Solution to Improve State Health Outcomes and Access to Care for Medicare Beneficiaries: Full Practice of APRNs

To identify the influence of advanced practice registered nurse (APRN) restrictive practice laws on the number of APRNs providing services in various care settings, acute, primary, nursing home (long stay), and skilled nursing facility (short stay); understand the relationship between restrictive practice and number of Medicare beneficiary services across settings; and to understand the relationship between restrictive practice and overall quality of health care as indicated by Commonwealth Report state health rankings.

One large federal data set and 2 national annual reports with state rankings from 2022 were used in this comparative, descriptive study.

We summarized number of services × APRN × 1000 patients by state practice restriction (full, reduced, or restricted) and setting of care.

We evaluated interstate variability and reported states that performed significantly above or below the overall median across all settings. Last, we fitted a linear regression model to explore the association of number of services × APRN × 1000 beneficiaries with Commonwealth Report health ranking.

APRNs in full-practice states provide significantly more services than in reduced or restricted, regardless of care setting. After adjusting for practice restriction and care setting, no significant association was found between the number of services × APRN × 1000 beneficiaries and the state overall health ranking (regression coefficient β = 0.003, P = .736). However, practice restriction was found to be highly significant, with full-practice states indicating overall better health (P < .001), regardless of setting.

Commonwealth Health ranking was found to be highly significant, with full-practice states indicating overall better health, 16 to 18 rankings better than reduced or restricted practice (P = .001), remaining consistent across all settings of care. Restrictive practice laws reduce access to care. It is time states with restrictive and reduced practice reexamine their APRN practice laws to enable Medicare beneficiaries increased access to care and improve overall health outcomes.