illnesses at these clinics by nurse practitioners provides them with a more accessible health care option.
This legislative session, several legislators have filed bills that would allow nurse practitioners to play a larger role in meeting Texas’ basic health care needs.
On March 26, the Texas Senate unanimously approved SB 532 by Sen. Dan Patrick, R-Houston. The bill allows for a waiver to be granted that, among other things, increases the number of collaborating nurse practitioners from three to six, decreases the amount of time a delegating physician must be on site with a practitioner, and increases the distance of the delegating physician’s residence or primary practice site.
Sen. Patrick’s legislation is a good step towards expanding nurse practitioners’ scope of practice. The House should move quickly to enact it into law.
While many in Washington and Austin look to government as the solution to Texas’ health care crisis, improving Texans’ access to health care services depends on reducing the government’s financial stake and involvement in our health care system. Easing regulations on nurse practitioners would offer more choices and affordable options for all Texas patients.
Andrea Whitman is a health care policy analyst at the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin.