The Association of Nurse Practitioner Scope-of-Practice Laws With Emergency Department Use

BACKGROUND: Overuse and inappropriate use of emergency departments (EDs) remains an important issue in health policy. After implementation of Medicaid expansion, many states experienced an increase in ED use, but the magnitude varied. Differential access to primary care might explain such variation. OBJECTIVE: To determine whether the increase in ED use among Medicaid enrollees following Medicaid expansion was smaller in states that allowed greater access to primary care providers by permitting nurse practitioners (NPs) to practice without physician oversight. RESEARCH DESIGN: Examining data on ED use by Medicaid beneficiaries, we estimated random effects models to examine changes in ED visits. Models for 8 different clinical conditions were estimated, with each model including a linear time trend, indicators for Medicaid expansion and for the absence of physician oversight requirements, and an interaction between these 2 indicators. RESULTS: States requiring physician oversight of NPs had a 28% increase in ED visits relative to the preexpansion period, while states allowing NP practice without physician oversight had only a 7% increase. The increase in the share of visits covered by Medicaid in no-oversight states was 40% of the size of the increase in oversight states. CONCLUSIONS: Allowing NPs to practice without physician oversight was associated with a reduction in the magnitude of increase in ED use following Medicaid expansion. States that restrict NP practice should weigh the costs of maintaining these restrictions against the potential benefits of lower ED use. States considering Medicaid expansion should also consider relaxing NP scope-of-practice laws

Association (psychology) · Emergency department · Health care · Medical emergency · Nurse practitioners · Physician assistants · Political science · Scope (computer science) · Scope of practice · Computer Science · Emergency and Acute Care Studies · Healthcare Policy and Management · Law · Medicine · Nursing · Nursing Roles and Practices · Psychology

• Public health insurance expansions and non‐physician providers

  Open Access•Sukriti Beniwal, Lauren Hoehn-Velasco et al.•Journal of Policy Analysis and…•2025

  Añadir item

• Medicaid Increases Emergency-Department Use

  Open Access•Sarah Taubman, Sarah L Taubman et al.•Science•2014

  Añadir item

• Physician Assistants and Nurse Practitioners as a Usual Source of Care

  Open Access•Christine M Everett, Christine Everett et al.•The Journal of Rural Health•2009

  Añadir item

• The Contribution of Physicians, Physician Assistants, and Nurse Practitioners Toward Rural Primary Care

  Mark P Doescher, C Holly A Andrilla et al.•Medical Care•2014

  Añadir item

• Trends in Preventable Inpatient and Emergency Department Utilization in California Between 2012 and 2015

  Peter Cunningham, Yaou Sheng et al.•Medical Care•2018

  Añadir item

• Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians

  Peter I Buerhaus, Peter Buerhaus et al.•Medical Care•2018

  Añadir item

• Role of Geography and Nurse Practitioner Scope-of-Practice in Efforts to Expand Primary Care System Capacity

  John A Graves, Pranita Mishra et al.•Medical Care•2016

  Añadir item