policy action plan: enabling competition for advanced practice registered nurses in illinois emily...
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Policy Action Plan:
Enabling Competition for Advanced Practice
Registered Nurses in Illinois
Emily ForrestHPA 430 Assignment
Outdated Laws of Illinois
“Dwarf-tossing” is outlawed in Springfield, IL Humming on public streets is prohibited on
Sundays in Cicero, IL A man with a moustache may not kiss a woman
in Eureka, IL Kites may not be flown within Chicago city limits Bowling is forbidden in Evanston, IL Roosters must back up 300 ft. from a residence
if they wish to crow in Kenilworth, IL An Illinois state law requires a man's female
companion shall call him "master" while out on a date.
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Outdated Laws of Illinois
Advanced Practice Nurses may not open their own business to practice a profession for which they are dually licensed to practice in Illinois.
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“Effective competition is at the core of America’s economy…staff urged several states to reject or narrow restrictions that curtail competition among healthcare providers and professionals because they limit patients’ access to health care and raise prices…Elimination of physician supervision and delegation requirements appears to be precompetitive.”
Federal Trade Commission-Office of Policy Planning, Bureau of Economics, and Bureau of Competition.
What is happening nationally? Patient Protection and Affordable Care Act
expected to add 32 million previously uninsured persons to rolls by 2019
78 million baby boomers will be 65 or older by 2030
Health care costs are rising on average 9-10% per year
RWJF-Alliance for Health Reform: 40% of physicians are 55 or older with 1/3
retiring in the next 10 years National movement to eliminate restrictions on
APN practice. 16 states and DC have independent practice for
APNs
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Illinois Demographics
Illinois’ elderly population will grow rapidly over the next 20 years as the “Baby Boomers” retire, many nurses & physicians among them. Every day for the next 10 years, 10,000 residents will turn age 65.Older populations have more chronic diseases and use more health care services.Healthcare demand will be high at the same time that the supply of nurses and physicians is dropping.Ranks 22nd in primary care physicians per 10,000 residents
8.1 per 10,000 people
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What is needed?
More competent and high quality healthcare providers to care for the aging and growing population!
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What is an APN?
Advanced Practice Nurse in Illinois Hold licensure as a Registered Nurse Hold licensure as an Advanced Practice Nurse Nationally certified to practice as a: Clinical
Nurse Specialist, Certified Registered Nurse Anesthetist, Nurse Midwife, or Nurse Practitioner
Have a Bachelor in Science and Nursing, at least 1 year of clinical experiences as a RN, and Masters of PhD in their clinical specialty
Focus on prevention
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Why Advanced Practice Nurses? They provide high quality health care equivalent
to or better than other health care providers at a lower cost.
Over 40 years or research has concluded Nurse Practitioners provide as good as or better care than primary care physicians Ask more questions and obtain better patient
history NPs patients follow recommended behavioral
changes better than patients of physicians. NPs were superior to physicians in management
of multiple chronic conditions, hypertension, and diabetes outcomes. BMJ, IOM, NEJM, OTA, FTC
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Why Advanced Practice Nurses? Certified Nurse Midwives
Compared to patients of physicians, CNM births with fewer costly tests and surgeries with comparable neonatal outcomes
Nurse Midwives have fewer births with complications compared to physicians (similar patients)
Clinical Nurse Specialists CNS outcomes reduce hospital length of stay Reduce hospital readmission rates Improve patient functioning
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Why Advanced Practice Nurses?Certified Registered Nurse Anesthetists
More likely to practice in rural areas. (Rural Health Research Center)
Lower mortality rates than Anesthesiologists based on Medicare data. (Research Triangle Institute)
Anesthesia care provided by CRNAs more cost effective (Nurse Economics)
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Cost of Education: CRNA vs. Anesthesiologist
Study published in Nursing Economics
CRNA Anesthesiologist
Direct Cost of Education
BA/BS/BSN $53,596 $53,696
Medical School $436,080
One year as acute care nurse
Required, no direct $134,042
First year residency
Total Pre-Anesthesia
$53,696 $623,818
Anesthesia Graduate Education
Direct Cost $68,465 $494,420
Student/Resident opp. cost
$291,353 $897,793
Productivity of students/residents
($251,704) ($755,073)
Total GE $108,113 $459,977
Total Estimated Cost
$161,809 $1,083,795
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Issue
In Illinois APNs are not allowed to legally open a business to practice nursing in a community.
Currently there are no restrictions in physician-ARPN collaborative agreement that require the APRN to work at the same practice as the collaborating physician
Illinois rural communities and elder population are in need of more health care services and access areas
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Proposed Action
Amending the Illinois Limited Liability Act and Professional Services Corporation Act
See handout for specific language
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Policy Paramours: Illinois General Assembly
Rep. Robin Gable (D-18)
Rep. Skip Saviano (R-77)
Rep. Monique Davis (D-27)
Rep. Barbara Flynn Currie (D-25)
Rep. Tom Cross (R-84)
Senator Heather Steans (D-7)
Sen. Mattie Hunter (D-3)
Sen. William Delgado (D-2)
Sen. Iris Martinez (D-20)
House of Representatives Senate
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Government Stakeholders
Illinois State Board of Health Illinois Board of Nursing Illinois Center for Nursing Illinois Department of Public Health Illinois Department of Financial &
Professional Regulation Illinois Department of Corrections Jessie White, Illinois Secretary of State
Business Services Department Agency for Healthcare Research and Quality
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Non Government Stakeholders
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Other Interest Groups
Lobbyists in Illinois who have relevant clients.Freeborn and Peters, LLP
Steven Mange, Senior Counsel John Stevens, Partner
Consulting 4 Biz Susan Clark, VP of Government Relations,
Illinois Association of Nurse Anesthetists Committees on Government Affairs, Political Action Committee, and Public Relations
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References
American Colleges of Medicine, Workforce Data 2010. The Future of Nursing. (2010) Institute of Medicine. United States Federal Trade Commission. Texas Senate Bill 1260
and 1339. Dulisse, B and Cromwel, J. (2010) No harm found when nurse
anesthetists work without supervision by physicians. Health Affairs Hogan, P et al. (2010).Cost Effectiveness Analysis of Anesthesia
Providers Nursing Economics. Horricks, S. et al. (2002) Systematic Review of Whether Nurse
Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors. British Medical Journal
Bielaszka-DuVernay, C. (2011). Improving Quality and Safety. Health Affairs.
Fairman, J. et al. (2011). Broadening the Scope of Nursing Practice. New England Journal of Medicine.
Consensus Model for APRN Regulation. (2008). National Council for State Boards of Nursing
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