Last month, the state House Professional Licensure Committee unanimously passed House Bill 100, which creates a pilot program for Pennsylvania’s nurse practitioners to practice without a physician’s collaborative agreement. At first glance, the legislation seems obscure, but in reality, it would transform Pennsylvania’s medical landscape by expanding access to rural health care.
Earlier this year, when the pandemic reached Pennsylvania, Gov. Tom Wolf and the Department of State first responded by repealing burdensome regulations in the health care sector. In other words, needless government red tape was removed when residents needed easy access to care. This included lifting restrictions on nurse practitioners, who were required to work under a collaborative agreement with a physician despite their extensive training.
Through HB 100, a pilot program would duplicate this year’s rule suspension within the limits of location- and population-based Health Professional Shortage Areas (HPSA), a federal designation of provider shortages. Today, 40 counties in Pennsylvania have at least one HPSA; Allegheny County alone contains six HPSAs.
As it stands, 31 of those 40 counties are in rural or semi-rural regions where expanding health care access is a top concern. According to the Center for Disease Control, rural residents are more likely to die prematurely from America’s 5 leading causes of death than residents in more urban areas. This sobering trend should resonate with Pennsylvania lawmakers. After all, based on the 2010 U.S. Census, over 1 in 4 Pennsylvanians live in rural areas.
Nurse practitioners, no doubt, are in a prime position to provide primary care in these struggling regions. As specialized high-level nurses—armed with masters’ degrees in their area of practice—they’re prepared to order and develop treatment plans for rural patients.
According to recent data from the Association of American Medical Colleges (AAMC), 12,910 of today’s 41,041 Pennsylvania physicians focus on primary care. Given Pennsylvania’s population, this means that for every primary care provider, there are almost 1,000 patients, which is an acceptable ratio. However, HB 100 would empower Pennsylvania’s 7,000 nurse practitioners, who are qualified to practice primary care in areas with provider shortages.
The reform makes sense, considering that nurse practitioners, in their specialized areas, can deliver care that is comparable to a physician. Jeffery Bauer, an internationally recognized medical economist, noted that in more than 100 published reports, “not a single study has found that nurse practitioners provide inferior services within the overlapping scopes of licensed practice.”
The data, then, is clear: nurse practitioners can play a vital role in expanding access to quality care in the regions that need it most. In a recent Capitolwire report, the Hospital and Healthsystem Association of Pennsylvania (HAP) stated that nurse practitioners “are a critical component of the health care delivery system, particularly during a time when research shows there is a health care workforce shortage in Pennsylvania.”
Even the Pennsylvania Medical Society (PAMED)—long opposed to removing collaborative agreements for nurse practitioners—concedes the role nurse practitioners can play in improving rural health care. In the Capitolwire report, PAMED Board of Trustees chair Dr. John Gallagher said that “as Pennsylvania struggles to identify ways to improve access to care in rural and underserved communities, PAMED’s Board of Trustees felt that this pilot program gave us the best opportunity to evaluate the clinical acumen of ‘independent CRNPs’ and measure their impact on quality and access in these areas.”
Last year, the state Senate approved an even broader bill granting independent practice for nurse practitioners. For now, HB 100’s passage in committee signals that both chambers are open to expanding rural health care access by eliminating unnecessary red tape. Though bureaucratic burdens remain—including for nurse anesthetists and physician assistants—this bill is a significant step to improve health care in Pennsylvania.