2024 NCSBN Scientific Symposium - Scope of Practice: Emerging Regulatory Issues in Home-based Care Provided or Led by Nurse Practitioners

Sep 21, 2026

Uploaded by Callum

Video transcript of the 2024 NCSBN Scientific Symposium focused on scope of practice for nurse practitioners delivering home-based primary care. Presenters describe background trends in Medicare-billed home visits, including growth tied to an aging population and an expanding nurse practitioner workforce. They frame regulators’ dual concerns: protecting vulnerable patients while avoiding reduced access to valuable services. The talk outlines research questions and a Medicare-claims-based, multi-level modeling approach comparing outcomes and access across provider types and state-level regulation.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Presenters and symposium context

Team science and funding background

Trends in home-based primary care visits

Scope-of-practice research questions

Access comparison across provider types

Acute care, prevention, and end-of-life measures

Multi-level modeling approach

Provider mix and visit volume patterns

Past Event: 2024 NCSBN Scientific Symposium-Scope of Practice: Emerging Regulatory Issues in Home-based Care Provided or Led by Nurse Practitioners Video Transcript ©2024 National Council of State Boards of Nursing, Inc. Event 2024 NCSBN Scientific Symposium More info: [https://www.ncsbn.org/past-event/2024-ncsbn-scientific-symposium](https://www.ncsbn.org/past-event/2024-ncsbn-scientific-symposium) Presenters Monica O’Reilly-Jacob, PhD, FNP-BC, FAAN, Assistant Professor, Columbia University School of Nursing; Alex Hoyt, PhD, RN, Associate Professor, Massachusetts General Hospital, Institute of Health Professions - [Monica] Really, in research, I think what makes our research more powerful, more impactful, more rigorous is when we engage in team science. So I'm really delighted to have my colleague with me here today, Dr. Alex Hoyt. He can perhaps introduce himself when it is his turn to go. But we received this funding from NCSBN in the middle of the pandemic. So grateful for their funding. I was a co-PI with Dr. Jennifer Perloff, who is at Brandeis University. And we also worked with a student at Boston College. And Dr. Perloff also has an appointment at the Institute for Accountable Care. So we're able to really take advantage of their rich, rich data source, which you'll hear about in a minute. So I'm hesitant to say that home-based primary care is an emerging innovation, because we all know that house calls and being seen in the home really has been around for centuries. But sometime in the 1800s, the American Hospital Association became powerful, and suddenly care shifted more conventionally into offices and into hospitals. But now it seems like receiving care in the home and not in an office space setting is making a resurgence. So home-based primary care visits billed to Medicare between 2012 to 2019, so pre-pandemic, increased by 42% . Some of this is really driven by the aging population. There's just a growing population that is really home-bound, where it's cumbersome for them to seek care in the office. And we also know that they've been receiving more primary care in skilled nursing facilities, and in assisted living facilities where primary care providers have been going to those facilities, which is really driving a lot of this growth. But there's also this expansion of this dedicated workforce. And nurse practitioners seem to be really driving a lot of this increase in volume. You can see here the comparison between physician decline in visits, that top line, the dark gray, and that slight increase or a stable line is nurse practitioners, the blue line on the bottom. And this is COVID, right, where care really dipped pretty low. So it's not surprising that that blue line is plateauing, it's pretty stable. But physician visits really decreased at about 35% between 2017 and 2021. And NPs increased by 10% . - [Dr. Hoyt] Thank you. I'm Alex Hoyt. Monica's colleague. Like Monica, I have my Ph.D. in social policy from Brandeis University. I'm now at the School of Nursing at the MGH Institute of Health Professions. And I do work for a research focused on APRNs. Thanks for having me here today. So if you are a nursing regulator whose mission is to protect the public from substandard nursing practice, you can be heartened by a large and growing literature showing the safety and quality of nurse practitioner care. However, the population of folks receiving home-based primary care is older, and frailer, and sicker than the general population of older adults. And the home environment is not structured as a healthcare setting. And finally, most nurse practitioner students don't get a clinical experience doing home care, or advanced practice home care, which has a unique combination of primary care, and sometimes acute care, and sometimes morphing into palliative care. Right? So the conundrum for regulators is that regulation can have a protective effect for a vulnerable population. And

FAQs

Why is scope of practice regulation important for home-based primary care?

The transcript explains that regulation can protect vulnerable patients, but it may also unintentionally restrict access to a valuable service. Regulators must balance safety with continued availability of home-based care.

What data and study period are used to answer the research questions?

The presenters state they use all Medicare claims from 2018 and 2019, attributing each beneficiary to a provider based on the number and proportion of visits.

How do the study measures evaluate access and care delivery?

Access is assessed by the number of visits by nurse practitioners and the proportion of nurse practitioners doing home-based primary care in a state. Care delivery is addressed using acute care events, prevention, composite measures, and end-of-life care.

Sep 21, 2026

Uploaded by Callum