FTC Urges State to Ease Up on Advanced Practice Registered Nurses

The Federal Trade Commission (FTC or Commission) published comments in response to a Missouri state legislative proposal to modify rules and regulations on collaborative practice arrangements between physicians and Advanced Practice Registered Nurses (APRNs). The FTC called on Missouri to consider further relaxation of physician supervision requirements in order to enhance competition.

The proposed bill would amend Missouri’s Nurse Practice Act to remove some constraints on collaborative practice arrangements between physicians and APRNs, changes the FTC praised. For example, the bill would permit offsite review of charts by a physician and potentially decrease the amount of time a collaborating physician must be physically present to supervise the APRN before the APRN can practice immediately.

On the other hand, the Commission warned that new restrictions imposed by the bill could harm competition. For instance, the bill may impose additional recordkeeping responsibilities for APRNs and add additional consultation responsibilities on physicians. The bill also retains the mandatory requirement for the collaboration structure and may continue to require in-person supervision twice per month.

In a statement applicable beyond Missouri’s borders, the FTC urged the state legislature to “scrutinize claimed health and safety justifications for its current supervision and collaboration requirements, review carefully whether any claims of potential patient harm are adequately substantiated and well founded, and evaluate whether the collaboration requirements are warranted.”

“If APRNs and other health care professionals are permitted to practice to the extent of their education, training, and abilities, the state could benefit from enhanced competition, including potentially lower costs and greater patient access to care. If the current restrictions are already greater than patient protection requires, we urge the legislature to adopt a bill that removes, rather than increases, oversight requirements that could further limit the provision of health care services by APRNs and, perhaps, other members of health care delivery teams.”

The Commission also referred to its recent policy paper on this issue, which concludes that these types of mandatory state requirements may stunt innovation in the health care system while increasing costs and provider shortages. The FTC believes that mandatory collaboration agreements – such as the ones required in Missouri – are not necessary to achieve the benefits of coordination between physicians and APRNs.

The comment can be found here. The FTC policy paper on the regulation of APRNs can be found here.

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