By Caleb Taylor

ACRE Director and BTĚěĚĂProfessor of Economics Dr. David Mitchell joined Americans for Prosperity-Arkansas on May 20th to discuss some of ACRE’s work in the recent legislative session.

Mitchell said ACRE experts speak to legislators and community groups “to show what the data actually shows on a variety of issues.”

Mitchell said:

The goal is to be that resource. We’re really open to talking to people about how we can make Arkansas better.”

Mitchell said he was “really excited” about legislation passed in the previous legislative session to expand scope of practice for nurse practitioners in Arkansas.

Mitchell said:

Arkansas is near the bottom for primary care. I was really excited that this year we had two really important bills that are going to help people in especially rural areas. There’s plenty of practitioners in more urban areas. The drive to see a provider is usually very far in rural areas so having more nurse practitioners is going to be great.”

You can listen to the full legislative recap with Americans for Prosperity-Arkansas .

For more on Mitchell’s recent research and testimony on scope of practice issues, check out this ACRE Review post on March 17th.

For more on the topic, you can read “A Broad Consensus on Expanding Nurse Practitioners’ Scope of Practice” here.

You can also read another of Mitchell’s recent publications on this issue “Addressing Arkansas’s Health Services Shortages By Empowering Nurse Practitioners” here.

For more of ACRE’s research on nurse practitioners, check out our labor market regulation page.

Mitchell is also the co-author with Jordan Pfaff and Zachary Helms of an ACRE Policy BriefĚý entitled “Solving Arkansas’s Primary Care Problems by Empowering Nurse Practitioners.”

By Caleb Taylor

What changes can Arkansas legislators make to improve residents’ access to care?

Arkansas’s primary care shortage is a result of its “excessively restrictive” medical scope of practice laws, according to ACRE Director and BTĚěĚĂAssociate Professor of Economics Dr. David Mitchell in “” published in the Arkansas Democrat-Gazette on March 13th.

Mitchell writes:

One cause of our primary-care shortage is Arkansas’ excessively restrictive medical scope of practice laws. These laws don’t allow qualified, independently practicing nurse practitioners (NPs) to meet Arkansans’ needs in areas where there aren’t enough physicians practicing.ĚýThat may soon change. House Bill 1254 would allow NPs to be Medicaid primary-care providers, and House Bill 1258 would enable them to attain full practice authority after a three-year transition period. These are great steps toward a healthier Arkansas.”

In the op-ed, Mitchell notes only 5 counties out of 75 in Arkansas are not designated as health professional shortage areas by the U.S. Health Resources and Services Administration.

Mitchell also on March 15th at the Senate Public Health, Welfare and Labor committee. (Mitchell’s testimony begins at 3:06:48 P.M.)

Mitchell said:

The outcomes are what we care about. That’s what’s really important. Arkansas doesn’t have enough providers. We’d like to see more NPs move into these underserved areas. If they can’t see Medicaid patients in underserved areas where most people are on Medicaid, they can’t be financially viable. They can’t open a practice if they won’t be financially viable.”

and both have already passed the House and passed the Senate committee Monday, March 15th. Both will now be considered by the full Senate.

For more on the topic, you can read “A Broad Consensus on Expanding Nurse Practitioners’ Scope of Practice” here.

Check out our one-pager infographic and research distillation.

You can also read another of Mitchell’s recent publications on this issue “Addressing Arkansas’s Health Services Shortages By Empowering Nurse Practitioners” here.

For more of ACRE’s research on nurse practitioners, check out our labor market regulation page.

Mitchell is also the co-author with Jordan Pfaff and Zachary Helms of an ACRE Policy BriefĚý entitled “Solving Arkansas’s Primary Care Problems by Empowering Nurse Practitioners.”

By Caleb Taylor

How can Arkansas improve access to mental health care?Ěý

Zak Massey, a former ACRE Research Fellow, discussed the benefits to Arkansas’s mental health outcomes of expanding scope of practice for nurse practitioners in an op-ed published in Arkansas Business on July 27 entitled “.”

Massey writes:

Nurse practitioners can provide additional mental health care in underserved areas. They are educated in specialties, allowing some to be board-certified as psychiatric mental health nurse practitioners. Their training prepares them to provide pharmacological and therapeutic treatment for anxiety, depression, bipolar disorder, schizophrenia and much more.”

However, state law currently restricts nurse practitioners from practicing to the full extent of their training and education.

Massey writes:

But in the absence of a contract with a doctor, a nurse practitioner is unable to prescribe medications for those with mental illness. Arkansas law prevents a nurse practitioner from practicing independently without a written collaborative agreement with a physician. However, some physicians do not accept collaborative relationships. Twenty-two states do not require similar agreements. If NPs were allowed to act independently, more Arkansans would have access to care.”

