1. Scopes of Practice: Best Practices to Address Big Problems 2011 BOC Athletic Trainer Regulatory Conference

2. Scopes of Practice: Best Practices to Address Big Problems Catherine Dower, JD Center for the Health Professions, UCSF July 8, 2011 2011 BOC Athletic Trainer Regulatory Conference

3. The Problems

4. Scope of practice laws are state- based and politically driven…

5. … resulting in state variability and unnecessary limitations on practice.

6. Exclusive scopes of practice exacerbate inter- professional tensions.

7. The Challenge

8. Federal Health Care Legislation PPACA

9. Federal Health Care Legislation PPACA 1.Expanded coverage 2.Workforce investment 3.Investment in existing and new models

10. New models will encourage shift from acute and specialty care to… Management of chronic conditions Primary care and care coordination Prevention and wellness Prevention of adverse events

11. New models will push providers and consumers to rethink how and where care is delivered.

12. New models will push for expanded and overlapping scopes of practice

13. Best Practices

14. Several states have committees to help decide scope issues.

15. Expert opinion, opinion pieces, anecdotes Meta- analyses Controlled trials Educational curricula, accreditation standards State laws & regulations Demonstrations Research studies Government data, OIG reports Survey articles, state studies Quality of Evidence Degree of filtering © 2008 UCSF Center for the Health Professions Evidence pyramid gives guidance.

16. California uses a waiver process to test new scopes of practice Source: Center for the Health Professions, UCSF 2010

17. State sunrise and sunset routes

18. Source: www.ncsbn.org

19. The Purpose of Regulation  The purpose of regulation – public protection– should have top priority in scope of practice decisions, rather than professional self-interest. Source: www.ncsbn.org

20. The Purpose of Regulation  Changes in scope of practice are inherent in our current healthcare system. Source: www.ncsbn.org

21. The Purpose of Regulation  Collaboration between healthcare providers should be the professional norm. Source: www.ncsbn.org

22. The Purpose of Regulation  Overlap among professions is necessary. Source: www.ncsbn.org

23. The Purpose of Regulation  Practice acts should require licensees to demonstrate that they have the requisite training and competence to provide a service. Source: www.ncsbn.org

24. Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education

25. Source: www.iom.edu

26. Recommendation # 1 Remove Scope of Practice Barriers Advanced practice registered nurses should be able to practice to the full extent of their education and training. To achieve this goal, the committee recommends actions for the following entities:  State Legislatures  Congress  Centers for Medicare and Medicaid Services  Office of Personnel Management  Federal Trade Commission and Antitrust Division of the Department of Justice Source: www.iom.edu

27. H Federal Options for Maximizing the Value of Advanced Practice Nurses in Providing Quality, Cost-Effective Health Care Barbara J. Safriet, J.D., L.L.M. Lewis & Clark Law School INTRODUCTION As decision makers at every level wrestle with the urgent need to broaden access to health care, three challenges have become clear. The care provided must be competent, efficient, and readily available at all stages of life; it must come at a cost that both individuals and society at large can afford; and it must allow for appropriate patient choice and accountability. Among the options available to promote these goals, one stands out: wider deployment of, and expanded practice parameters for, advanced practice nurses (APNs). The efficacy of this option is uniquely proven and scalable. These well-trained providers—including nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse Source: www.iom.edu

28. Three Take- Away Themes

29. INTEGRATION

30. ACCOUNTABILITY

31. CREATIVITY

32. Thank You! Catherine Dower cdower@thecenter.ucsf.edu 2011 BOC Athletic Trainer Regulatory Conference © 2011 C Dower Photos licensed to C Dower by istockphoto.