House Bill 216 Health and Aging Committee Proponent Testimony January 20, 2016 Terri Miller MSN, APRN-CNP, CCTN and OAAPN President

Transcription

1 House Bill 216 Health and Aging Committee Proponent Testimony January 20, 2016 Terri Miller MSN, APRN-CNP, CCTN and OAAPN President Chairwoman Gonzales, Vice Chairman Huffman, Ranking Member Antonio, and members of the committee, I am Terri Miller, president of the Ohio Association of Advanced Practice Nurses. My comments today are based on the dash 3 version of the legislation. OAAPN has been working with our sponsor and the other interested parties toward what we believe will be an agreed upon bill. Changes have been made to the original version to address concerns from multiple parties. OAAPN s membership consists of certified registered nurse anesthetists, certified nurse practitioners, clinical nurse specialists and certified nurse midwives. All four of the advanced practice specialties have different scopes of practice based upon their education, certification, and training. All APRNs have either a Masters or Doctorate degree, are certified by their national certifying body, meet continuing education requirements, and are recognized nationally as advanced practice registered nurses. I am a certified nurse practitioner at The Ohio State University Wexner Medical Center s Comprehensive Transplant Center. I have been a nurse for 25 years, 10 of these as an APRN. The landscape of health care has changed dramatically since I became a nurse. Currently, the system is overwhelmed as more patients are insured and seeking primary care, baby boomers are aging, and the number of primary care physicians continues to Page 1 of 6

2 decline. Patients are suffering the consequences of this imbalance by experiencing delays in access, inefficient service and higher costs. With all this transformation, the last systemic change to the Nurse Practice Act was House Bill 241 in the 123 rd General Assembly, 16 years ago. This legislation established collaborative arrangements and a formulary, which were initially intended to provide oversight and ensure the APRN had a knowledgeable resource and a perception of safety. However, despite initial intent, these measures have become barriers to safe and effective patient care in today s rapidly changing health care environment. Presently, there are 22 states and the District of Columbia that authorize APRNs to practice to the full extent of their education, training and certification. National institutions and organizations have studied the impact of physician supervision of APRNs on quality outcomes and health care costs. The results of these studies have led these organizations to support the removal of physician supervision and mandatory collaborative agreements. Some of these groups include the National Governors Association, the National Academy of Medicine, the Federal Trade Commission, the American Association of Retired Persons, The Robert Wood Johnson Foundation and the National Council of State Legislators. Currently in Ohio, APRNs must have a Standard Care Arrangement, otherwise known as a collaborative agreement, with a physician to practice. Without this agreement, APRNs cannot practice and, in many instances, physicians are paid by the APRN or a health system to collaborate. Page 2 of 6

3 I want to give you a clear understanding of the APRN/collaborator relationship. Legal collaboration has nothing to do with professional collaboration in which APRNs practice on a daily basis. APRNs are seeing patients and professionally collaborate with a variety of providers based on a patient s need. We agree with our physician colleagues that given the complexity of modern health care, an inter-professional, coordinated approach is vital. House Bill 216 does not dismantle professional collaboration. House Bill 216 merely removes the overly burdensome administrative requirement of a legal agreement with a physician. The Standard Care Arrangement puts patient care delivery at risk. Should a collaborator become incapacitated for any reason, lose a medical license, leave the state or no longer wish to collaborate, that APRN cannot practice until a new collaborator is found. For example, my colleague Diann owns a primary care practice in Gahanna. If something happens to her collaborator, she has 2,000 patients she can t treat until she finds a new collaborator. Imagine if you were her patient and could not get the care you needed or needed prescription refills. Shortly, you will hear from Tiffany Pottkotter about how collaboration has limited the mental health care services she is able to provide in Findlay. Finding a collaborator is not easy. The number of potential collaborators is declining. Many physicians have become employees of health care systems, which don t allow physicians to collaborate with APRNs not employed by the same system. Additionally, the Standard Care Arrangement inflates Ohio health care costs by millions of dollars. As you can see by the info graphic, many APRNs, as part of their standard care Page 3 of 6

4 agreements, must pay their collaborators in the form of cash, a percentage of their productivity, and/or work for free. What 216 seeks to do is to end the requirements of a contractual, mandatory collaboration. To suggest that a nurse practitioner, a certified nurse anesthetist, a certified nurse midwife or a clinical nurse specialist will no longer collaborate with other practitioners if this bill were passed is simply untrue. The day this bill becomes effective, nurses will continue to collaborate on a team-based approach with other health care providers, just as they do today to ensure patients receive the care they need. Opponents of House Bill 216 argue that this bill is not safe for patients, claiming that a team-based approach to health care is best served under the direction of a physician. So far the only suggestion they have made during our interested party meetings has been to increase the ratio of APRNs that can collaborate with a physician. The truth is there are no current laws limiting the ability of a physician from engaging in a collaborative agreement with more than three APRNs. The current ratio only states that a collaborating physician cannot collaborate with more than three APRNs who are prescribing at any one time. Increasing ratios does not address the dependency of an APRN on a physician to practice. Increasing ratios keeps the status quo. When it comes to a team-based approach to care, it takes a team of health care professionals to care for the complex needs of patients, and all professional team members bring expertise from their respective disciplines. One discipline does not automatically supersede the other. House Bill 216 is not about comparing the qualifications of a physician with the qualifications of an APRN. It is about the practice of Page 4 of 6

5 advanced practice nursing, as defined by the Ohio Revised and Administrative codes - not the practice of medicine. It is important to understand that the legal standard of care, that of evidence based, practice based on national guidelines, is the same for APRNs as it is for any other medical provider. Ohio APRNs have been ordering diagnostic tests, prescribing medications and developing treatment plans without physician consultation, within their specific scope of practice, safely since Nurse anesthetists have been safely administering anesthesia for 150 years. In spite of assertions to the contrary, the passage of House Bill 216 will not increase the current APRN scope of practice. Patients will see no difference in the care they receive from an APRN between the day before and the day after the bill is effective due to the removal of legal collaboration. From the clinic to the operating room, current laws cause unnecessary roadblocks that put a patient s quality of care at risk. House Bill 216 will modernize the Nurse Practice Act for APRNs by: Allowing APRN licensure to align with the national APRN Consensus Model; and Authorize CRNAs to order medication within their scope of practice to enhance patient safety. Ensuring that happens means: Retiring the mandatory and regulated collaboration between physicians and APRNs; and Retiring the multi-page drug formulary to an exclusionary statement for medications prohibited by federal law only. This action decreases care inefficiency and increases patient safety. Page 5 of 6

6 These changes will benefit Ohio s patients and decrease the state s health care expenditures. It s important we act now. Page 6 of 6