AMA, radiology groups ‘strongly oppose’ federal bill that would expand nurses’ authority

Radiology groups and the American Medical Association “strongly oppose” a proposed federal bill that would expand advanced-practice registered nurses’ authority.

Bipartisan members of the U.S. House first introduced the Improving Care and Access to Nurses, or I CAN, Act in April. Sponsors said the bill would increase access, improve the quality of care and lower costs by allowing such nurses to practice “to the full scope of their education and clinical training.”

However, the AMA, American College of Radiology and 90 other state and national associations believe the proposal will do more harm than good.

“In general, we are deeply concerned that this broad, sweeping bill endangers the care of Medicare and Medicaid patients by expanding the types of services nonphysician practitioners can perform and removing physician involvement in patient care,” the associations wrote in a June 1 letter to leaders of the committees on Ways & Means and Energy & Commerce. “This legislation would allow nonphysician practitioners to perform tasks and services outside their education and training and could result in increased utilization of services, increased costs and lower quality of care for patients.”

In backing their claims, the AMA et al. cited a 2022 study from the National Bureau of Economic Research comparing productivity between physicians and nurse practitioners in the ED. It found that NPs ordered more tests and formal consults than doctors and sought more information from external sources such as CT scans and X-rays. NPs practicing independently actually ended up increasing costs by about $66 per emergency department visit, the physician groups wrote. Another 2018 analysis in JACR concluded that the ordering of X-rays by nonphysicians such as NPs and PAs had increased by more than 400% between 2003 and 2015.

The professional societies also cited physicians’ more rigorous training than NPs and PAs as a reason to keep the MD/DO at the center of the care team.

“Due to the increased education and training of physicians, the ability of physicians to more accurately treat and diagnose patients, the lack of additional access provided by expanding scope of practice laws, and the negative consequences of removing physicians from the care team, the undersigned organizations strongly oppose the I CAN Act,” the letter concluded. “Congress should avoid advancing this sweeping bill that places patient safety at risk.”

On the other side, numerous nurse societies have voiced their enthusiastic endorsement of the bill. Those include the American Association of Nurse Anesthesiology, American Association of Nurse Practitioners, American College of Nurse-Midwives, the Hospice & Palliative Nurses Association and the American Nurses Association. Other non-nursing groups—such as the National Rural Health Association and LeadingAge—also have joined them.

“As a nurse practitioner, it has always frustrated me that Medicare and Medicaid programs have barriers in place that prevent nurses from caring for patients to the full extent of their abilities,” Rep. Jennifer Kiggans, R-Va., vice chair of the Congressional Nursing Caucus, said in an April 24 announcement. “Limiting the care our nurses can provide is the last thing we should be doing when our nation is facing a healthcare worker shortage.”

Others introducing the bill included Reps. Dave Joyce, R-Ohio, Suzanne Bonamici, D-Ore., and Lauren Underwood, D-Ill., who also is a registered nurse.  H.R. 2713 had a total of 13 co-sponsors as of June 1. In a Thursday news post, the ACR noted that many of the current co-sponsors hail from rural areas that are facing healthcare staffing challenges. Others opposing the bill include the American Society for Radiation Oncology, the American Society of Neuroradiology and the Society of Interventional Radiology.

Members of the House also previously introduced the I CAN Act in 2022, but it failed to find passage.