On March 4, Indiana’s COVID-19 public health emergency executive orders, first authorized in March 2020 by Gov. Eric Holcomb, came to an end. These executive orders have been vital in combating the pandemic and, importantly, in empowering advanced practice registered nurses—referred to as APRNs—to significantly strengthen Hoosiers’ access to health care across the state.
It’s clear patients directly benefited from the temporary suspension of these regulatory barriers for APRNs. The executive order reduced wait times for care, enabled underserved patients to receive care closer to home, allowed APRNs to travel where they are most needed and removed regulatory roadblocks—at no cost to the taxpayer.
This proved to be a boon to Hoosiers’ health and access. Given the state’s ongoing primary care access crisis and the continuing pandemic, it is time for the Legislature to repeal these outdated regulations permanently, giving Hoosiers the option to choose APRN-provided health care year-round, not only during a public health emergency.
Under current law, the state’s nearly 8,000 educated and clinically trained, nationally certified and state-licensed APRNs are required to sign a contract with a physician—known as a “collaborative practice agreement”—to deliver patient care. Far from professional collaboration, these contracts are a condition of APRN practice, and the contracting physician retrospectively reviews a small subset of patient charts for “quality assurance.” The contracted physician is not involved with patient care and, in fact, is likely not present when care is delivered.
According to the congressionally chartered National Academy of Medicine, states should empower nurses to work to the top of their profession. The Federal Trade Commission has repeatedly found these contracts to be anti-competitive.
Today, more than 2.1 million Hoosiers lack access to essential primary health care services in their community. The federal government has designated 117 health care provider shortage areas across the state. If that weren’t bad enough, the United Health Foundation’s 2021 America’s Health Ranking put Indiana an alarming 36th among all states when it comes to health care access, quality and other measures.
In that same United Health Foundation ranking, nine of the 10 healthiest states have removed regulations restricting access to care provided by nurse practitioners, which represent the largest APRN segment in Indiana. In total, 24 states, the District of Columbia, the national VA health system and two U.S. territories have removed these regulations and have seen increased access to care for their states. Unfortunately, the Indiana Legislature has yet to follow suit.
Permanently removing these regulations will ensure that APRNs are able to deliver the care they were educated, clinically trained and certified to provide, expanding access to health care for patients across the state. Giving Hoosiers direct access to APRN care will also give the state’s residents more choice in selecting a health care provider that meets their needs. APRNs are more available, provide more personal attention, and provide a patient-centered, prevention-focused, holistic approach to care.
Throughout the pandemic, we have relied on Indiana’s APRNs to establish and staff COVID-19 testing centers, administer vaccines in underserved communities and care for patients in primary care, home health, telehealth, nursing home, and hospitals and intensive care settings. As we look forward to better days ahead, we urge our policymakers to permanently grant patients direct access to the high-quality care APRNs deliver. It’s a no-cost, no-delay solution to ensure Hoosiers affordable, accessible health care everywhere.•
Thompson is president of the Coalition for Advanced Practice Nurses of Indiana and is a family nurse practitioner specializing in the care of adolescents and adults with diabetes.