While Massachusetts has led the nation with health care reform, residents of the Commonwealth continue to lack basic access to primary and specialty care across the state. Poor patient access to care, an uncontrolled opioid epidemic and rising healthcare costs together present a perfect storm. Many states however, have been proactive about removing practice barriers to increase access to NP driven care.
While other states have taken steps to position the Nurse Practitioners (NP) workforce to meet rising needs, antiquated and unnecessarily restrictive laws and licensing requirements leave Massachusetts as one of only 13 states in the nation – and the only state in New England – that continues to maintain a such a restrictive nurse practice act. The unintended consequence of health reform is access to healthcare coverage without the same level of access to health care. Without intervention for those patients seeking health care in Massachusetts, it is not likely to improve.
There are 9,500 qualified, educated Nurse Practitioners available to meet the healthcare challenges facing the Commonwealth. NPs are licensed, board certified and have achieved a Master’s or Doctoral degree. With documented high quality outcomes, they are equipped to fill the gaps, enhance access to care, provide life-saving treatment for opioid use disorder and deliver a much-needed cost savings to the Commonwealth – and to patients. In failing to use NPs to the full extent of their education and training to optimize the state’s healthcare delivery system, Massachusetts is missing an opportunity to best serve patients.
For patients seeking access to basic healthcare services in Massachusetts, including both primary and specialty care, restricted NP practice contributes to longer wait times. Research supports that for those patients seeking a new family medicine appointment, access delays in the Commonwealth are amongst the worst in the nation. Faced with longer wait times for appointments and contending with significant delays in care, patients may risk adverse health outcomes or rely on more costly care delivery settings, such as emergency rooms, for treatment.
Like the rest of the nation, the Commonwealth is experiencing an escalating number of opioid related deaths. According to the MA Department of Public Health, in 2016 there were 2,155 reported opioid related deaths in Massachusetts. Heartbreaking stories of neighbors, friends, coworkers, and family members dying from overdoses have become too familiar. All available resources must be leveraged to combat this public health crisis, including access to Medication Assisted Treatment (MAT), which has proven to be lifesaving. Nationally, NPs have contributed significantly to treating this disease. However, in Massachusetts, antiquated and unnecessarily restrictive laws and regulations mandating physician supervision for NP prescriptive practice are limiting the ability of NPs to respond to the epidemic. For those patients with opioid use disorder, such delays in receiving care can be life-threatening.
In 2009, a study by the Rand Corporation evaluating access and cost of care estimated Massachusetts could save millions of dollars through increased utilization of NPs. Despite these recommendations, the state has still not acted. Office visits with an NP are 20 – 35 percent lower in cost than physician driven visits, without compromise in quality outcomes. Medicare, Medicaid and private insurers presently reimburse NPs at rates that are 75-85% of the physician rate. As Healthcare costs continue to increase, utilization of NPs in care is a viable and responsible way to help bring costs down.
Presently, there is legislation pending on Beacon Hill which will remove barriers impeding Nurse Practitioners’ ability to practice to the full extent of their training and education. H.2451/S.1257, An Act to Contain Health Care Costs and Improve Access to Value Based Nurse Practitioner Care as Recommended by the IOM and FTC, will modernize Massachusetts licensure laws and grant Full Practice Authority to Nurse Practitioners in Massachusetts, thus removing the requirement for physician oversight for NP prescriptive practice. In doing so, NPs will be better positioned to respond to the evolving care delivery needs of the Commonwealth. Increased access to basic healthcare, specialty services and opioid use disorder treatment all mean significant cost savings for the Commonwealth.
As registered nurses with advanced Master’s or Doctoral level education and national certification in advanced practice nursing specialties, Nurse Practitioners have the knowledge and experience needed to deliver high-quality, cost-effective healthcare to patients.
Stephanie Ahmed, DNP, FNP-BC is Chair of the Massachusetts Coalition of Nurse Practitioners’ Legislative Committee and Former MCNP President