Antiquated state laws have shut out competition and blocked the use of innovative technology in health care for far too long.
Incumbent providers claim these government barriers are necessary to ensure safety, but in reality, these protectionist policies hurt patients by driving up the costs of and reducing access to care. The pandemic has made these realities painfully obvious, so many Governors have made temporary changes to help fight the virus.
Americans for Tax Reform’s Grover Norquist was joined by Tay Kopanos of the American Association of Nurse Practitioners, Latoya Thomas of Doctor on Demand, and Nick Schilligo of 1-800 Contacts in a recent virtual panel discussion about the importance of states building upon these deregulatory efforts and making them permanent.
“At Americans for Tax Reform, at our website ATR.org/rules, we’ve come up with 500 different regulations, rules, and laws that have been either repealed or suspended because they got in the way of trying to get health care to people, trying to get hospitals and respirators to people, trying to get doctors and nurses to people or people to them as rapidly as possible,” said Norquist.
One of the deregulatory actions that Governors have taken to avoid provider shortages during the virus is expanding the scope of practice for certain health care providers.
Nurse Practitioners, for example, are highly trained, thoroughly educated medical professionals who can examine, diagnose, and treat injuries and illnesses. They can also prescribe medication and, in many cases, are primary care providers. Despite this, only 22 states and the District of Columbia grant Nurse Practitioners full practice authority, meaning their license to practice is not contingent on oversight by the state medical board or a contract with a physician.
“In the remaining 28 states and two other territories, NPs are required by law to have a contract with a physician – a permission slip, if you will – getting additional permission from a physician to be able to provide those services to patients,” explained Kopanos. “Those really create delays. If you don’t have a permission slip, even though your education qualifies you to provide those [types of] care, you can’t provide it.”
Five Governors, including Louisiana Governor John Bel Edwards, have issued executive orders completely waiving such requirements in their states. Others have taken baby steps in that direction by removing smaller barriers.
Governors in both red and blue states have also issued orders suspending some of the rules and regulations that restrict the use of telemedicine. The expanded use of telemedicine during the pandemic has allowed people to avoid getting sick or spreading the virus in a doctor’s office or hospital, and has made it easier for the elderly, who may have a harder time traveling, and people in remote areas to communicate with a doctor.
“[F]ar too many states have outdated and unnecessary laws and regulations that really prevent the full and widespread adoption of telemedicine,” explained Schilligo. “What some states require is a two-way interaction…some states require audio-visual, like we are doing now. Some states require a two-way audio. Some states even require that you have an in-person visit first to establish that patient-provider relationship, and then you could use telemedicine.” These pointless requirements make it more difficult for patients to use telemedicine.
State licensure laws are another barrier to telemedicine, and health care in general, for that matter. The pandemic has highlighted the way licensing requirements can prevent doctors and nurses from helping out – both in person and via telemedicine – in states with a higher number of cases.
“Then you also saw states that really did respond to it and were really immediate in waiving those out of state licensure requirements,” explained Thomas. “As long as they [providers] were duly licensed in another state, many of those states were able to just kind of acknowledge and recognize and allow them to see patients during the COVID period.”
To avoid provider shortages during the pandemic, Governors in many states, including Texas Governor Greg Abbott, issued orders granting some type of licensing reciprocity for medical providers.
While these temporary changes are a step in the right direction, Governors and legislatures should not stop there. Expanding upon these orders and making them permanent will increase the number of options for patients, improve quality, and naturally reduce the costs associated with health care.
“When you cut that bureaucratic red tape, those permission slips, and some of those hoops that come with it, costs of care go down,” explained Kopanos. “When we look at states that require those types of relationships against states that don’t, those head to head studies show [not only] that patient outcomes are high, but we’re [also] saving money in costs, were having decreased readmission, and there is also a bureaucratic cost savings to the states.”
“It’s great to have these temporary allowances for companies to come in and provide that care, but legislatures are still going to need to act in order to allow that in the long term,” explained Schilligo.
“I mentioned before that there are states, like Illinois, that have lifted that barrier, but with a condition. That you can practice here, only if you already have a relationship with a patient here. You also have states like California and Maryland, unfortunately, who’ve lifted that barrier, but have said ‘but you have to be employed by one of our hospitals or health systems,’ and that’s not fair market,” explained Thomas. “[T]hose are all conditional things that don’t allow for practices like ours, who have relationships with a number of patients and who want to support those larger systems and allow them to focus on some of the harder hit needs there.”
“The idea that medicine can work on computers and on phone lines and that people who have been trained to be Nurse Practitioners can actually do all the things that have been trained to do, and that people can cross state lines both on phones and on foot to provide the same services in New Hampshire that they’re capable of doing in Massachusetts seem kind of like obvious steps forward,” said Norquist. He added, “but Uber probably seemed obvious after somebody started doing it.”