Massachusetts is a leader in health care reform, yet patients continue to lack basic access to primary and specialty care.
Antiquated and restrictive laws and licensing requirements leave Massachusetts as the only state in New England that does not currently grant authority to nurse practitioners to practice to the full extent of their education and training. Massachusetts remains one of only 13 states in the country where their practice remains so restricted.
While there is a false perception that these barriers might somehow contribute to the safety of patients, in reality, the restrictions have real-life negative consequences, inhibiting the ability of patients seeking access to care. This challenge becomes most apparent as patients who are seeking a new health care provider for either primary care or specialty care are faced with longer wait times for appointments. This results in significant delays in care and patients are often forced to rely on more costly services provided in emergency room settings. In a worst-case scenario, patients face adverse health outcomes.
A striking example of how patients are directly impacted by such unnecessary restrictions to nurse-practitioner-driven care occurred locally in 2013 when a group of Quincy based mental health Nurse Practitioners were abruptly forced to stop delivering treatment to patients after the supervising physician was abruptly terminated from the practice. Under the current Massachusetts licensing regulations, this highly competent group of nurse practitioners no longer had the authority to prescribe necessary medications for this vulnerable population of patients. There was absolutely no change in their clinical skills and abilities, the only thing that changed is that the physician was no longer employed with the practice. Without any notice, 1,000 patients, many with significant mental health conditions, were left to find treatment elsewhere. With few options to choose from, many likely fell into emergency rooms and urgent care settings to obtain prescriptions from authorized providers who did not know them and lacked access to their behavioral health history.
Similarly, access to care has been documented as problematic for patients with opioid use disorder. Tragically, delays in treatment for this population can mean the difference between life and death. According to the Massachusetts Department of Public Health, of the 2,155 reported opioid related deaths in Massachusetts in 2016, 405 were in Plymouth and Norfolk counties. Although medication-assisted-treatment can be lifesaving for patients with opioid use disorder, there is a shortage of physicians who have sought the training required to prescribe this medication. Nationally, nurse practitioners contribute significantly to treating patients with opioid use disorder, but in Massachusetts restrictive licensing laws prohibit trained and qualified Nurse Practitioners from doing so without a supervising physician.
Lawmakers on Beacon Hill have an opportunity to address these access issues by passing pending legislation to modernize the licensure laws for nurse practitioners by removing the requirement for physician oversight of prescriptive practice and allowing nurse practitioners to practice to the full extent of their education, training and national certification.
Currently there are more than 9,500 actively licensed nurse practitioners in Massachusetts who are providing care to patients every day. As registered nurses with advanced degrees and national certification, nurse practitioners have the knowledge and experience needed to deliver high-quality, cost-effective healthcare to patients.
Research conducted in states where the practice is not unnecessarily restricted have lower health care administrative costs, improves health outcomes, increases the frequency of routine care and decreases emergency department use.
As a state beleaguered by access issues, a devastating opioid epidemic and unsustainable health care spending, Massachusetts must utilize the experience and expertise of nurse practitioners more fully. It is the right thing to do for patients and makes fiscal sense for the Commonwealth.
Stephanie Ahmed is former president of the Massachusetts Coalition of Nurse Practitioners and chairman of its legislative committee. Maria Grotz is a nurse practitioner who lives in Quincy.
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