State should clear the path for coronavirus health response

Along with the rest of the nation, North Carolina is facing an unprecedented health challenge with the COVID-19 virus. In the coming days, the General Assembly will formulate its response to the current crisis. Many of the most impactful health policy steps the legislature can take simply consist of getting burdensome government barriers out of the way in order to open up the state’s healthcare supply capacity. The following policies provide a good starting point towards that objective.

First, the General Assembly should codify and expand upon the waiver of the state’s Certificate of Need (CON) regulations issued by the state Department of Health and Human Services and the North Carolina Emergency Management Division. CON is an outdated regulation that requires healthcare providers to get government permission to open or expand healthcare facilities. It is always bad policy, but the COVID-19 pandemic has highlighted the dangers that come from artificially restricting healthcare supply through government intervention.

The existing waiver loosens regulations on acute care hospital beds for existing CON holders. The General Assembly should extend the waiver to include all facilities and equipment currently covered under CON restrictions. Healthcare providers in North Carolina are currently required to obtain a CON for things such as MRI machines, helicopters to transport patients, a variety of hospital or treatment beds, and much more.

Expanding the total supply of healthcare – even non-COVID related services – could help mitigate the impact of this crisis. The pandemic may be less likely to overwhelm provider capacity if non-coronavirus patients can be treated at alternative facilities, such as ambulatory surgery centers, which currently operate under CON restrictions.

Second, the General Assembly should expand the scope of practice for both pharmacists and advanced practice registered nurses (APRN). Florida recently passed legislation to allow pharmacists to test and treat for the flu, strep throat, and other non-chronic conditions. This would be a simple way to free up other healthcare providers to treat COVID-19 patients, and would provide patients a safer way to deal with their medical needs with less risk of being exposed to COVID-19 themselves by going into a hospital or doctor’s office.

APRNs, such as nurse practitioners or certified registered nurse anesthetists, have long advocated for loosening the restrictions on their ability to practice within the full scope of their training. The supervisory physician requirements are overly burdensome and can prevent these qualified healthcare professionals from even volunteering during times of crisis. The language from the SAVE Act, filed in 2019 as House Bill 185 and Senate Bill 143 with broad bi-partisan support, could go a long way to expanding the scope of practice for APRNs.

Finally, the legislature should expand the state’s telemedicine capacity. When the governor issues an executive order declaring a state of emergency, he expanded healthcare licensing reciprocity to healthcare providers with licenses in good standings in other states. This should be extended to include telemedicine. Providers in other states should be able to remotely consult with patients in North Carolina. This is another method of relieving some of the pressure on our state’s healthcare system.

It will be important in this time for the legislature to resist the urge to over-regulate telemedicine through burdensome parity or coverage mandates. The flexibility of telemedicine is part of its cost-saving benefits. Many insurance companies are currently electing toward reimbursement parity for telemedicine during this crisis, and it should be up to them to negotiate reimbursement terms with providers in the future as well.