SD25 - Study of the Optimum Use of Nurse Practitioners Pursuant to SJR 164 of 1994

Executive Summary:
Senate Joint Resolution (SJR) 164 of the 1994 Session requested the Joint Commission on Health Care to study the strategies and incentives necessary to promote cost-effective health care delivery by making optimum use of nurse practitioners.

This report summarizes the current status, education, and distribution of nurse practitioners in our state. Nurse practitioners, nurse midwives, and nurse anesthetists are licensed and regulated by the Virginia Boards of Nursing and Medicine. Virginia is one of seventeen states which grant to nurse practitioners the authority to prescribe Schedule VI controlled substances. Virginia educates approximately 3% of the country's total nurse practitioner graduates each year. The distribution of nurse practitioners reflects an urban and suburban predominance, with 55% practicing in three major metropolitan areas of the state. Salaries of Virginia nurse practitioners are comparable to national averages. Nationally, twenty-five states (including two of Virginia's five border states) require direct reimbursement by third party insurers to nurse practitioners.

This issue brief discusses the numerous barriers to optimum utilization of Virginia nurse practitioners in primary care settings, and outlines various options to address these barriers. Options for consideration include:

• reconsideration of restrictive statutory requirements for supervision of nurse practitioner prescriptive authority;

• inclusion of nurse practitioners as mandated non-physician health service providers for the purposes of accident and sickness insurance policies;

• development of a method for collecting data on the services provided by nurse practitioners;

• analysis of including NPs as primary care providers under Key Advantage and Medallion, and expanding the categories of NPs eligible for reimbursement under Medicaid;

• examination of state-sponsored incentives to practice in underserved areas;

• an increase in the amount of state scholarships for nurse practitioner education;

• provision of support for collaborative training models for physicians and nurse practitioners in the state academic medical centers.

Our review process on this topic included an initial staff briefing which you will find in the body of this report followed by a public comment period during which time interested parties forwarded written comments to us on the report. In many cases, the public comments, which are provided at the end of this report, provided additional insight Into the various topics covered in this study.