While the number of nurse practitioners is expected to nearly double by 2025, many in the field say payer policies hurt their efficiency, even more than state scope-of-practice laws. 

A study by the National Institute for Health Care Reform, published Feb. 28, interviewed NPs, practice managers and physicians in six states to evaluate how different scope-of-practice laws may impact care. Nurse practitioners are seen as a way to fill the nation’s primary care physician gap, and to serve a need in long-term care facilities.

That’s especially true in states where NPs can prescribe Schedule II controlled substance medications, which are often used to treat pain. In states such as Arkansas and Michigan, which have greater restrictions on how the NPs can prescribe those controlled substances, patients are more likely to see delays, said researchers.

Still, the biggest problem is that payers are in a position to determine the billing rate for NPs, and to determine whether they are considered primary care providers, the researchers noted. That can be a particular problem when a patient or resident is on Medicaid, especially as states move to Medicaid managed care plans.