Why Does the FTC Care About NPs? We promote competition and protect consumers, utilizing a range of tools Health care competition has long been a significant part of our mission and work Deep engagement in NP scope of practice issues as part of our competition advocacy program Significant experience with the procompetitive effects of market disruption, more broadly If NPs help to disrupt the status quo, health care markets can function better.

FTC Perspective: Key Features of the Health Care Marketplace Industry participants at all levels are rethinking how to deliver and pay for health care services Shift from volume to value is key to achieving “triple aim” goals Increased coordination and collaboration are viewed as essential to effective reform

Competition Is Important! Competition benefits consumers – especially in industries undergoing rapid evolution and restructuring Promotes innovation Expands supply Improves quality and efficiency (“value”) May help to control costs Prevents harmful accumulation/exercise of market power Competition is good for health care delivery, just as it is for other industries and services.

APRN Scope of Practice Advocacy Remains a core focus of the FTC’s competition advocacy efforts March 2014 APRN Policy Paper Subsequent advocacy comments NPs should envision themselves as key marketplace competitors, capable of driving positive change. That’s certainly how the FTC thinks of them.

What Is Competition Advocacy? Provide a framework for thinking about public policy issues from a competition perspective What is the likely competitive impact? How will this affect consumers? Any legitimate justifications to restrict competition? Are there less restrictive alternatives? Protect consumers and fulfill other important public policy goals, BUT Do not unnecessarily restrict legitimate business activities, especially those that may promote competition

FTC Scope of Practice Advocacy: Main Themes All health care professionals should be allowed to practice to the top of their license, consistent with their training and knowledge Unnecessary supervision requirements, in particular, allow one group of health care professionals to restrict market access by a competing group Negative effects on access, cost, innovation “Safety” justifications may be pretextual

The Value of Collaboration Common argument: “FTC scope of practice advocacy demonstrates that the FTC is against team-based care” Another common argument: “Antitrust law prohibits collaboration among health care providers and frustrates the goals of health care reform” Both arguments are fallacies

Takeaway Lessons Competition among health care providers is good for health care consumers NPs should compete vigorously in the health care marketplace Requires removal of unnecessary scope of practice restrictions, among other barriers It’s entirely possible to compete AND collaborate Market disruption often fosters new forms of competition Innovative business models New ways of delivering services