Wednesday August 20th 2014

FTC policy paper examines competition and the regulation of APRNs

The Federal Trade Commission (FTC) recently released a policy paper that should be required reading for state legislators. “Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses” is a positive outcome of the 2011 Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health, which found that scope-of-practice restrictions “have undermined the nursing profession’s ability to provide and improve both general and advanced care.” The IOM report also stated that APRNs’ scope of practice varies widely “for reasons that are related not to their ability, education or training, or safety concerns, but to the political decisions of the state in which they work” and called upon the FTC to “review existing and proposed state regulations concerning advanced practice registered nurses to identify those that have anticompetitive effects without contributing to the health and safety of the public.”

In the past three years, FTC staff analyzed pending legislation and sent comment letters on the likely competitive effects of proposed APRN legislation in Connecticut, Florida, Kentucky, Louisiana, Massachusetts, Texas and West Virginia. Building on FTC agency work, related advocacy comments, and decades of research and experience, this new FTC policy paper sets forth recommended principles for evaluating APRN scope of practice proposals. As the policy paper states, “Numerous expert health care policy organizations have concluded that expanded APRN scope of practice should be a key component of our nation’s strategy to deliver effective health care efficiently and, in particular, to fill gaps in primary care access. Based on our extensive knowledge of health care markets, economic principles and competition theory, the FTC staff reach the same conclusion: expanded APRN scope of practice is good for competition and American consumers.”

Key findings:

• Decades of research and on-the-ground experience demonstrate that APRNs provide safe and effective care.

• Mandatory physician supervision and collaborative practice agreements are NOT justified by health and safety concerns.

• Mandatory physician supervision and collaborative practice agreements lead to higher costs, less innovation, reduced quality of care and decreased access to services.

• APRNs collaborate effectively with physicians and other health care providers without rigid, mandated models.

• Expanded APRN scope of practice is good for competition and consumers.

ANA supports the removal of barriers and discriminatory practices to RN and APRN practice, and believes that every patient deserves access to safe, quality care from all health care providers. ANA supports initiatives that allow all members of the health care team to fully function consistent with their education and training in a cooperative manner. To that end, ANA encourages the FTC to continue its competition advocacy work as health care evolves and overlapping patient care responsibilities between health care team members is the norm.

— Andrea Brassard is the director of Health Policy at ANA.

ANA resources

Visit the ANA website to learn more about APRN positions and resources at

Take action to support legislation in favor of APRNs at

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