There’s no disagreement that health care access is a critical issue for Ohioans. Elected, business and civic leaders have spent hundreds of millions of dollars attempting to solve this problem, but Ohio still falls short in delivering care.
The state should support a no-cost, high-reward way to address this shortage by providing patients with easier access to Ohio’s 16,000 Advanced Practice Registered Nurses (APRNs). Ohio should eliminate the so-called Standard Care Arrangement (SCA), an outdated state regulation amounting to little more than a fee APRNs must pay a physician in order to practice.
This cumbersome, unnecessary contract actually comes at a high financial cost to many APRNs and prevents patients from full and direct access to care where and when they need it most.
The need for care can’t be overstated. According to the Kaiser Family Foundation and the federal government, there are 159 areas in Ohio that face significant shortages of primary care health professionals. Nearly 1.5 million Ohioans live in these shortage areas. Statewide, nearly 45 percent of the demand for health care is unmet.
This is unthinkable considering Ohio has 16,000 APRNs qualified to fill this need, but they are limited by the state’s Standard Care Arrangement. These agreements do not ensure that physicians provide guidance to APRNs on patient care. Physicians don’t actually see the patients treated by APRNs. APRNs are required to provide a subset of their charts to physicians for review long after care is provided.
According to a recent study from nationally respected Peter Buerhaus for the American Enterprise Institute, people living in rural areas, and vulnerable populations such as nonwhites and women, are significantly more likely to receive their primary care from a nurse practitioner than a physician. This study also found that people living in states with laws reducing or restricting nurse practitioners’ scope of practice have significantly less access to primary care.
The study found no evidence to suggest that allowing nurse practitioners more autonomy had any negative impact on the quality of care. In fact, patients treated by nurse practitioners receive significantly higher quality care than physicians’ patients in several respects.
Other states have already acknowledged these conclusions. Twenty-two states and the District of Columbia have updated their laws to ensure patients can receive full and direct access to care from nurse practitioners. As a result, most of these states have experienced an increase in the APRN workforce practicing in underserved and rural areas.
The federal Department of Health and Human Services, in cooperation with the departments of Treasury and Labor and the Federal Trade Commission, recently released a study recommending that “states should consider changes to their scope-of-practice statutes to allow all health care providers to practice to the top of their license,” thereby utilizing their full skill set.
In its 2018 Best State Rankings, U.S. News & World Report ranks Ohio 36th in terms of health care access and quality. It's no coincidence that eight of the top 10 states for health care allow patients full and direct access to APRN care.
Thankfully, state Rep. Thomas Brinkman has recently acted for the benefit of Ohioans by introducing House Bill 177. This legislation would retire the Standard Care Arrangement, and, despite claims to the contrary, this does nothing to modify prescribing authority for APRNs. H.B. 177 would simply provide them more freedom to work and, in the process, assist in solving Ohio’s health care provider workforce shortage.
The time for the Ohio legislature to act is now. Giving Ohio's 16,000 APRNs the freedom to do their jobs will improve patient access and help thousands of Ohioans get the high-quality care they need and deserve.
Greaves is an advanced practice registered nurse and president of the Ohio Association of Advanced Practice Nurses.