Savings Estimate for Full Practice Authority
North Carolina could save almost
each year by cutting unnecessary, outdated red tape on APRNs.
A 2015 report from Dr. Chris Conover with Duke University’s Center for Health Policy and Inequalities Research showed that North Carolina would save between $433 million and $4.3 billion annually by granting Full Practice Authority to Advanced Practice Registered Nurses.
In 2023 and again in 2026, NCNA asked Dr. Conover how his numbers might have changed over the years, especially with the implementation of Medicaid Expansion. He responded with a handful of updates, including the ACA’s sustainability, demographic shifts, and healthcare spending changes, that significantly raise the floor.
His new estimates? North Carolina could save between $932.9 million and $8.9 billion in healthcare spending each year by granting APRNs Full Practice Authority.
Row |
Annual Savings (millions) |
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|---|---|---|---|---|
| Lower bound | Upper bound | Notes/Sources | ||
| 1 | $68,778 | $68,778 | 2012 NC health care spending baseline (billions) | Table B-4 [S4] |
| 2 | 0.63% | 6.2% | Savings due to less restrictive APRN laws | [A] |
| 3 | $433.30 | $4,264.24 | 2012 baseline savings (#1 × #2) | Calculated |
| 4 | 14.40% | 14.40% | % increase in health spending due to demographic changes (population increase + aging): 2012–2020 | Table B-1 [S4] |
| 5 | 10.62% | 10.62% | Projected increase due to demographic changes, 2020–2026 | [B] |
| 6 | $108.40 | $1,066.76 | Increased savings due to demographic changes (#3 × (#4 + #5)) | Calculated |
| 7 | 78.46% | 78.46% | % increase in U.S. per capita personal health care spending from 2012 ($7,409) to 2024 ($13,222) | [S1] |
| 8 | 6.12% | 6.12% | Projected increase in per capita personal health care spending from 2024 to 2025 | [C] |
| 9 | $366.46 | $3,606.43 | Increased savings due to health spending changes (#3 × (#7 + #8)) | Calculated |
| 10 | 3.1% | 3.1% | % increase due to ACA without Medicaid | Table B-4 [S4] |
| 11 | 2.6% | 2.6% | % increase due to ACA-related Medicaid expansion | Table B-4 [S4] |
| 12 | $24.70 | $243.06 | Increased savings due to ACA/Medicaid expansion (#3 × (#10 + #11)) | Calculated |
| 13 | $932.86 | $9,180.48 | Projected Annual Savings in 2026 (#3 + #6 + #9 + #12) | Calculated |
| 14 | -3.3% | -3.3% | Reduction in savings due to less restrictive regulation of nurse midwives in 2023 | [D] |
| 15 | $902.04 | $8,877.21 | Net annual savings in 2026 if less restrictive regulation of NPs, CRNAs and CNS is adopted (#13 × (1 + #14)) | Calculated |
Notes |
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| [A] | Lower bound estimate is from RAND Corporation study for Massachusetts [S5]; upper bound is from Perryman study for Texas [S6]. | |||
| [B] | Imputed assuming same annual rate of change during last 6 years as was experienced in the first 8 years after 2012: [(1+14.4%)^(1/8)]^6 - 1 | |||
| [C] | Calculated from estimates of personal health care expenditures in 2024 ($4,463.3 b.) and 2025 (4,778.4 b.) reported in [S3] and U.S. populatin in 2024 (337 m.) and 2025 (340 m.) reported in [S2]. | |||
| [D] | Calculated as the CNM share of total APRN spending in 2012 using figures reported in Table C-6 [S4]. CNMs = $29.293 m. in compensation + $35.893 m. in practice expenses. Total APRNs = $1.065.207 m. in compensation + $908.039 m. in practice expenses. | |||
Sources |
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| [S1] |
Centers for Medicare and Medicaid Services. Table 1 National Health Expenditures; Aggregate and Per Capita Amounts, Annual Percent Change and Percent Distribution: Selected Calendar Years 1960-2024 Available at https://www.cms.gov/files/zip/nhe-tables.zip › |
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| [S2] |
Centers for Medicare and Medicaid Services. Table 1 National Health Expenditures and Selected Economic Indicators, Levels and Annual Percent Change: Calendar Years 2013-2033 Available at https://www.cms.gov/files/zip/nhe-projections-tables.zip › |
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| [S3] |
Centers for Medicare and Medicaid Services. Table 2 National Health Expenditure Amounts and Annual Percent Change by Type of Expenditure: Calendar Years 2017-2033 Available at https://www.cms.gov/files/zip/nhe-projections-tables.zip › |
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| [S4] | Conover, Christopher J. and Robert Richards. Economic Benefits of Less Restrictive Regulation of Advanced Practice Registered Nurses in North Carolina: Technical Appendices. Duke University, Center for Health Policy and Inequalities Research, February 2015. | |||
| [S5] | Eibner, Christine E., Peter S. Hussey, M. Susan Ridgely and Elizabeth A. McGlynn. Controlling Health Care Spending in Massachusetts: An Analysis of Options. RAND Health, 2009. | |||
| [S6] | Perryman Group. The Economic Benefits of More Fully Utilizing Advanced Practice Registered Nurses in the Provision of Health Care in Texas: An Analysis of Local and Statewide Effects on Business Activity. Waco, TX: The Perryman Group, 2012. | |||
