New brief offers implementation guidance for California bill allowing NPs to practice without physician supervision

The implementation of Assembly Bill 890 has the potential to improve critical workforce shortages and expand access to care in the state, says a new issue brief from the California Health Care Foundation (CHCF).

 

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AB 890, passed in September 2020 and scheduled to take effect in 2023, will allow nurse practitioners (NPs) who meet certain criteria to practice without physician supervision under the NPs’ own licenses. 

The brief details opportunities and potential challenges with the implementation of AB 890 and expanding NP services in the state, as well as recommendations for policymakers, health plans, NPs, and communities to best support NP practice as the bill takes effect. 

The brief cites physician-to-NP ratio mandates, supervision costs, and other administrative burdens as historical challenges in hiring NPs. Required physician-NP ratios limit the number of NPs that can be hired when there are less physicians, CHCF says.

“Without sufficient physicians to satisfy the ratio mandates, NPs could not be hired even when they were available and interested in working,” the brief says.

Clinic and health system leaders consulted in the development of the brief emphasized that, without the requirement of physician supervision, the administrative costs associated with physician supervision could be redirected so that support personnel could be hired to take over certain activities from these physicians. The brief states this would help ease physicians’ heavy workloads and help lessen burnout. 

The brief includes several recommendations, informed by key stakeholders, to ensure the most effective implementation of AB 890. 

“Promote understanding of NP practice”

To address a lack of understanding of the NP role, NP leaders suggest increasing exposure and messaging regarding NPs toward the public and community leaders to emphasize the important role NPs play in the health care system. The NPs interviewed for the brief suggested publishing accessible research about positive outcomes resulting from NP practice and using physician allies, especially those in primary care, to help spread messaging about the high-quality care NPs can provide. 

The interviewees also suggested community entities to promote NP practice, such as the AARP and child and family service providers who recognize the value of NPs in serving populations that often experience a lack of access to care to be messengers. 

“Remove remaining practice barriers”

The brief cites hospital policies limiting NP privileges and leadership roles, NP practices being unable to apply for rural health clinic designation, NPs being unable to serve as laboratory directors to offer lab services in their own clinics, and telehealth regulations as “unnecessary barriers” to NP practice. The brief also notes that some insurers do not allow NPs to bill for services directly.

The brief recommends providing NPs support in working with policymakers to help remove these barriers and align other laws with the provisions of AB 890. 

“Increase awareness of nurse-managed health centers”

According to the brief, nurse-managed clinics are typically affiliated with academic health centers for financial purposes. However, under AB 890, nurse-managed clinics not affiliated with academic health centers could expand existing or create new nurse-managed clinics to contract with county systems and FQHCs, which CHCF says will provide greater access to care. 

“Provide education/supports for NPs”

The interviewed NPs emphasized the need for continued education and supports, including skills to manage institutional, financial, billing, and other business operations-related tasks they will face. 

“If California NPs are to expand access to health care services, particularly in areas where practices do not already exist, they need to have business knowledge and skills to find funding and run their own businesses or expand practices within institutions,” the brief states.