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Changes in healthcare affecting AHP credentialing, Part 3: AHP scopes of practice

Credentialing & Verification Update, November 7, 2007

Note: This is the third entry in a multi-part series focusing on changes in healthcare that are affecting the way non-physician practitioners are credentialed and monitored. This week, we focus on AHPs' scopes of practice.

Several factors have converged to contribute to the expansion of AHPs' scopes of practice, including the following:

• Physician shortages, especially in underserved areas
• The need for hospitals and MCOs to stem costs
• Physicians' requests for higher levels of education and training for their AHP support staff
• AHPs' own expanding interests to seek advanced training and perform procedures that historically have been performed only by physicians

Over the past 10 years, at both the state and federal levels, many pieces of legislation have been introduced that propose expanding AHPs' scopes of practice, extending the level of AHPs' clinical independence, entitling more categories of AHPs to direct reimbursement.

Some of these efforts were successful. For example, in West Virginia, nurse practitioners won the right to be considered primary care practitioners within health maintenance organizations. Optometrists were able to expand their authority to prescribe diagnostic and therapeutic pharmaceuticals in several states.

In Virginia, physical therapists now have the authority to see patients without the need for a physician order, and several other states are also considering this option. Early on, Florida, Georgia, Kentucky, Maine, Minnesota, Rhode Island, West Virginia, and Washington legislated the right of registered nurse first assistants to direct reimbursement. As of this writing, several more states have approved or were considering similar legislation.

There is continuing controversy over the level of independence of the certified registered nurse anesthetist (CRNA). Until the end of 2001, the Centers for Medicare & Medicaid Services required physicians to supervise CRNAs. However, a rule published in the November 13, 2001, Federal Register gave state governors the authority to allow CRNAs to administer anesthesia care to Medicare patients without physician supervision. So far at least 12 states have opted out, thus exempting CRNAs from physician supervision.

Editor's note: For more information about AHPs' scopes of practice, see Solving the AHP Conundrum: How to Comply with HR Standards Related to Non-Privileged Practitioners, by Carol S. Cairns, CPMSM, available at www.hcmarketplace.com.

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