Group lobbies for progress on bills that would cut red tape between Pennsylvania nurse practitioners and physicians

Two bills aimed at ending the mandatory cooperation between Pennsylvania’s nurse practitioners and medical doctors are stalled in legislative committees in both the state House and Senate.

And the Pennsylvania Coalition of Nurse Practitioners rallied in support of the bills moving forward today at the Capitol Rotunda as part of the organization’s annual Lobby Day.

The group said in a release, “We can band together to provide our residents with top-notch and cost-effective healthcare by doing our part to convince lawmakers that HB 765 and SB 717 are vital to the future health of Pennsylvanians.”

House Bill 765 and Senate Bill 717 would allow a certified nurse practitioner to order home health and hospice care, make physical therapy and dietician referrals, and “perform and sign initial assessment of methadone treatment evaluations,” among other abilities without mandatory collaboration with a physician.

Collaboration for a nurse practitioner requires “immediate availability to a licensed physician,” including regularly scheduled meetings between the two parties, and a predetermined emergency plan.

House Bill 765 was referred to the House Committee on Professional Licensure on March 23, 2015 and has been stalled in the committee since.  Similarly, Senate Bill 717 was sent to the Senate Committee on Consumer Protection and Professional Licensure on April 10, 2015, where it currently sits.

If either bill passes, Pennsylvania would join 21 other states and Washington, D.C., as locations where nurse practitioners are not required to have full collaborative agreements in place with physicians.

A recent study from the University of Texas found that patients who have nurse practitioners as their primary care provider require fewer hospital admissions. A similar study conducted by the University of Montana found that having nurse practitioners work with patients individually can reduce healthcare costs by as much as 29 percent.

Dr. Amitesh Agarwal, a University of Texas doctor who authored the study, said, “For some processes, the outcomes are somewhat better with nurse practitioners and physician assistants, compared with physicians.”

Nurse practitioner positions are becoming increasingly sought after jobs across the country, as well. The Bureau of Labor Statistics expects the growth in nurse practitioners to exceed 30 percent in the coming decade. This may come to be a blessing for Pennsylvania, where the U.S. Health Resources and Service Administration has identified 155 areas in the state that lack adequate primary care.

Ben Reynolds, director of UPMC’s Office of Advance Practice Providers, told WESA that UPMC is the nation’s second largest employer of nurse practitioners and physician assistants.

Opposition to the bills in the state Senate and House is primarily coming from the Pennsylvania Medical Society, which argues that requiring a collaborative contract between nurse practitioner and doctor ensures the most access to medical expertise for a patient’s health, especially if complex medical issues should arise.

"Anything that leads to the fragmentation of the team detracts from that ultimate goal of providing the highest quality of care for patients in the safest environment possible," Medical Society President Dr. Karen Rizzo told The Allentown Morning Call last year.

Rizzo also noted that, according to the American Medical Association, trained physicians spend 12,000 to 16,000 hours in clinical training, while nurse practitioners comparatively spend only 500 to 700 hours in training.

During a meeting on April 26, the Hospital and Healthsystem Association of Pennsylvania (HAP) issued support to certified nurse practitioners to operate within their full scope, without a required collaboration with a physician.  

“The full use of CNPs and other clinical professionals is needed to build strong patient relationships, help patients and families follow care plans, coordinate care across the continuum, improve patients' health literacy, and provide health education,” according to HAP President and CEO Andy Carter.

“Allowing full-practice authority for CNPs after meeting the appropriate physician collaboration requirements is a reasonable, responsible approach to helping to meet the growing health care needs for Pennsylvania," Carter said.

Reach Iain Oldman at ioldman@publicsource.org.