Why Does the FTC Care About NPs?
• We promote competition and protect consumers,
utilizing a range of tools
• Health care competition has long been a
significant part of our mission and work
• Deep engagement in NP scope of practice issues
as part of our competition advocacy program
• Significant experience with the procompetitive
effects of market disruption, more broadly
If NPs help to disrupt the status quo,
health care markets can function better.
FTC Perspective: Key Features of the
Health Care Marketplace
• Industry participants at all levels are
rethinking how to deliver and pay for health
care services
• Shift from volume to value is key to achieving
“triple aim” goals
• Increased coordination and collaboration are
viewed as essential to effective reform
Competition Is Important!
• Competition benefits consumers – especially in
industries undergoing rapid evolution and
restructuring
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Promotes innovation
Expands supply
Improves quality and efficiency (“value”)
May help to control costs
Prevents harmful accumulation/exercise of market power
Competition is good for health care delivery,
just as it is for other industries and services.
APRN Scope of Practice Advocacy
• Remains a core focus of the FTC’s
competition advocacy efforts
– March 2014 APRN Policy Paper
– Subsequent advocacy comments
NPs should envision themselves as key
marketplace competitors, capable of
driving positive change. That’s certainly
how the FTC thinks of them.
What Is Competition Advocacy?
• Provide a framework for thinking about public
policy issues from a competition perspective
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What is the likely competitive impact?
How will this affect consumers?
Any legitimate justifications to restrict competition?
Are there less restrictive alternatives?
• Protect consumers and fulfill other important
public policy goals, BUT
– Do not unnecessarily restrict legitimate business
activities, especially those that may promote
competition
FTC Scope of Practice Advocacy:
Main Themes
• All health care professionals should be allowed to
practice to the top of their license, consistent
with their training and knowledge
• Unnecessary supervision requirements, in
particular, allow one group of health care
professionals to restrict market access by a
competing group
– Negative effects on access, cost, innovation
– “Safety” justifications may be pretextual
The Value of Collaboration
• Common argument:
“FTC scope of practice
advocacy demonstrates
that the FTC is against
team-based care”
• Another common argument: “Antitrust law prohibits
collaboration among health care providers and
frustrates the goals of health care reform”
• Both arguments are fallacies
Takeaway Lessons
• Competition among health care providers is good
for health care consumers
• NPs should compete vigorously in the health care
marketplace
– Requires removal of unnecessary scope of practice
restrictions, among other barriers
– It’s entirely possible to compete AND collaborate
• Market disruption often fosters new forms of
competition
– Innovative business models
– New ways of delivering services