Expanding Nursing Scope of Practice to Address Michigan’s Healthcare Costs and Physician Shortages

Memorandum 1142, September 2016
In Brief

Patient health outcomes, patient experiences, and costs each are threatened by trends in Michigan’s healthcare services. Chronic health concerns coupled with expanded Medicaid and health insurance coverage and an aging population have created a higher demand for physicians, particularly primary care physicians. Healthcare costs are growing faster than the economy as a whole, making quality healthcare less affordable for individuals, businesses, and governments. These and other factors constrict access to healthcare.
Seven states, including Michigan, require a written agreement with a physician for a nurse practitioner to prescribe medication. Eighteen states plus Washington, D.C., permit nurse practitioners to diagnose and treat patients and prescribe medications without physician oversight, while 25 states require oversight of nurse practitioners’ diagnoses, treatment plans, and prescribing of medications. Michigan currently has the most restrictive scope of practice regulations in the Great Lakes Region.
The FTC position and a great deal of independent research supports that Advance Practice Registered Nurses (APRNs) practicing independently and with prescriptive authority will likely help reduce primary care physician shortages, improve access to healthcare in underserved areas, reduce healthcare costs, and provide care at or above the quality offered by physicians.
The primary considerations for policymakers considering expanding the scope of practice for APRNs include threats to patient safety that might result from care by professionals with less education and training, the need to update laws providing for medical malpractice liability for APRNs working independent of physicians, and voluntary or mandatory changes to third-party payment policies to reimburse APRNs for the services provided.
Michigan’s licensing of advanced practice registered nurses (APRNs), the laws allowing for creation of limited liability companies and allowing for the prescription of medications without written authorization from a physician, and the practices of insurance companies to allow for the direct payment APRNs for their services would need be altered to fully allow advance practice nurses to practice to the full extent of their training and certification.
An ideal healthcare system will create a seamless structure for consumers in which registered nurses, advance practice registered nurses, physician assistants, and physicians create a continuum of care and all health care providers can participate.

Memorandum 1142, September 2016
In Brief

Patient health outcomes, patient experiences, and costs each are threatened by trends in Michigan’s healthcare services. Chronic health concerns coupled with expanded Medicaid and health insurance coverage and an aging population have created a higher demand for physicians, particularly primary care physicians. Healthcare costs are growing faster than the economy as a whole, making quality healthcare less affordable for individuals, businesses, and governments. These and other factors constrict access to healthcare.
Seven states, including Michigan, require a written agreement with a physician for a nurse practitioner to prescribe medication. Eighteen states plus Washington, D.C., permit nurse practitioners to diagnose and treat patients and prescribe medications without physician oversight, while 25 states require oversight of nurse practitioners’ diagnoses, treatment plans, and prescribing of medications. Michigan currently has the most restrictive scope of practice regulations in the Great Lakes Region.
The FTC position and a great deal of independent research supports that Advance Practice Registered Nurses (APRNs) practicing independently and with prescriptive authority will likely help reduce primary care physician shortages, improve access to healthcare in underserved areas, reduce healthcare costs, and provide care at or above the quality offered by physicians.
The primary considerations for policymakers considering expanding the scope of practice for APRNs include threats to patient safety that might result from care by professionals with less education and training, the need to update laws providing for medical malpractice liability for APRNs working independent of physicians, and voluntary or mandatory changes to third-party payment policies to reimburse APRNs for the services provided.
Michigan’s licensing of advanced practice registered nurses (APRNs), the laws allowing for creation of limited liability companies and allowing for the prescription of medications without written authorization from a physician, and the practices of insurance companies to allow for the direct payment APRNs for their services would need be altered to fully allow advance practice nurses to practice to the full extent of their training and certification.
An ideal healthcare system will create a seamless structure for consumers in which registered nurses, advance practice registered nurses, physician assistants, and physicians create a continuum of care and all health care providers can participate.