AAFP Warns of Dangers in Bill to Expand NPPs’ Practice Scope

The Improving Care and Access to Nurses Act (H.R. 8812), cautioned the AAFP and more than 75 co-signatories, “would allow NPPs to perform tasks and services outside their education and training and could result in increased utilization of services, increased costs and lower quality of care for our patients.”

“We are deeply concerned that this broad, sweeping bill endangers the care of Medicare and Medicaid patients by expanding the types of services NPPs can perform and removing physician involvement in patient care,” said the Nov. 2 letter.

The legislation would broaden the authority of nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, clinical nurse specialists and physician assistants while narrowing or removing supervisory requirements. For example, NPs, CRNAs, nurse midwives and clinical nurse specialists would be allowed to order and supervise cardiac and pulmonary rehabilitation as well as perform all mandatory examinations in skilled nursing facilities.

The letter reinforced long-standing AAFP support for physician-led, team-based care, saying that patients expect “physician experts with unmatched training, education and experience to be diagnosing and treating injured or sick individuals and making often complex clinical determinations.” Passing H.R. 8812, the groups said, would lower the standard of care and clinical expertise for Medicare and Medicaid patients.

“Moreover, NPPs overutilize services and unnecessarily increase costs by overprescribing, ordering more X-rays than are needed and over-engaging specialists,” the letter added. “In states that allow independent prescribing, NPs and PAs were 20 times more likely to overprescribe opioids than those in prescription-restricted states.

The letter was sent to ranking members of the U.S. House of Representatives’ Ways and Means and Energy and Commerce committees. The national and state medical groups co-signing with the AAFP included the AMA, the American Osteopathic Association and the American College of Physicians.