Policy Action Plan: Enabling Competition for Advanced Practice Registered Nurses in Illinois Emily Forrest HPA 430 Assignment

Outdated Laws of Illinois  “Dwarf-tossing” is outlawed in Springfield, IL  Humming on public streets is prohibited on Sundays in Cicero, IL  A man with a moustache may not kiss a woman in Eureka, IL  Kites may not be flown within Chicago city limits  Bowling is forbidden in Evanston, IL  Roosters must back up 300 ft. from a residence if they wish to crow in Kenilworth, IL  An Illinois state law requires a man's female companion shall call him "master" while out on a date. 2

Outdated Laws of Illinois  Advanced Practice Nurses may not open their own business to practice a profession for which they are dually licensed to practice in Illinois. 3

“Effective competition is at the core of America’s economy…staff urged several states to reject or narrow restrictions that curtail competition among healthcare providers and professionals because they limit patients’ access to health care and raise prices…Elimination of physician supervision and delegation requirements appears to be precompetitive.” Federal Trade Commission-Office of Policy Planning, Bureau of Economics, and Bureau of Competition.

What is happening nationally?  Patient Protection and Affordable Care Act expected to add 32 million previously uninsured persons to rolls by 2019  78 million baby boomers will be 65 or older by 2030  Health care costs are rising on average 9-10% per year  RWJF-Alliance for Health Reform:  40% of physicians are 55 or older with 1/3 retiring in the next 10 years  National movement to eliminate restrictions on APN practice.  16 states and DC have independent practice for APNs 5

Illinois Demographics  Illinois’ elderly population will grow rapidly over the next 20 years as the “Baby Boomers” retire, many nurses & physicians among them.  Every day for the next 10 years, 10,000 residents will turn age 65.  Older populations have more chronic diseases and use more health care services.  Healthcare demand will be high at the same time that the supply of nurses and physicians is dropping.  Ranks 22 nd in primary care physicians per 10,000 residents  8.1 per 10,000 people 6

What is needed? More competent and high quality healthcare providers to care for the aging and growing population! 7

What is an APN? Advanced Practice Nurse in Illinois  Hold licensure as a Registered Nurse  Hold licensure as an Advanced Practice Nurse  Nationally certified to practice as a: Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, Nurse Midwife, or Nurse Practitioner  Have a Bachelor in Science and Nursing, at least 1 year of clinical experiences as a RN, and Masters of PhD in their clinical specialty  Focus on prevention 8

Why Advanced Practice Nurses?  They provide high quality health care equivalent to or better than other health care providers at a lower cost.  Over 40 years or research has concluded Nurse Practitioners provide as good as or better care than primary care physicians  Ask more questions and obtain better patient history  NPs patients follow recommended behavioral changes better than patients of physicians.  NPs were superior to physicians in management of multiple chronic conditions, hypertension, and diabetes outcomes. BMJ, IOM, NEJM, OTA, FTC 9

Why Advanced Practice Nurses?  Certified Nurse Midwives  Compared to patients of physicians, CNM births with fewer costly tests and surgeries with comparable neonatal outcomes  Nurse Midwives have fewer births with complications compared to physicians (similar patients)  Clinical Nurse Specialists  CNS outcomes reduce hospital length of stay  Reduce hospital readmission rates  Improve patient functioning 10

Why Advanced Practice Nurses? Certified Registered Nurse Anesthetists  More likely to practice in rural areas. (Rural Health Research Center)  Lower mortality rates than Anesthesiologists based on Medicare data. (Research Triangle Institute)  Anesthesia care provided by CRNAs more cost effective (Nurse Economics) 11

Cost of Education: CRNA vs. Anesthesiologist Study published in Nursing Economics CRNAAnesthesiologist Direct Cost of Education BA/BS/BSN$53,596$53,696 Medical School $436,080 One year as acute care nurse Required, no direct $134,042 First year residency Total Pre-Anesthesia$53,696$623,818 Anesthesia Graduate Education Direct Cost$68,465$494,420 Student/Resident opp. cost $291,353$897,793 Productivity of students/residents ($251,704) ($755,073) Total GE$108,113$459,977 Total Estimated Cost$161,809$1,083,795 12

Issue  In Illinois APNs are not allowed to legally open a business to practice nursing in a community.  Currently there are no restrictions in physician-ARPN collaborative agreement that require the APRN to work at the same practice as the collaborating physician  Illinois rural communities and elder population are in need of more health care services and access areas 13

Proposed Action  Amending the Illinois Limited Liability Act and Professional Services Corporation Act See handout for specific language 14

Policy Paramours: Illinois General Assembly Rep. Robin Gable (D-18) Rep. Skip Saviano (R-77) Rep. Monique Davis (D-27) Rep. Barbara Flynn Currie (D-25) Rep. Tom Cross (R-84)  Senator Heather Steans (D-7)  Sen. Mattie Hunter (D-3)  Sen. William Delgado (D- 2)  Sen. Iris Martinez (D-20) House of Representatives Senate 15

Government Stakeholders  Illinois State Board of Health  Illinois Board of Nursing  Illinois Center for Nursing  Illinois Department of Public Health  Illinois Department of Financial & Professional Regulation  Illinois Department of Corrections  Jessie White, Illinois Secretary of State  Business Services Department  Agency for Healthcare Research and Quality 16

Non Government Stakeholders  Illinois Society of Advanced Practice Nurses  American Nurses Association-Illinois  Illinois Nurses Association  Illinois Association of Nurse Anesthetists  Association of Clinical Nurse Specialists  Better Business Bureau of Chicago and Illinois  Illinois Hospital Association  AARP-Illinois  Blue Cross Blue Shield of Illinois  Illinois Association of Health Plans  OSF Health Care  Methodist Medical Center of Illinois  Illinois Primary Health Care Association  Association of Women’s Health, Obstetric, and Neonatal Nurses  American Nurses Association  American Association of Nurse Anesthetists  NCSBN  American Academy of Nurse Practitioners  American Association of Colleges of Nursing  American Psychiatric Nurses Association 17

Other Interest Groups  Lobbyists in Illinois who have relevant clients.  Freeborn and Peters, LLP Steven Mange, Senior Counsel John Stevens, Partner  Consulting 4 Biz Susan Clark, VP of Government Relations,  Illinois Association of Nurse Anesthetists  Committees on Government Affairs, Political Action Committee, and Public Relations 18

References  American Colleges of Medicine, Workforce Data  The Future of Nursing. (2010) Institute of Medicine.  United States Federal Trade Commission. Texas Senate Bill 1260 and  Dulisse, B and Cromwel, J. (2010) No harm found when nurse anesthetists work without supervision by physicians. Health Affairs  Hogan, P et al. (2010).Cost Effectiveness Analysis of Anesthesia Providers Nursing Economics.  Horricks, S. et al. (2002) Systematic Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors. British Medical Journal  Bielaszka-DuVernay, C. (2011). Improving Quality and Safety. Health Affairs.  Fairman, J. et al. (2011). Broadening the Scope of Nursing Practice. New England Journal of Medicine.  Consensus Model for APRN Regulation. (2008). National Council for State Boards of Nursing 19