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APSHO Supports Full Scope-of-Practice Regulation for Advanced Practitioners in Open Letter to President Biden

Published by Sandra Kurtin 3 months ago

The Advanced Practitioner Society for Hematology and Oncology (APSHO) sent an open letter to President Biden requesting support for regulatory changes that authorize advanced practitioners and other health professionals to practice to the full extent of their education, clinical competence, and experience during the COVID-19 pandemic.

The letter highlights scholarly research that demonstrates the safety and quality of care provided by advanced practitioners, and encourages continued commitment to promoting policies and regulations that maximize the education and skill sets of all health professionals.

The full letter follows:

President Joseph R. Biden, Jr.
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

Dear Mr. President:

On behalf of the Advanced Practitioner Society for Hematology and Oncology (APSHO), we congratulate you on winning the 2020 election. APSHO is a national organization representing advanced practitioners (APs) in oncology: nurse practitioners (NPs), physician assistants (PA), clinical nurse specialists (CNS), advanced degree nurses, and pharmacists (PharmD), roles critical to maintaining access to care for all patients living with a cancer diagnosis. Like you and your administration, we are committed to the peace of mind that comes with knowing every person in the United States of America has access to affordable, quality health care. To that end, APSHO stands ready to support and fully participate in the legislation and initiatives designed to improve access to quality and state-of-the-art health care across all groups regardless of age, income, place of residence, ethnicity, or gender identity. We endorse building on the Executive Order #13890, Protecting and Improving Medicare for our Nation's Seniors and the Health and Human Services (HHS) report “Reforming America’s Health Care System Through Choice and Competition.” The HHS report specifically recommends:

a. “Extremely rigid collaborative practice agreements and other burdensome forms of physician and dentist supervision are generally not justified by legitimate health and safety concerns,” and

b. “States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their license, utilizing their full skill set.”

APSHO, on behalf of our AP members, has a particular interest in continued work on emerging successfully from the COVID-19 pandemic, improving overall access to quality health care through re-invigorating the Affordable Care Act, extending the Centers for Medicare & Medicaid Services’ (CMS) guidelines to improve access to care, and continued work on the Cancer Moonshot initiative. COVID-19 has required enormous individual, team, and institutional agility and adaptability with an immediacy that has rarely if ever been required before. Health care organizations and individual health care personnel have had to quickly adapt and shift priorities. This demand for interprofessional agility requires each team member to work to the full scope of their practice to enhance each role in the team across the entire continuum of care.

The CMS rapid response to the COVID-19 public health emergency was essential to adding options to maximize health care delivery efficiency and to maintaining patient access to high-quality medical care in the early days of COVID-19. APSHO supported the numerous temporary waivers and regulatory changes that authorize APs and other health professionals to practice to the full extent of their education, clinical competence, and experience to meet the needs of our patients. By lifting burdensome and outdated restrictions on nurse practitioners, physician assistants, and pharmacists during the COVID-19 pandemic, CMS and many states demonstrated full confidence in and dependence upon AP practice.

Unfortunately, a leading physician organization, the American Medical Association (AMA), launched the #StopScopeCreep Campaign, suggesting that care given by APs is not safe care. A robust amount of scholarly research refutes this claim. Objective reports across multiple medical specialties and primary care settings have come to the opposite conclusion (Bruinooge et al., 2018; Cairo et al., 2017; Hylton & Smith, 2017; Johnson et al., 2019; McCleery et al., 2011; Patio et al., 2018; Shulman et al., 2017; Yen et al., 2020). APSHO has responded in kind with a campaign to positively emphasize the critical role APs play in the delivery of health care across health care settings: #APCareSafeCare.

Demands for primary care providers continue to be a concern today and even more so in our future. By 2025, at least 37 states will experience serious physician shortages (Streeter et al., 2017). Advanced practitioners contribute significantly to primary care, constituting more than 40% of the workforce (AHRQ, 2020). Physician recruitment to primary care in underserved areas is poor, but the number of APs delivering primary care in underserved areas has increased (Pohl et al., 2014). Team-based care, including expanded AP scopes of practice and development of state compacts for licensure, has been recommended for the past several years as one solution to this problem. Unfortunately, in most of the states with provider shortages, APs have restricted scopes of practice (Streeter et al., 2017).

Similar shortages have been projected for cancer care because the physician supply cannot match the demand of increased numbers of patients with new cancer diagnosis, those undergoing treatment, and long-term cancer survivors (ASCO, 2017; Yang et al, 2014). A collaborative workforce study between APSHO, the American Society of Clinical Oncology (ASCO), the American Academy of Physician Assistants (AAPA), the Association of Physician Assistants in Oncology (APAO), and the Oncology Nursing Society (ONS) examined the role of APs in oncology in the United States (Bruinooge et al., 2018). Conclusions from this study note that with the growing complexity of care, an AP independent model in a collaborative practice setting increased access to quality cancer care.

