Does Scope of Practice Affect Mobility of Nurse Practitioners Serving Medicare Beneficiaries?
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Does Scope of Practice Affect Mobility of Nurse Practitioners Serving Medicare Beneficiaries? Shishir Shakya1 · Alicia Plemmons2 Accepted: 30 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The shortage of nurse practitioners in the United States has broadly decreased access, decreased quality, and increased care costs. In some states, policymakers are trying to address such shortages by expanding nurse practitioners’ scope of practice or extending autonomy for nurses to order tests, prescribe medications, diagnose patients, and initiate and manage treatments. We exploit the state-level variations in the nurse practitioner’s scope of practice laws to estimate the impact on the mobility decisions of the nurse who serve Medicare beneficiaries. We identify nurse’s practice locations from 2013 to 2017 by gleaning their National Provider Identifiers from Part D Prescriber Public Use File data. We find that nurses in full-practice states are 0.41 percent less likely to move out of the state compared to nurses in restrictive-practice states. Also, nurses who move are 5.70 percent more likely to move to full-practice states than restrictive-practice states. Our estimates demonstrate nurses’ preference for practicing in states with the full scope of practice. Keywords Scope of practice · Nurse practitioners · Regulation · Mobility JEL Classification J44 · I18 · H75
Shishir Shakya
[email protected] Alicia Plemmons [email protected] 1
Department of Economics, Shippensburg University, 1871 Old Main Drive, Shippensburg, PA, 17257, USA
2
Department of Economics, Southern Illinois University, Edwardsville 125 Peck Services Road, c/o Alicia Plemmons AH 3132, Edwardsville, IL, 62026, USA
Journal of Labor Research
Introduction The shortage of nurse practitioners (NPs) in the United States has broadly limited access, reduced quality, and increased cost for an aging population in both metro and rural areas. The NP shortage is a key part of the more general and ever-increasing shortage of primary care. Accordingly, some states have expanded NPs’ scope of practice (SOP). In these states, NPs can use all of their training and education in various primary care roles, such as ordering testing, prescribing medication, diagnosing patients, and initiating and maintaining patient treatment. However, little is known about whether these policy changes incentivize NPs to relocate to areas where they have a full SOP. We estimate the impact of expanded NP SOP on the mobility decisions of NPs who serve Medicare beneficiaries enrolled in the Part D prescription-drug program. These expansions occurred at the state level. Therefore it is important for policy evaluation to know whether the legal differences in the job roles of NPs affect where they decide to both live and practice. We identify the location of practice decisions of individual NPs between 2014 and 2017 by gleaning their National Provider Identifiers (NPI) from the Part D Prescriber Public Use File data. Using a regression framework, we then
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