providers across state lines and may have fewer choices of safe and effective providers [emphasis added]” (AAHC, 2008, pp. 21, 26, 27).

  • A National Association of Community Health Centers report on transforming primary care services noted that “NPs and PAs play a vital role in the delivery of primary care. State scope of practice laws, which regulate the range of permissible practice for various health care professionals, encourage NPs to locate in states allowing them to provide a broader range of services.” The report added that “State scope of practice standards set the boundaries by which key primary care providers, namely NPs and PAs, can deliver care. State policymakers must consider how these standards encourage or discourage primary care professionals to locate in and form teams in underserved areas. Some states, including Colorado and Pennsylvania, have dealt with primary care shortages in underserved areas by expanding scope of practice for NPs, PAs, CNMs, nurses, and dental hygienists. If health centers are to form medical or health care homes and maximize quality and efficiency, policies that facilitate team functions for patients will be needed [emphasis added]” (NACHC, 2009).

  • An analysis by the National Academy of State Health Policy of state regulations governing retail clinics concluded that such clinics are a desirable service-delivery mechanism providing accessible, less costly, evidence-based services. The analysis went on to note that, as reported by clinic representatives, the “most powerful state regulatory tools affecting their operations are the scope of practice regulations that govern nurse practitioners and [physician assistants].” “These kinds of regulations can greatly affect the cost structure of retail clinics and may affect where retail clinics locate, their staffing, and their hours of operation.” The report concluded that many states have chosen not to regulate these clinics directly, but rather have relied on existing health care provider regulations and market forces to decide the fate of these clinics, with one ‘most notable exception’”: “often in response to physician groups, states have increased physician oversight of non-physician practitioners who work at retail clinics [emphasis added]” (NASHP, 2009).

Pulling It All Together: The RAND Corporation Study

All of these themes are echoed and elaborated in one of the most recent and comprehensive reports in the field, which focused specifically on the access, quality and cost gains to be realized by reforming the current regulatory mélange. The Massachusetts Division of Health Care Finance and Policy commissioned the RAND Corporation to “develop a comprehensive menu and assessment of cost containment strategies and options and to determine their potential effect on the health care system.” The resulting report released in August 2009 (Eiber et



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