We appreciate your continued commitment to removing unnecessary practice barriers and expanding patient access to needed health care services. By promoting policies and regulations that maximize the education and skill sets of all health professionals, states, and communities are empowered to make informed decisions to improve access to quality health care tailored to their individual circumstances, available resources, and unique patient needs.

Sincerely,

Sandra E. Kurtin, PhD, ANP-C, AOCN®
President, Advanced Practitioner Society for Hematology and Oncology (APSHO)

References

Agency for Healthcare Research and Quality. (2020). 2018 National Healthcare Quality and Disparities Report. Content last reviewed April 2020. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/research/findings/nhqrdr/nhqdr18/index.html

American Association of Nurse Practitioners. States categorized by type. (2018b).

ASCO. (2017). The State of Cancer Care in America, 2017: A Report by the American Society of Clinical Oncology. J Oncol Pract, 13(4), e353-e394. doi:10.1200/JOP.2016.020743

Bruinooge, S., Pickard, T. A., Vogel, W., Hanley, A., Schenkel, C., Garrett-Mayer, E.,... Williams, S. F. (2018). Understanding the Role of Advanced Practice Providers in Oncology in the United States. J Oncol Pract, 14(9):e518-e532. DOI: 10.1200/JOP.18.00181

Cairo, J., Muzi, M. A., Ficke, D., Ford-Pierce, S., Goetzke, K., Stumvoll, D.,…Sanchez, F. A. (2017). Practice Model for Advanced Practice Providers in Oncology. Am Soc Clin Oncol Educ Book, 37, 40-43. doi:10.1200/edbk_175577

Hylton, H. M., & Smith, G. L. (2017). Collaborating With Advanced Practice Providers: Impact and Opportunity. Am Soc Clin Oncol Educ Book, 37, e1-e7. doi:10.1200/edbk_175654

Johnson, D., Ouenes, O., Letson, D., de Belen, E., Kubal, T., Czarnecki, C.,…Peabody, J. (2019). A Direct Comparison of the Clinical Practice Patterns of Advanced Practice Providers and Doctors. Am J Med, 132(11), e778-e785. doi:10.1016/j.amjmed.2019.05.004

McCleery, E., Christensen, V., Peterson, K., Humphrey, L., & Helfand, M. (2011). VA Evidence Synthesis Program Reports Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses. In VA Evidence Synthesis Program Evidence Briefs. Washington (DC): Department of Veterans Affairs (US).

Patio, C., Ali, N., Ketner, J., Young, C., Chou, E., Chong, C., & Su, W. (2018). Physician Assistants and Nurse Practitioners in Head and Neck Surgery. Cancer Treat Res, 174, 17-30. doi:10.1007/978-3-319-65421-8_2

Pohl, J., Barksdale, D., & Werner, K. (2014). Revisiting Primary Care Workforce Data: a Future without Barriers for Nurse Practitioners and Physicians. Health Affairs Blog, July 28, 2014. Accessed at https://www.healthaffairs.org/do/10.1377/hblog20140728.040428/full/

Shulman, L. N., Sheldon, L. K., & Benz, E. J. (2020). The Future of Cancer Care in the United States-Overcoming Workforce Capacity Limitations. JAMA Oncol, 6(3), 327-328. doi:10.1001/jamaoncol.2019.5358

Walling, A. M., D'Ambruoso, S. F., Malin, J. L., Hurvitz, S., Zisser, A., Coscarelli, A.,…Wenger, N. S. (2017). Effect and Efficiency of an Embedded Palliative Care Nurse Practitioner in an Oncology Clinic. J Oncol Pract, 13(9), e792-e799. doi:10.1200/jop.2017.020990

Yang, W., Williams, J. H., Hogan, P. F., Bruinooge, S. S., Rodriguez, G. I., Kosty, M. P.,…Goldstein, M. (2014). Projected supply of and demand for oncologists and radiation oncologists through 2025: an aging, better-insured population will result in shortage. J Oncol Pract, 10(1), 39-45. doi:10.1200/JOP.2013.001319

Yen, T. W. F., Laud, P. W., McGinley, E. L., Pezzin, L. E., & Nattinger, A. B. (2020). Prevalence and scope of advanced practice provider oncology care among Medicare beneficiaries with breast cancer. Breast Cancer Res Treat, 179(1), 57-65. doi:10.1007/s10549-019-05447-x

About APSHO

The Advanced Practitioner Society for Hematology and Oncology (APSHO) is a society for advanced practitioners—nurse practitioners, physician assistants, pharmacists, clinical nurse specialists, and other oncology health-care professionals. The mission of APSHO is to improve the quality of care for patients with cancer by supporting critical issues in educational, clinical, and professional development for advanced practitioners in hematology and oncology.