Dataset Information

Effects of the ACA Medicaid expansions on access and health by nurse practitioner scope of practice laws.

ABSTRACT:

Background

The Affordable Care Act (ACA) Medicaid expansions increased demand for care whereas the Scope of Practice (SOP) laws for nurse procatitioners affect the supply of primary care providers. It is important to udnerstand the interaction of the demand and supply side policies on measures of access to care and health status.

Purpose

To examine whether effects of the Affordable Care Act (ACA) Medicaid expansions on access to care and health status are moderated by state scope of practice (SOP) laws for nurse practitioners.

Methods

Using data from the 2011 to 2019 Behavioral Risk Factor Surveillance System, the study used a difference-in-differences design that compared outcome changes between expansion and non-expansion states and evaluated whether these changes differed by state SOP laws.

Discussion

Following Medicaid expansion, forgoing a needed doctor's visit due to cost declined more in expansion states with full SOP laws than states with reduced SOP laws by 3.0 percentage-points in years 1 to 3 after the expansion (p < .05). Furthermore, completing a routine checkup with a doctor increased more in expansion states with full SOP laws by 3.2 percentage-points in 4 to 6 years (p < .05).

Conclusion

The ACA Medicaid expansions were associated with larger gains in certain access measures in states with full SOP laws.

SUBMITTER: Bin Abdul Baten R

PROVIDER: S-EPMC9007859 | biostudies-literature | 2022 Mar-Apr

REPOSITORIES: biostudies-literature

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Publications

Effects of the ACA Medicaid expansions on access and health by nurse practitioner scope of practice laws.

Bin Abdul Baten Redwan R Wehby George L GL

Nursing outlook 20220131 2

<h4>Background</h4>The Affordable Care Act (ACA) Medicaid expansions increased demand for care whereas the Scope of Practice (SOP) laws for nurse procatitioners affect the supply of primary care providers. It is important to udnerstand the interaction of the demand and supply side policies on measures of access to care and health status.<h4>Purpose</h4>To examine whether effects of the Affordable Care Act (ACA) Medicaid expansions on access to care and health status are moderated by state scope ...[more]

PMID: 35105452

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Project description:Policy Points The increased use of nurse practitioners represents a viable policy option to address continuing access-to-care deficiencies across the United States, but state scope-of-practice laws limit the ability of nurse practitioners to deliver health care. Groups in favor of restrictive scope-of-practice laws have argued that relaxing these laws will lead to increases in opioid prescriptions during an already severe opioid crisis, implicating patient safety concerns. An examination of a data set of 1.5 billion opioid prescriptions demonstrates that relaxing nurse practitioner scope-of-practice laws generally reduces opioid prescriptions. This evidence supports eliminating restrictive scope-of-practice laws that currently govern nurse practitioners in many states.ContextAs many parts of the United States continue to face physician shortages, the increased use of nurse practitioners (NPs) can improve access to care. However, state scope-of-practice (SOP) laws limit the ability of NPs to provide care by restricting the services they can provide and often requiring physician supervision of their practices. One important justification for the continuation of these restrictive SOP laws is preventing the overprescription of certain medications, particularly opioids.MethodsThis study examined a data set of approximately 1.5 billion individual opioid prescriptions between 2011 and 2018, which were aggregated to the individual provider-year level. A series of difference-in-differences regression models was estimated to examine the association between laws allowing NPs to practice independently and opioid prescribing patterns among physicians and NPs. Opioid prescriptions were measured in total annual morphine milligram equivalents (MMEs) prescribed by individual providers.FindingsAcross all NPs and physicians, independent NP practice was associated with a statistically significant decline of 6%, 2%, 3%, 7%, and 5% in total annual MMEs prescribed to commercially insured, cash-paying, Medicare, government-assistance, and all patients, respectively. Medicaid patients saw no statistically significant change in annual MMEs. Across all payers, NPs generally increase and physicians generally decrease the number of opioids they prescribe following a grant of NP independence. These counterbalancing changes result in an overall net decline in MMEs.ConclusionsNo evidence supports the contention that allowing NPs to practice independently increases opioid prescriptions. The results support policy changes that allow NPs to practice independently.

