1. The Effects of Expanded Nurse Practitioner and Physician Assistant Scope of Practice on the Cost and Intensity of Medicaid Patient Care
Edward Timmons
Director, Knee Center for the Study of Occupational Regulation (CSOR)
Professor of Economics Saint Francis University
Loretto, PA
August 20 ; Alexandria, VA JCPP Summer 2019 Meeting

2. Motivation of Research
Does liberalizing the scope of practice have measurable impact?
Preview: Broader PA scope of practice (allowing prescription of controlled substances) associated with lower outpatient Medicaid claims
Additional research: Broadening NP scope of practice increases care intensity without increasing cost.

3. Evolving Role of PAs and NPs
Most states have expanded the role of each professional, but some laggards remain.

4. PA prescriptive authority in 2012
Note: Florida added in 2016.

5. NP prescriptive authority in 2012
Note: Alabama added in 2013 and Florida added in 2016

6. NP prescriptive authority changes: 1999-2012

7. Evolving Role of PAs and NPs
Almost all states now allow PAs to prescribe controlled substances (KY only exception)
All NPs are the same
More states are allowing NPs authority to prescribe w/o physician supervision or obtaining a collaborative practice agreement.

8. Strategy
Use what is called a difference-in-difference (DID) methodology, relying on states changing status
Centers for Medicare and Medicaid Services Medicaid Statistical Information System ( )

9. Results
Evidence that expanded PA scope of practice is associated with lower outpatient Medicaid claims ( % reduction)
Why? Medicaid reimbursement rates for PAs in many states are lower. Market fees also are generally lower.
Little evidence that expanded NP scope of practice is having measurable effect

10. Additional research
Poghosyan, Timmons, Abraham, and Martsolf 2019 Journal of Nursing Regulation
Use AANP definitions of scope of practice and focus on NPs
Expanded NP SOP increases total care days by 8%, but does not increase cost.
Grant funded: National Council of State Boards of Nursing

11. Conclusion
Expanded PA and NP scope of practice seems to reduce healthcare cost without sacrificing access or quality
States should consider expanding scope of practice for each professional.