Arkansas legislators have previously considered removing this restriction. ACRE Director and BTĚěĚĂAssociate Professor of Economics Dr. David Mitchell spoke before both the House and Senate Public Health, Welfare, and Labor committees on February 20 and February 26, 2019 about the need for increased scope of practice for nurse practitioners in Arkansas.

Members of the Senate Public Health, Welfare and Labor committee considered sponsored by Senator Dave Wallace. You can watch the livestream of the committee meeting . Members of the House Public Health, Welfare and Labor committee considered sponsored by Representative Robin Lundstrum. You can watch the livestream of the committee meeting .

Both bills failed narrowly in committee but this legislation will likely be deliberated on again in the next legislative session in 2021.ĚýĚý

For more of ACRE’s research on nurse practitioners, check out our labor market regulation page.

Mitchell is also the co-author with Jordan Pfaff and Zachary Helms of an ACRE Policy Brief entitled “Solving Arkansas’s Primary Care Problems by Empowering Nurse Practitioners.”

By Caleb Taylor

Does expanding the scope of practice of nurse practitioners improve mental health outcomes in certain populations?

ACRE Undergraduate Research Fellow Zakree Massey and BTĚěĚĂAssociate Professor of Economics and ACRE Director Dr. David Mitchell answer this question and more in a forthcoming paper entitled “Expanding the Use of Nurse Practitioners and Young Adult Mental Health.”Ěý

Massey is a part of ACRE’s Research Fellowship Program. In this program, students work with a professor or policy analyst to write a publishable research paper.Ěý

According to the abstract of the paper:

This paper examines the impact that expanding Nurse Practitioners’ scope of practice has on the mental health of certain populations. The state of mental health in the United States has been a growing area of concern over the past 30 years, especially in certain areas of the country within specific demographic groups. Unlike other studies, we concentrate on those distinct characteristics of the populations such as rurality and access to care. Using a panel data fixed effects model, and the NLSY97 panel data set, we find a relationship between the economy and anxiety/depression in young people.”

The NLSY97 panel data set refers to a survey of young men and women born in the years 1980-84; respondents were ages 12-17 when first interviewed in 1997, according to the .

Zak Massey is from Perryville, Arkansas. He is a senior majoring in Economics. His current research is considering whether the scope of practice of nurse practitioners in the state is too limited and contributing to the state’s shortage of medical care.

For more of ACRE’s research on nurse practitioners, check out our labor market regulation page.

Mitchell is also the co-author with Jordan Pfaff and Zachary Helms of an ACRE Policy Brief entitled Solving Arkansas’s Primary Care Problems by Empowering Nurse Practitioners.

How can Arkansas improve its access to medical care?

Let nurse practitioners practice to the full extent of their education and training, according to ACRE Economic Policy Analyst Dr. Maryam Almasifard in an op-ed “” published in the Arkansas Democrat-Gazette on March 9.Ěý

Almasifard says:

Residents in rural areas are even more likely to die from preventable causes than those in urban areas, according to the 2019 CDC report “Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties–United States, 2010–2017.”ĚýWhy is this happening? One explanation is that we have a serious shortage of primary-care providers, and primary-care shortages disproportionately affect people in poor and rural areas as well as racial and ethnic minorities. That makes getting access to health services more expensive and difficult than it has to be.”

According to Almasifard, Arkansas faces a growing primary care shortage.Ěý

Almasifard says:

What can we do? Increase access to quality health services, health information, and preventive care. Access to primary care reduces health inequalities and health-care costs by decreasing the need for expensive and unnecessary specialized care.ĚýOne way to do this is to let Arkansas nurse practitioners (NPs) practice to the full extent of their education and training. The National Academy of Medicine (2010), National Governors Association (2012), and Federal Trade Commission (2014) all support this proposal. All of these organizations have careful studies pointing toward the clear benefits of removing costly restrictions. This is not a radical idea. In 2017, 22 other states and the District of Columbia allowed NPs full practice authority, which includes the ability to legally provide primary-care services.ĚýNurse practitioners are registered nurses with either a master’s or a doctorate in nursing who practice in ambulatory, acute, or long-term care as primary and/or specialty providers. Right now, they are hamstrung by rules requiring them to work under a supervising physician. Our state regulations require NPs to be in a complicated and expensive collaborative agreement with a physician before they can provide services they are educated and trained to provide.”

You can read the entire op-ed .

Mitchell spoke before both the House and Senate Public Health, Welfare, and Labor committees on February 20 and February 26, 2019 about the need for increased scope of practice for nurse practitioners in Arkansas.

Members of the Senate Public Health, Welfare and Labor committee considered sponsored by Senator Dave Wallace. You can watch the livestream of the committee meeting . Members of the House Public Health, Welfare and Labor committee considered sponsored by Representative Robin Lundstrum. You can watch the livestream of the committee meeting .

