Scopes of Practice: Best Practices to Address Big Problems 2011 BOC Athletic Trainer Regulatory Conference.

Scopes of Scopes of Practice: Practice:

Best Practices Best Practices to Address to Address

Big ProblemsBig Problems

Scopes of Practice: Scopes of Practice: Best Practices to Address Big Best Practices to Address Big ProblemsProblems

Catherine Dower, JD

Center for the Health Professions, UCSF

July 8, 2011

2011 BOC Athletic Trainer Regulatory Conference

The Problems

Scope of practice laws are

state-based and politically driven…

… resulting in state

variability and

unnecessary limitations on

practice.

Exclusive scopes of practice

exacerbate inter-

professional tensions.

The Challenge

Federal Health Care Legislation

PPACA

Federal Health Care Legislation

PPACA

1.Expanded coverage

2.Workforce investment

3.Investment in existing and new models

New models will encourage shift from acute and specialty

care to…

•Management of chronic conditions

•Primary care and care coordination

•Prevention and wellness

•Prevention of adverse events

New models will push providers and consumers to rethink how and

where care is delivered.

New models will push for expanded and overlapping scopes of practice

Best Practices

Several states have committees to help decide

scope issues.

Expert opinion, opinion pieces, anecdotes

Meta-analyses

Controlled trials

Educational curricula, accreditation standards

State laws & regulations

Demonstrations

Research studies

Government data, OIG reports

Survey articles, state studies

Qua

lity

of E

vide

nce

Degree of filtering

© 2008 UCSF Center for the Health Professions

Evidence pyramid gives guidance.

California uses a waiver process to test new scopes

of practice

Source: Center for the Health Professions, UCSF 2010

State sunrise

and sunset routes

Source: www.ncsbn.org

The Purpose of Regulation

The purpose of regulation – public

protection– should have top

priority in scope of practice

decisions, rather than

professional self-interest.

Source: www.ncsbn.org

The Purpose of Regulation

Changes in scope of practice are

inherent in our current healthcare

system.

Source: www.ncsbn.org

The Purpose of Regulation

Collaboration between healthcare

providers should be the

professional norm.

Source: www.ncsbn.org

The Purpose of Regulation

Overlap among professions is

necessary.

Source: www.ncsbn.org

The Purpose of Regulation

Practice acts should require

licensees to demonstrate that

they have the requisite training

and competence to provide a

service.

Source: www.ncsbn.org

Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education

Source: www.iom.edu

Recommendation # 1 Remove Scope of Practice Barriers

Advanced practice registered nurses should be able to practice to the full extent of their education and training. To achieve this goal, the committee recommends actions for the following entities:

State Legislatures

Congress

Centers for Medicare and Medicaid Services

Office of Personnel Management

Federal Trade Commission and Antitrust

Division of the Department of JusticeSource: www.iom.edu

HFederal Options for

Maximizing the Value of Advanced Practice Nurses in Providing Quality, Cost-

Effective Health CareBarbara J. Safriet, J.D., L.L.M.

Lewis & Clark Law SchoolINTRODUCTION

As decision makers at every level wrestle with the urgent need to broaden

access to health care, three challenges have become clear. The care

provided must be competent, efficient, and readily available at all

stages of life; it must come at a cost that both individuals and society

at large can afford; and it must allow for appropriate patient choice

and accountability. Among the options available to promote these

goals, one stands out: wider deployment of, and expanded practice

parameters for, advanced practice nurses (APNs). The efficacy of this

option is uniquely proven and scalable. These well-trained providers—

including nurse practitioners, nurse midwives, nurse anesthetists, and

clinical nurse Source: www.iom.edu

Three Take-Away Themes

INTEGRATION

ACCOUNTABILITY

CREATIVITY

Thank You!Thank You!

Catherine DowerCatherine [email protected]@thecenter.ucsf.edu

© 2011 C Dower Photos licensed to C Dower by istockphoto.