Nurse practitioners as attending providers in the workers' compensation system: policy evaluation of recent legislation in Washington State
Sears, Jeanne Marguerite, 1959-
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Advanced registered nurse practitioners (NPs) have been directly reimbursed for providing health care services to injured workers within the Washington State workers' compensation system for many years. However, prior to July 2004, NPs were restricted from independently performing those functions limited to attending physicians, such as signing accident report forms and certifying time loss. Concern about disparities in access to health care for injured workers in rural areas, delays in work-related injury reporting, and efforts by NPs to expand their scope led to the passage of pilot legislation that authorized NPs to function as attending providers in the Washington State workers' compensation system. The subject of this dissertation was the comprehensive evaluation of the effects of Substitute House Bill (SHB) 1691 (Chapter 65, Washington State Laws of 2004) on provider distribution, access to health care for injured workers, system efficiency, quality of care, worker outcomes and medical costs.NPs were more likely than primary care physicians to be located in rural areas and counties with high unemployment. Other case mix variables, such as sociodemographics, injury type, and injury severity/complexity indicators, were similar across provider type. Authorizing NPs to function as attending providers for injured workers was not associated with any negative impact on quality of care, medical costs, or disability outcomes, and appeared to positively affect provider enrollment, availability of authorized attending providers in rural areas, and administrative efficiency. In addition, by increasing access to providers willing to care for injured workers and improving the timeliness of accident report filing, SHB 1691 may have improved system costs and outcomes. From a societal perspective, expanding the use of NPs in appropriate settings is an efficient use of resources. This research suggests that authorizing NPs as attending providers for injured workers may be a cost-effective approach to expanding the available workers' compensation provider workforce.
- Health services