NR510 Week 7 Discussion Part 3: Restraint of Trade on NP Practice

NR510 Week 7 Discussion Part 3: Restraint of Trade on NP Practice (graded) The Federal Trade Commission has weighed in on several state battles over scope of practice, arguing that physician groups have no valid reason for blocking such laws other than to thwart competition. Discussion Question: How does “restraint of trade” apply to NP practice limitations? Provide evidence for your response. Topic responses • • More Sort By:    Meghan Mills Part 3 8/16/2016 2:11:28 PM How does “restraint of trade” apply to NP practice limitations? Provide evidence for your response. According to Timmons and Ridenour (1994), the concept of restraint of trade applies to nurse practitioner (NP) practice limitations with examples such as, the denial of hospital admitting or staff privileges and/or inequitable reimbursement levels. The application of the "restraints on trade" concept to advanced nursing practice is not a new development. In 1980, the Journal of Health Politics, Policy, and Law, published a report concerning federal antitrust law regarding physician dominance of other health practitioners. Dolan (1980) discusses the susceptibility of three specific practices to antitrust remedy, “the denial of admitting privileges, third-party reimbursement, and physician backup to nonphysician practitioners” (p. 675). Historically, advanced practice nurses and nursing organizations since the 1960s have fought hard for the NP role, specifically using the restraint of trade argument when lobbying to obtain malpractice insurance for NPs (Brush & Capezuti, 1996). NPs have and continue to face such challenges in the health care environment as Kuntz (2011) points out, “Advice previously offered by Timmons and Ridenour (1994) continues to ring true: more than ever, NPs must become politically active and pursue legal pathways to ensure that NPs’ contributions are recognized, and that fair practice and reimbursement policies are adopted” (p. 575). References Brush, B.L., & Capezuti, E.A. (1996). Revisiting “a nurse for all settings”: The nurse practitioner movement, . Journal of the American Academy of Nurse Practitioners, 8(1), 5- 11. Retrieved from Dolan, A.K. (1980). Antitrust law and physician dominance of other health practitioners. The Journal of Health Politics, Policy, and Law, 4(4), 675-690. doi:10.1215/ Kuntz, K.R. (2011). “Deadly spin” on nurse practitioner practice. Journal of the American Academy of Nurse Practitioners, 23(11), 573-576. doi:10.1111/j..2011.00667.x Timmons, G., & Ridenour, N. (1994), Legal approaches to the restraint of trade of nurse practitioners: Disparate reimbursement patterns, Journal of the American Academy of Nurse Practitioners, 6(2), 55-59. doi:10.1111/00918.x Show Less Katherine De Los Trinos-Ocamporeply to Meghan Mills RE: Part 3 Dear Meghan, 8/18/2016 3:31:25 PM You make a great point in acknowledging that NPs must become politically active to ensure that NPs are being recognized and fairly reimbursed for their services. The Institute of Medicine (IOM) published a report stating that NPs should be able to practice without restrictions that affect their scope of practice and that they should be compensated as primary care providers. In this report they also appealed to the FTC to further investigate the purpose of these restrictive laws because there has been a vast amount of data that provides evidence that NPs are capable of providing safe, effective, quality care regardless of the level of restrictions placed on the NPs level of autonomy (Iglehart, 2013). The report went as far as implying that these state laws were put in place not in the best interest of the population, but rather that of physicians. As we learned in this week's discussion interprofessional collaboration is the key to providing seamless, safe, effective care. Both nursing and medical organizations must come together to develop a new model of care that highlights the team dynamics needed to produce optimal patient outcomes (Inglehart, 2013). Until then NPs must be diligent in ensuring that their contributions to healthcare are being accurately documented and that they actively participate in the healthcare reformation process. Thanks for sharing! Katherine Reference Iglehart, J. (2013). Expanding the role of advanced nurse practitioners -Risks and rewards. The New England Journal of Medicine, 368, . doi:10.1056/NEJMhpr1301084 Show Less Instructor Duncanreply to Meghan Mills RE: Part 3 8/20/2016 12:09:23 PM Meghan, Unfortunately, this is a main concern for nurse practitioners as limitations like you mentioned greatly impede the NP ability to practice to the full extent of their education and training. Excellent post! Dr. Duncan Show Less Mijanou Marretta-Lewis Discussion Part Three Dr. Duncan and Classmates, 8/17/2016 1:21:27 PM If national healthcare reform is a basic right for all Americans to have quality healthcare, then there needs to be more primary care providers to fill those needs. The fundamental principle of the health care reform effort was to utilized human resources to their fullest extent. Advanced practice nurses (APNs) have demonstrated their ability to increase access to primary health care while maintain quality and reducing costs. Limitation on APNs scope-of- practice, prescriptive authority and third-party reimbursement impair the ability of successful integration into the delivery of this care. Regulation reform to enable APNs effective deployment not only will better this nation’s health, but also be the most singular step to further the practice of nursing. In regards to the physician shortage, practicing primary-care physicians are aging and retiring from practice, and replacement opportunities are diminishing. There is clear economic disincentive and disinterest in specializing in this field of practice. This could possibly be due to the fact the primary physicians are the lowest paying physician set thus causing medical students to specialize in a field that yields a higher income. The nurse practitioner shortage in some states is due to the discriminatory laws at state and national levels which impose legal constraints to independent practice. The National Alliance of Nurse Practitioners estimates 6,400 NP positions remain vacant due to limitation on scope of practice, prescriptive authority and third party reimbursement which impairs their integration into the healthcare delivery system. These barriers prevent large numbers of APNs from working efficiently and discourage them from staying in the field (Summers, 2016). Access health care became an issue in the 1960’s when President Johnson’s “Great Society” and the civil rights movement began. At the time for a small additional cost and education preparation, nurses could deliver primary health care services safely to the poor and more rural population. At the time physicians thought the idea was good because they could collect the revenue, increase their profits and not have to provide health care to the less desirable population of indigent and rural patients (The American Nurse, 2016).