Both bills failed narrowly in committee but increasing awareness about this issue may bring positive changes in the future.Ěý For more of ACRE’s research on nurse practitioners, check out our labor market regulation page.

Mitchell is also the co-author with Jordan Pfaff and Zachary Helms of an ACRE Policy Brief entitled Solving Arkansas’s Primary Care Problems by Empowering Nurse Practitioners.

By Caleb Taylor

Could Arkansans get better healthcare and save money with a simple regulatory change?

Dr. David Mitchell, an associate professor of economics at BTĚěĚĂand director of the Arkansas Center for Research in Economics, told the legislature that the answer is yes — and all Arkansans would have to do is let nurse practitioners do the work they already do in 22 other states.

Mitchell spoke before both the House and Senate Public Health, Welfare, and Labor committees on February 20th and February 26th about the need for increased scope of practice for nurse practitioners in Arkansas.

Members of the Senate Public Health, Welfare and Labor committee considered sponsored by Senator Dave Wallace. You can watch the livestream of the committee meeting . Members of the House Public Health, Welfare and Labor committee considered sponsored by Representative Robin Lundstrum. You can watch the livestream of the committee meeting .

Mitchell discussed the many groups that find increasing scope of practice for nurse practitioners to have positive effects, including both the Trump and Obama White Houses, the Federal Trade Commission, and the American Association of Retired Persons and noted that 22 states have full practice authority for nurse practitioners.

Mitchell went on to discuss the positive benefits that those 22 states experienced when they increased their scope of practice. Increasing scope of practice led to having a larger number of healthcare providers available as well as an increase in the quality of care provided. Mitchell also gave legislators an overview of the academic literature on nurse practitioners and explained that there is little to no evidence that increasing scope of practice leads to negative patient outcomes or overprescribing.

Mitchell then pointed out that in rural states like Arkansas, collaborative practice agreements (between nurse practitioners and doctors) make it more difficult for nurse practitioners to move to rural areas and provide better access to care.

Mitchell said his “conservative estimates” of expanding scope of practice for nurse practitioners would save state taxpayers $575,000 to $881,000 annually.

Mitchell testified on February 26th:

Nurse practitioners provide great care. Arkansans would be better off with better access to care. It saves the state money. The most important thing is this isn’t some radical idea. It’s narrow and low-risk…22 states already do this.”

Critics of the legislation focused on the lower educational requirements to become a nurse practitioner as opposed to those requirements for a physician.

Both bills failed narrowly in committee but increasing awareness about this issue may bring positive changes in the future. ĚýFor more of ACRE’s research on nurse practitioners, check out our labor market regulation page.

Mitchell is also the co-author with Jordan Pfaff and Zachary Helms of an ACRE Policy Brief entitled Solving Arkansas’s Primary Care Problems by Empowering Nurse Practitioners.

ACRE Director and BTĚěĚĂAssociate Professor of Economics Dr. David Mitchell recently discussed the role of nurse practitioners in increasing access to care in Arkansas.

Arkansas currently ranks 46th on the physician per capita list produced by the Association of American Medical Colleges, according to the Arkansas Democrat-Gazette.

Mitchell stated in an interview with Paul Harrell of Conduit News that reforming scope of practice regulations on nurse practitioners to allow for full practice authority could lead to hundreds of thousands of dollars in savings for Arkansas taxpayers annually.

Currently, Arkansas law only allows for nurse practitioners to practice under the supervision of physicians. Twenty-two other states have less restrictions on nurse practitioners than Arkansas.

Mitchell said:

We figured out that if only a few people on Medicaid switched to Nurse Practitioners from physicians we’d save about $575,000 per year. If more people switched, we’d save $1.7 million per year. What could we do with $1.7 million per year? We could give the money back to taxpayers. That’s a lot of police officers and a lot of school teachers. That’s a huge savings.”

For a full breakdown of the Medicaid savings from expanding scope of practice for nurse practitioners in Arkansas, check out our infographic here.

You can watch the full interview with Harrell here:Ěý

Mitchell also authored an op-ed on December 31st entitled “” in the Arkansas Democrat-Gazette. Mitchell discussed some of the common objections to increasing scope of practice authority for nurse practitioners in Arkansas.

Mitchell wrote:

Some worry that advanced-practice clinicians like NPs might have worse results than physicians or be practicing inferior medicine. Yet a randomized trial published in The Journal of the American Medical Association (JAMA) between physicians and nurse practitioners showed that nurse practitioners provide equivalent care. JAMA is the premier peer-­reviewed medical journal. A follow-up in Medical Care Research and Review confirmed that there was no difference between the groups in terms of primary-care health outcomes.”

For more on this topic, check out ĚýSolving Arkansas’s Primary Care Problems by Empowering Nurse Practitioners Ěýco-authored by Mitchell, Jordan Pfaff, and Zachary Helms.