title: Effects of Regulation and Payment Policies on Nurse Practitioners' Clinical Practices.
abstract: Increasing patient demand following health care reform has led to concerns about provider shortages, particularly in primary care and for Medicaid patients. Nurse practitioners (NPs) represent a potential solution to meeting demand. However, varying state scope of practice regulations and Medicaid reimbursement rates may limit efficient distribution of NPs. Using a national sample of 252,657 ambulatory practices, we examined the effect of state policies on NP employment in primary care and practice Medicaid acceptance. NPs had 13% higher odds of working in primary care in states with full scope of practice; those odds increased to 20% if the state also reimbursed NPs at 100% of the physician Medicaid fee-for-service rate. Furthermore, in states with 100% Medicaid reimbursement, practices with NPs had 23% higher odds of accepting Medicaid than practices without NPs. Removing scope of practice restrictions and increasing Medicaid reimbursement may increase NP participation in primary care and practice Medicaid acceptance.
authors.affiliation: 1 University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Barnes
authors.affiliation: 1 University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Claudia B
authors.initials: CB
authors.lastname: Maier
authors.affiliation: 1 University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Altares Sarik
authors.affiliation: 1 University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Hayley Drew
authors.initials: HD
authors.lastname: Germack
authors.affiliation: 1 University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
authors.affiliation: 1 University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McHugh
mesh_terms: D033161:Government Regulation; D018166:Health Care Reform / Q000379:methods; D006801:Humans; D008484:Medicaid; D006278:Medicare; D009722:Nurse Practitioners / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000639:trends*; D014481:United States
keywords: Medicaid; access to care; nurse practitioners; primary care; scope of practice