The Association of Nurse Practitioner Scope-of-Practice Laws With Emergency Department Use


Benjamin J. McMichael, Joanne Spetz, and Peter I. Buerhaus

March 12, 2019

Overuse and inappropriate use of emergency departments (EDs) remains an important issue within the US health care system, as an estimated 37% of ED visits involve nonurgent care that could be provided in other care settings such as physician offices and urgent care centers.

Inappropriate ED use has salient consequences with some estimates placing its cost at $4.4 billion. 

This study examined whether nurse practitioners (NPs) and the scope-of-practice laws that govern them are associated with different levels of ED use following an increase in insurance access. In 2016, over 175,000 NPs were licensed to practice, NPs are the principal providers of primary care services in many areas of the country—particularly in rural areas that lack adequate access to care—and NPs are more likely than physicians to practice in primary care. NPs also practice in nontraditional settings, such as retail and urgent clinics.

NPs play a significant role in providing primary care, and scope-of-practice laws—particularly laws regulating the degree to which a physician must supervise the practice of an NP—impact the ability of NPs to fulfill this role. 

This study examined emergency department (ED) use following Medicaid expansion in states that allowed and prohibited NPs to practice without physician oversight.

We find that allowing NPs to practice without physician oversight was associated with a smaller increase in ED use following Medicaid expansion. 

States that restrict NP practice should weigh the potential costs of maintaining these restrictions relative to the likely benefits of lower ED use which may be achieved by their removal.