By Christen Smith
Staff Reporter
Capitolwire
HARRISBURG (April 29) — The Pennsylvania Coalition of Nurse Practitioners — donning lab coats and blue signage emblazoned with their “patients first” mantra — ascended the marble steps of the Main Capitol Building Tuesday like a sea of white, rallying support for legislation they say would free some 9,000 nurse practitioners from physician oversight and extend healthcare access to all corners of the state.
Senate Bill 1063, sponsored by Sen. Patricia Vance, R-Cumberland, eliminates a state mandate that prohibits nurse practitioners from operating independently by requiring a written collaborative agreement with at least one physician — two, if the nurse practitioner wants the authority to prescribe medications. The bill would also circumvent the “hidden provider” phenomenon by allowing insurance companies to bill the nurse practitioner directly rather than through the sponsoring physician.
“I think the biggest problem is that if that physician decides they aren’t going to work anymore, we can’t practice anymore, so that’s why it’s a really big deal,” said Donald Bucher, an acute care certified nurse practitioner and the coalition’s northwestern chapter president. “It’s not just a signature on a piece of paper. It’s much more than that.”
The coalition says 17 states and Washington D.C. have already outlawed collaborative agreements and doing the same in Pennsylvania will cut costs, attract new healthcare companies and shrink a provider gap exacerbated by the influx of newly-insured under the Affordable Care Act.
“That’s what we’ve told Congress year after year,” said Sheila Gealey, western coordinator for the coalition’s “Putting Patients First” campaign and vice president of the Community Health Clinic of Butler County. “We have the capacity to grant access to patients, so just write us into the bill.”
The provider gap right now equates to just one physician for every 382 residents in urban areas. The ratio doubles for rural populations — which includes some 3.5 million residents across 48 of Pennsylvania’s 67 counties.
The coalition says that gap will widen as one quarter of the state’s 5,000 physicians retire over the next few years.
“No healthcare provider works in isolation,” Gealey said. “We all collaborate with each other. We all interconnect. We just want to be responsible for our practice.”
Opponents of the bill, including the Pennsylvania Medical Society, call the coalition’s statistics “outdated” and worry about its potential to sever the cooperation between physicians and nurse practitioners.
“PAMED does not support this bill primarily because it would break up health care teams at a time when great emphasis is being placed on such teams,” said Chuck Moran, spokesman for the society. “Many of the arguments used in support of this bill are outdated, including arguments about primary care access and rural care.”
The American Medical Association echoed the society’s criticism in a joint letter addressed to the state Senate, dated April 14.
Dr. Bruce MacLeod, president of the society, and Dr. Ardis Hoven, president of the association, argued that a “team-based” approach remains the future of healthcare and that only physicians bring “the highest level of training and preparation” required of a healthcare team leader.
“These two different approaches — independent practice and team-based care — take health policy in two very different directions,” MacLeod and Hoven wrote. “One approach (independent practice) would further compartmentalize and fragment health care delivery. The other (team-based) would foster integration and coordination.”
The nurses’ coalition shakes off the criticism as misleading and unsubstantiated.
“Show me the money,” Gealey said. “They don’t have one documented study that shows nurse practitioners deliver inferior care or unsafe care … but there are numerous studies that show nurse practitioners deliver safe, effective care.”
“We were nurses first,” said Mary Joe Cerepani, an emergency nurse practitioner for Emergency Resource Management and president of Nurse Practitioners of Southwestern Pennsylvania. “We went back for our Masters degrees and now some of us have our doctorates, so we have a lot of experience.”
Cerepani graduated nursing school in 1983 and became a certified nurse practitioner 16 years later. She earned her doctorate from Waynesburg University in 2010.
She disregards the notion that the bill discourages team-based care.
“We work as a team,” she said. “We work with physicians and multidisciplinary groups. We are in it for the patients and what is best for those patients. This bill doesn’t change that.”
Sen. Lisa Boscola, D-Lehigh, signed on as the bill’s 19th cosponsor Tuesday after meeting with nurse practitioners.
“There are a lot of us that support you and we want this bill to pass,” she said. “I commit myself to trying to make that happen.”
The Senate referred the bill to the Consumer Protection and Professional Licensure Committee — on which Boscola serves as minority chairwoman — last July. There’s been no movement in the 10 months since.
Majority Chairman Sen. Tommy Tomlinson, R-Bucks, could not be reached for comment Tuesday.
A team based approach seems inefficient. The larger the organization the more communication must take place and the more communication required means less time for patient care and more opportunity for information to fall through the cracks. Team care seems to mean committee care which means no single point of responsibility. Having had experience with a nurse practitioner as my primary health provider in another state I support SB 1063.