Project description:ObjectiveNurse turnover can compromise the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. In this study, we used human resource records from a multistate home health organization to examine the relationship between nurse turnover and whether nurses can delegate tasks to unlicensed aides.DesignA retrospective, cross-sectional analysis.Setting and participantsThe study sample included 1820 licensed practical nurses and 3309 registered nurses, who spanned 30 states. The study period was 2016 through 2018.MethodsWe used weighted least squares to study the relationship between nurse turnover for registered and licensed practical nurses and task delegation across state-years. We measured task delegation continuously (0-16 tasks) and as a binary variable (14 or more tasks, which indicated the state was in the top half of the distribution).ResultsAcross state-years, the turnover rate was 30.8% for licensed practical nurses and 36.8% for registered nurses. Although there was no significant relationship between task delegation and turnover among registered nurses, we found that states in which nurses could delegate the most tasks had lower turnover rates among licensed practical nurses.Conclusion and implicationsThe ability to delegate tasks to unlicensed aides was correlated with lower turnover rates among licensed practical nurses, but not among registered nurses. This suggests that the ability to delegate tasks is more likely to affect the workload of licensed practical nurses. This also points to a potential and unexplored element of expanding the scope of practice for nurses: reduced turnover. Given the added work-related hazards associated with home health care, including working in isolation, a lack of social recognition, and inadequate reimbursement, states should consider whether changes in their policy environment could benefit nurses working in home health.

Project description:BackgroundSeveral states expanded Medicaid under the Affordable Care Act using Section 1115 waivers to implement healthy behavior incentive (HBI) programs, but the impact of this type of expansion relative to traditional expansion is not well understood.ObjectiveTo examine whether Medicaid expansion with healthy behavior incentive programs and traditional Medicaid expansion were associated with differential changes in coverage, access, and self-rated health outcomes among low-income adults.DesignDifference-in-differences analysis of American Community Survey and Behavioral Risk Factor Surveillance System data from 2011 to 2017.ParticipantsLow-income adults ages 19-64 in the Midwest Census region (American Community Survey, n = 665,653; Behavioral Risk Factor Surveillance System, n = 71,959).InterventionsExposure to either HBI waiver or traditional Medicaid expansion in the state of residence.Main measuresCoverage: Medicaid, private, or any health insurance coverage; access: routine checkup, personal doctor, delaying care due to cost; health: cancer screening, preventive care, healthy behaviors, self-reported health.Key resultsHealthy behavior incentive (HBI) and traditional expansion (TE) states experienced reductions in uninsurance (- 5.6 [- 7.5, - 3.7] and - 6.2 [- 8.1, - 4.4] percentage points, respectively) and gains in Medicaid (HBI, + 7.6 [2.4, 12.8]; TE, + 9.7 [5.9, 13.4] percentage points) relative to non-expansion states. Both expansion types were associated with increases in rates of having a personal doctor (HBI, + 3.8 [2.0, 5.6]; TE, + 5.9 [2.2, 9.6] percentage points) and mammography (HBI, + 5.6 [0.6, 10.6]; TE, + 7.3 [0.7, 13.9] percentage points). Meanwhile, checkups increased more in HBI than in TE states (p < 0.01), but no other changes in health care services differed between expansion types.ConclusionsMedicaid expansion was associated with improvements in coverage and access to care with few differences between expansion types.

Project description:AimsTo investigate the scope of practice of nurse-led services for people experiencing homelessness, and the influence on access to healthcare.DesignA scoping review.Data sourcesOn 20 November 2020, the following databases were searched: CINAHL, Embase, MEDLINE, PubMed and Scopus.Review methodsIncluded studies focused on people experiencing homelessness aged 18 years and over, nurse-led services in any setting and described the nursing scope of practice. Studies were peer-reviewed primary research, published in English from the year 2000. Three authors performed quality appraisals using the mixed methods assessment tool. Results were synthesized and discussed narratively and reported according to the PRISMA-ScR 2020 Statement.ResultsNineteen studies were included from the United States (n = 9), Australia (n = 4), United Kingdom (n = 4) and Canada (n = 2). The total participant sample size was n = 6303. Studies focused on registered nurses (n = 10), nurse practitioners (n = 5) or both (n = 4), in outpatient or community settings. The nursing scope of practice was broad and covered a range of skills, knowledge and attributes. Key skills identified include assessment and procedural skills, client support and health education. Key attributes were a trauma-informed approach and building trust through communication. Important knowledge included understanding the impact of homelessness, knowledge of available services and the capacity to undertake holistic assessments. Findings suggest that nurse-led care facilitated access to healthcare through building trust and supporting clients to access services.ConclusionOptimized nursing scope of practice can facilitate access to healthcare for people experiencing homelessness. Key factors in enabling this include autonomy in nursing practice, organizational support and education.ImpactThe broad range of skills, knowledge and attributes reported provide a foundation from which to design an educational framework to optimize the nursing scope of practice, thereby increasing access to healthcare for people experiencing homelessness.

Dataset Information

Effects of the ACA Medicaid expansions on access and health by nurse practitioner scope of practice laws.

Background

Purpose

Methods

Discussion

Conclusion

Publications

Effects of the ACA Medicaid expansions on access and health by nurse practitioner scope of practice laws.

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