re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187

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Wrong again. In the rural settings of Louisiana

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Hell, in the VERY metro Houston setting, "on premises or immediately available" is interpreted very liberally.

Unless the doc is leaving the state, I rarely would see sign offs to the alternate supervising physician.

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Wrong...Can you show me that, because that is false... The collaborative practice agreement doesn't require any charts to be reviewed...

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Most the physicians I talk to require some percentage to be reviewed. It's left up to the collaborater. You are correct that there is no legal standard, but most the ones I've come across are reviewed at about that rate or higher.

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In the rural settings of Louisiana, where physicians pretty much refuse to go because the large amount of patients they would see are uninsured or Medicaid only, the collaborating physician is miles away. He is always available by phone however.

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Which rural areas are there NPs and absolutely no physicians within miles?

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But there shouldn't be a paper needed for that right? Collaboration takes place every day by medical professionals and no piece of paper is needed.

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The collaborative agreement allows a licensed independent provider to allow an NP to practice under his license at a level he's comfortable with with restrictions set in place by him on an individual level based on the NP and the amount of trust he has for the NP. Physicians collaborate with one another all the time without pieces of paper. They also have medical licenses and are held to the standard of board certified physicians in their field.

Grant NPs medical licenses by a process determined through the LSBME and hold them to the same standard, and then you won't need to have a collaborative service agreement. You shouldn't be able to practice medicine without a medical license. But a midlevel shouldn't be able to practice without supervision because they're...a midlevel. By name. And by training. And by licensing. There's nothing dishonorable or wrong with that, either. But that's the job they're trained to do. Want a path to licensure? I'm all for it. But their needs to be licensed physician input on that practice until that occurs.

I still have not made up my mind on how I feel about this bill (not that the way I feel has any say so)and through the thread I have been swayed back and forth, but if you are telling me that currently a supervising physician only has to be available, and only a handful or so charts are reviewed, then the majority of patients being seen by a NP, nothing would change, and if we are so worried about safety then shouldn't every chart be reviewed? so, if that is the way it is, I am inclined to support the bill, however if it is more like Smack does and reviews every chart and is directly available night or day then I would support continuing that level of supervision

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currently a supervising physician only has to be available, and only a handful or so charts are reviewed, then the majority of patients being seen by a NP, nothing would change

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Careful with that "nothing would change." Currently an MD meets with the NP on an annual basis and must renew the agreement to be in collaborative practice. There are suggested requirements. The practice I looked at today is 100% reviewed by the phayciian- his NP works in his office, and he sees every patient or chart every time.
He also collaborated with some in small towns 5-10 miles away. He speaks with them frequently and reviews charts periodically. He's had a longstanding relationship and trusts them with some amount of autonomy- it's defined in their agreement what he allows them to do and what he specifically does not allow them to do (conditions they can see/treat, drugs they can write, etc).

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if we are so worried about safety then shouldn't every chart be reviewed?

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The LSBME was considering attempting to remove the off-site requirements and force the collaborator to be within X miles and available the last I spoke with one of them on the board (~2m ago). Make no mistake, the LSBME is currently in a stage of being more limiting on who can practice solo. They're considering removing allowing MDs from gaining a license until after they've completed a residency. They're literally being tougher on physicians meanwhile this legislation is attempting to loosen restrictions on mid levels.

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if it is more like Smack does and reviews every chart and is directly available night or day then I would support continuing that level of supervision

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A lot of folks do it like this. They are performing above the bare minimum. The bare minimum is a cell phone and access to the EHR with recommended chart review. In my experience, the majority practice much more like Smack, but the few that exploit the weak wording of the law do allow a few NPs to practice almost unsupervised. That said, they still must annually have the MD renew the agreement to let them practice and specify things they can and can't do. If that goes away, the state board of nursing may or may not enumerate conditions to be treated/seen, but the state board of nursing cannot issue a medical license, and the LSBME isn't going to allow a non-collaborating NP access to a medical license just because of this bill. So you'll have people practicing medicine without a medical license. Should something go wrong, I sure as heck wouldn't want to be in their shoes.

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the "fallout" will be the same. np's have med mal insurance just like docs.

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The NPs will be practicing medicine without a license. It's not the same. And the same rules don't necessarily apply.

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There were posts earlier proclaiming doctors to be experts on drug interactions (at least over other specialists), but pharmacists catch mistakes all the time.

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I'm not sure if you're talking about my earlier post. If so, I was responding to someone suggesting that more drugs should be made OTC so that anyone can just go prescribe themselves whatever they think they need.

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Get rid of that and malpractice costs will soar.

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you're missing a pretty important part of the equation here - there have to actually be "soaring" rates of np malpractice. any evidence that that has been the case elsewhere?

also, lawyers won't be "chomping at the bit" because the limits aren't any higher for a np than for a md.

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There's an NP in the house.

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so that one dude single handedly runs congress? dude must be a serious B.S.D.