Leg­is­la­tors con­sider grant­ing nurse prac­ti­tion­ers au­thor­ity to work solo

South Florida Sun-Sentinel (Sunday) - - Local - By Chris­tine Sex­ton News Ser­vice of Florida

TAL­LA­HAS­SEE – Twenty-two states, Washington, D.C. and two U.S. ter­ri­to­ries al­low ad­vanced reg­is­tered nurse prac­ti­tion­ers to work in­de­pen­dently of physi­cians.

And af­ter years of de­bate, law­mak­ers this spring will again grap­ple with whether to take the leap and give the ad­di­tional au­thor­ity in Florida.

The House Health Care Qual­ity Sub­com­mit­tee on Wed­nes­day heard the pros and cons of al­low­ing ad­vanced reg­is­tered nurse prac­ti­tion­ers to op­er­ate in­de­pen­dently of physi­cians and whether it would in­crease ac­cess to care.

Tay Kopanos, vice pres­i­dent of state gov­ern­ment affairs for the Amer­i­can As­so­ci­a­tion of Nurse Prac­ti­tion­ers, said states are turn­ing to a num­ber of so­lu­tions to in­crease ac­cess to care, in­clud­ing build­ing more med­i­cal schools, in­creas­ing the num­ber of med­i­cal res­i­den­cies, es­tab­lish­ing re­pay­ment pro­grams for providers will­ing to work in un­der­served ar­eas and in­vest­ing in tele­health ini­tia­tives. “As states are mov­ing for­ward, they are re­al­iz­ing it’s not go­ing to be one sin­gle sil­ver bul­let that solves this but it’s re­ally go­ing to be all-of-the-above so­lu­tions that are needed,” Kopanos said.

“And out of all the so­lu­tions that are on the ta­ble, right­siz­ing li­cen­sure laws is the only so­lu­tion that is at no added cost to the state, no de­lay in the ben­e­fit to the con­sumer and the state, and it is the only so­lu­tion that has a track record of 40 years of suc­cess in other states around the coun­try.”

The Repub­li­can-led state House has re­fused to ex­pand Med­i­caid un­der the fed­eral Af­ford­able Care Act. But in lieu of ex­pand­ing Med­i­caid, House Speaker Jose Oliva, R-Mi­ami Lakes, has made it a pri­or­ity to lower health care costs by elim­i­nat­ing what he says are un­nec­es­sary reg­u­la­tions.

Oliva main­tains that Florida is “be­hind the curve” be­cause it doesn’t al­low nurses “to prac­tice to the ex­tent of their train­ing.” But

tak­ing steps such as grant­ing more au­thor­ity to ad­vanced reg­is­tered nurse prac­ti­tion­ers has run into opposition from doc­tors.

The Se­nate in re­cent years has been more re­luc­tant than the House to re­write rules and reg­u­la­tions sur­round­ing health-care prac­ti­tion­ers and fa­cil­i­ties. Se­nate Pres­i­dent Bill Gal­vano, RBraden­ton, has said that he wants to “make sure we are lis­ten­ing to our doc­tors in terms of what they see in the sys­tem.”

The 2019 leg­isla­tive ses­sion will start March 5.

Ad­vanced reg­is­tered nurse prac­ti­tion­ers have ad­vanced de­grees and can work in pri­mary-care en­vi­ron­ments de­liv­er­ing ba­sic care or in sur­gi­cal set­tings ad­min­is­ter­ing anes­the­sia.

Florida has 29,100 ad­vanced reg­is­tered nurse prac­ti­tion­ers who have ac­tive li­censes, ac­cord­ing to the lat­est avail­able data from the state Depart­ment of Health.

That fig­ure in­cludes cer­ti­fied reg­is­tered nurse anes­thetists, nurse prac­ti­tion­ers, cer­ti­fied nurse mid­wives and clin­i­cal nurse spe­cial­ists.

Florida law re­quires that so-called ARNPs prac­tice un­der the su­per­vi­sion of med­i­cal doc­tors, os­teo­pathic physi­cians or den­tists. Man­ning Han­line, a Pen­saco­labased in­ternist, said that al­low­ing ARNPs to prac­tice in­de­pen­dently wouldn’t in­crease ac­cess to care.

“We believe that the pa­tients will re­ceive min­i­mal, if any, ben­e­fit from this in­de­pen­dent prac­tice. And, fur­ther­more, we think that there is a risk that pa­tients may be re­quired to see nurse prac­ti­tion­ers rather than physi­cians,” he said.

“We believe that pa­tients should have the right to ac­cess to care by a physi­cian. We have the high­est re­gard for the nurse prac­ti­tion­ers. I’ve worked with them for many years, but their train­ing is, in fact, less than pri­mary-care physi­cians. And they should not be viewed as equiv­a­lent to physi­cians.”

More­over, Han­line said that al­low­ing the change wouldn’t mean nurse prac­ti­tion­ers would go to med­i­cally un­der­served or ru­ral ar­eas. He said nurse prac­ti­tion­ers in Pen­sacola clus­ter around large doc­tor groups and sub-spe­cial­ists be­cause that’s how they get paid.

“I would do the same thing,” he said adding, “I have yet to have a nurse prac­ti­tioner come to my of­fice, knock on the door and and say, ‘Dr. Han­line, I have this burn­ing de­sire to go out to … some ru­ral area or even in the in­ner city, and serve the pop­u­la­tion there. Will you be my su­per­vis­ing physi­cian?’ It hasn’t hap­pened. I think the nurse prac­ti­tion­ers will be just like doc­tors, they will fol­low the pat­tern of re­im­burse­ment.”

But Kopanos coun­tered, saying that in other states, in­de­pen­dent nurse prac­ti­tion­ers head to ru­ral or un­der­served ar­eas.

“States with more fa­vor­able li­cen­sure laws have more nurse prac­ti­tion­ers work­ing in ru­ral ar­eas,” she said.

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