Patient Outcomes and Cost Variations across Different Nurse Practitioner Scope of Practice Levels

During the COVID-19 pandemic, several executive orders and regulatory changes were issued to temporarily expand the scope of practice for various healthcare providers. These expansions were intended to increase the healthcare workforce's capacity to respond to the surge in COVID-19 cases and ensure continued access to care for patients.

Executive orders in many states temporarily allowed advanced practice nurse practitioners (NPs) and physician assistants (PAs) to practice independently without physician supervision (e.g. CMS 1135 Waivers). This expansion enabled NPs and PAs to perform tasks such as diagnosing and treating patients, prescribing medications, and managing patient care more autonomously.

While it is believed this expansion in NPs and PAs scope of practice can help to alleviate the burdens on physicians and increase access to care for patients, some physicians and physician organizations have also expressed strong concerns about these expansions, advocating that physicians should be the lead of the care team, as nonphysicians have less training than physicians, and allowing nonphysicians to practice independently could lead to reduced safety, lower quality or care, and even higher healthcare cost.

This proposal will examine patient outcomes (hospital readmission and in-hospital mortality) and care cost across three categories of States (full NP practice authority [n=27], reduced NP practice authority [n=12], and restricted NP practice authority [n=11]) for patients living with three common acute care conditions (acute myocardial infarction [AMI], heart failure, and pneumonia) and three common rehabilitation care conditions (ischemic stroke, total hip arthroplasty/total knee arthroplasty [THA/TKA], and hip/femur fractures).

Findings of this study will shed light on the potential benefits and challenges in varying NPs practice scopes, and in both clinical results and financial implications.