As America grapples with the COVID-19 virus, state governments are acting quickly to mitigate the spread in their state. Governor Roy Cooper declared a state of emergency last week, which gives the governor the power to waive specific state regulations to aid the response.
Slowing the spread of the disease is a top priority among public health officials. To keep spread as minimal as possible, citizens are encouraged to practice social distancing. Distancing ourselves from others as much as possible will mitigate the spread of the disease by minimizing human contact. This is important for what public health officials call “flattening the curve” or spreading out the number of cases more evenly over time as not to overwhelm the health care system at one time. North Carolina should consider some policies which would increase access and decrease the burden on the health care system as a whole.
In this research update, I will describe the steps North Carolina’s state government has already taken in response to the spread of the virus as well as look at some more policy recommendations that could be implemented to aid public health officials and private sector entities who step up, to assist the response.
What Has the State Done?
Gov. Cooper’s emergency declaration waived the licensure requirements for health and behavioral health professionals, which would otherwise require a North Carolina license to provide care in the state. With medical needs arising all over the country, state boundaries should not keep well-qualified professionals from treating patients. President Trump’s March 13 emergency declaration provides Medicare and Medicaid flexibility to pay physicians licensed in other states. These requirements should remain waived indefinitely.
Last week, the state lifted Certificate of Need (CON) restrictions on hospital beds. Certificate of Need laws regulates the availability of health care facilities, the number of beds, and the addition of medical equipment in the state. To increase beds or buy new equipment in North Carolina, a health care provider would normally need permission from the state. Hospitals and other providers should be able to increase or convert beds to meet the needs of their community rather than seek permission from a Raleigh-based government board. This regulation should remain lifted indefinitely.
Other promising measures include the state’s use of universities and private labs for testing and the advent of drive-through testing at Wal-Mart, Target, Walgreens, and other retailers.
What Could the State Do?
Similar to a licensed physician from another state needing a North Carolina license to provide in-person care in the state, an out-of-state physician would also need a North Carolina license to provide medical care via telemedicine from another state. Telemedicine is a very important tool to provide care while minimizing contact with others and decreasing the burden on the health care system. Telemedicine will provide patients an opportunity for diagnosis or medical advice from a licensed professional. There is no reason to limit that opportunity to physicians who only work within our state borders. The state should waive requirements for out-of-state telemedicine providers to increase access for patients. Increasing access to telemedicine could help to coordinate patient care and keep unnecessary visits to a minimum.
To free as many essential medical professionals as possible, the state should consider granting pharmacists the ability to test and prescribe medication for non-chronic conditions such as strep or the flu. Florida recently passed similar legislation that will allow a pharmacist, through an agreement with a primary care physician, to test and prescribe for some illnesses. This could free up primary care doctors and other point-of-contact providers who will need to conduct testing and treatment for COVID-19-related illnesses.
Another way to increase the number of health care providers available would be to grant nurse practitioners full practice authority. Again, to free up and better utilize all available health care personnel, we should remove any restrictions that would hinder health care professionals from practicing to the full extent of their training. At the present time, we may not know how each type of health care professional will be utilized. Freeing up these professionals from excessively burdensome supervisory requirements will allow North Carolina’s nurse practitioners to contribute equally to the response, as we have seen in other states that allow full practice authority for nurse practitioners.
Finally, the state should request a Section 1135 Medicaid waiver to eliminate some burdensome regulations within the Medicaid program. During an emergency, the secretary of the N.C. Department of Health and Human Services could waive certain state Medicaid requirements relating to enrollment, benefits, and provider workforce. In conjunction with the U.S. Department of Health and Human Services in Washington D.C., NC DHHS could work on a waiver that would allow for the state to make changes to the Medicaid program. This would allow for much more flexibility for providers to care for Medicaid patients.
The response to this virus will require all of us to help out in any way we can. The state government can aid the response, in part, by removing any barriers which may increase burdens on health care professionals or the system as a whole. Any policy responses should focus on utilizing the current health care infrastructure the state already has, utilizing all medical professionals as much as possible and increasing the ways that patients can get diagnosis or treatment with the goal being to mitigate any further spread of the virus.