scopes of practice: best practices to address big problems 2011 boc athletic trainer regulatory...
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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.