States push independence for NPPs: A solution to work force crisis?

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

Of the myriad proposed solutions to physician shortages, an expanded scope of practice for non-physician providers (NPPs) can be swiftly implemented by policymakers eager for a quick fix. Unfortunately, quick fixes usually involve shoddy workmanship and, as applied to the provision of health care, shoddy workmanship endangers patient safety.

Seventeen states and the District of Columbia already grant advanced practice registered nurses (APRNs) “full practice” authority as of December 2013, according to the American Association of Nurse Practitioners. In these jurisdictions, essentially no distinction is made between a medical doctor’s 11 years of training and an APRN’s 6 years of education and clinical instruction. New York will become the 18th state with unsupervised APRNs on Jan. 1, 2015, when a law signed earlier this year takes effect. In legislative sessions taking place across the country this spring, more nuanced proposals promise independent practice after a certain amount of experience, whether measured in hours or years.

Here are highlights of statewide 2014 scope of practice initiatives:

Connecticut: SB 36 authorizes APRNs to prescribe drugs and treat patients without physician oversight after being licensed in Connecticut for 3 years. The bill, supported by Gov. Dannel Malloy (D), was approved by the state Senate April 9. The House is expected to grant favorable consideration prior to that body’s May 7 adjournment.

Minnesota: HF 435/SF 511 allows unsupervised practice for APRNs engaged in most primary care and psychiatric specialties. Even this limited expansion is troublesome, however, in a state where the Board of Nursing routinely fails to enforce current standards. Gov. Mark Dayton (D) accused the board of being “asleep at the switch” in November 2013, when news outlets reported that some nurses have kept their licenses despite neglecting patients, stealing drugs, and practicing while impaired.

Florida: HB 7071 creates a new “independent APRN” classification for APRNs with at least 2,000 clinical hours within a 3-year period. Legislators are also considering bills that propose a reasonable and safety-conscious expansion of physician assistants’ scope of practice. SB 1230 increases the number of physician assistants that a physician may supervise at any one time and carefully revises the circumstances under which a physician assistant is authorized to prescribe medication.

Ohio: Gov. John Kasich (R) signed HB 139 on Feb. 8. The new law allows collaborative physician-led care to continue and grants APRNs and PAs admitting privileges if their supervisor is a medical staff member and the hospital grants the NPPs relevant credentials. The Ohio State Medical Association actively supported this measure, which also requires NPPs to notify the collaborating physician of their intent prior to admission.

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Missouri: HB 1481 proposes another rational and safe expansion of APRNs’ scope of practice supported by most physician organizations. This bill removes geographic proximity requirements while also allowing for electronic communication and review of APRN records.

Other states considering unsupervised APRN practice in 2014 are: California (expected), Kansas (stalled), Michigan (active), Mississippi (dead), Nebraska (active), New Jersey, Pennsylvania, and West Virginia. A complete list is available at the AACU Scope of Practice Action Center.

In addition to these state activities, the Federal Trade Commission (FTC) is stepping into the scope of practice arena, asserting its role regulating marketplace competition. A recently published FTC analysis of health care professional regulations ominously concludes that requiring physician supervision of non-physician providers “may do more harm than good." Patient safety implications notwithstanding, the FTC’s report does not take into account how liability insurance and reimbursement impact the health care marketplace. If supervisory requirements are eliminated state by state nationwide, would the FTC then advance NPPs’ advocacy agenda by calling for Oregon-style “pay equity” laws?

The AACU, for one, believes properly supervised NPPs can play a significant role in the delivery of health care in a post-Affordable Care Act world. NPP integration into physician-led teams will allow urologists to offer timely and high-quality care, even in the midst of physician shortages. The AACU Scope of Practice Action Center includes safety-conscious recommendations and resources that urologists may share with elected officials who seek rational solutions to the work force crisis.

As the multidimensional work force crisis plays out in Washington and across the country, organizations such as the AACU aggressively advocate on behalf of the urologic community. We cannot do it alone, however, and encourage support via membership and participation in grassroots mobilization campaigns.

Update:

As an update to a recent article (Legal hurdles may stall telehealth’s role in work force crisis), the Federation of State Medical Boards recently adopted a Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine. Though state medical boards are not required to adopt the Model Policy, policymakers are likely to use it to guide their deliberations on telemedicine. Datta Wagle, MD, past president of both the AACU and AUA, will address this subject during the AACU/AUA Health Policy Forum, held in conjunction with the AUA annual meeting, on Sunday, May 18.

Continue to next page for links to previous Legislative Updates from the AACU.

Like this article? Check out these other Legislative Updates from the AACU:

SGR repeal and the 2014 Joint Advocacy Conference: Timing is everything

Legal hurdles may stall telehealth’s role in work force crisis

Battle over tort reform, physician drug testing wages in California

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