Last week, a joint report prepared by the Departments of Treasury, Health and Human Services, and Labor articulated a number of potential reforms to inject more “choice and competition” into the U.S. healthcare system.
Many of the reforms are related to the structure and implementation of the Affordable Care Act, Medicare, Medicaid, and hospital consolidation, but much of the report has to do with labor market regulation, particularly with respect to licensing and scope-of-practice restrictions.
The report contains a wealth of information related to the costs of licensing, scope-of-practice restrictions, and certificate of need laws, which are implemented at the state level and restrict the ability of healthcare providers to purchase medical equipment, often with fatal and preventable consequences.
Here are some of the administration’s best recommendations.
On scope-of-practice restrictions:
The federal government and states should consider accompanying legislative and administrative proposals to allow non-physician and non-dentist providers to be paid directly for their services where evidence supports that the provider can safely and effectively provide that care.
States should consider eliminating requirements for rigid collaborative practice and supervision agreements between physicians and dentists and their care extenders (e.g., physician assistants, hygienists) that are not justified by legitimate health and safety concerns.
On improving geographic mobility among healthcare professionals:
States should consider adopting interstate compacts and model laws that improve license portability, either by granting practitioners licensed in one state a privilege to practice elsewhere, or by expediting the process for obtaining licensure in multiple states.
The nurse licensure compact (NLC) is a great example of this, and while research shows only “modest positive effects” from NLC for geographic mobility, it certainly can’t hurt.
For telemedicine:
States should consider adopting licensure compacts or model laws that improve license portability by allowing healthcare providers to more easily practice in multiple states, thereby creating additional opportunities for telehealth practice. Interstate licensure compacts and model laws should foster the harmonization of state licensure standards and approaches to telehealth.
On increasing the supply of MDs by allowing more foreign-born doctors to practice without jumping through the hoops U.S.-educated and trained doctors have to (not all of which are directly related to licensing):
The Department of Health and Human Services, in coordination with the Accreditation Council for Graduate Medical Education (GME), should identify foreign medical residency programs comparable in quality and rigor to American programs. Graduates of such equivalent programs should be granted “residency waivers,” allowing them to forgo completing an American residency and instead apply directly for state licensure.
States should create an expedited pathway for highly qualified, foreign-trained doctors seeking licensure who have completed a residency program equivalent to an American GME program.
The report doesn’t go after licensing as the model labor market regulation directly, but these recommendations would trim some of the fat in our healthcare system created by these regulations.
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