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

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would think more about hospitals and FQHC companies opening up more NP clinics as soon as this happens

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FQHC are already required to use midlevel providers. Allowing NP's to practice without oversight will not result in any "increased revenue streams" for hospitals or FQHC's. Unless of course you are talking about the increased lab and imaging burden proven time and again when across patient panels by NP's. Or possibly the increased number of OV that result from incorrect diagnosis and or treatment. However the last is a wash as this also increases patient dissatisfaction, legal costs, and liability to the over sighting facility or employer. Many ER's have seen the pendulum shift from no midlevel usage, to heavy usage of NPs for lower acuity patients with only the minimal 20% required oversight, and more recently back to limited NP usage with hospital policy mandated physician review of 100% or patients seen.

There's 105 reps in the house

Tomorrow
House
2 pm


My guess is 54 against, 46 for, 5 absent

And yes we make 100 pages

LINK

1. Scary harpsichord music
2. Misleading but entitled 'The Truth'
3. They state there is no supervision but that they have a collaborative practice agreement. Doesn't make any sense.

4. No scope of practice change?? But you want to legislatively remove the physician signing off on your charts. That doesn't make sense

5. Some of our patients are Medicare. Ok but can they be seen by an NP w/o the Cpa?

6. We have a collaborative practice agreement with a doctor but he does not review our charts or oversee the practice... ? Does that make it ok?? Ummm no

7. Affordable health care... Umm increased testing ordered by NPs, 85% pay, probably will lobby for equal pay soon

8. We don't have a doctor - go drive to one nearby - or better yet recruit one to your town. You spend money on police, school, and street lights? Why not a physician for your citizens

9. Quality of care --- 1/5 to 1/10 the education of an MD

10. Referrals - yes these will go up

11. We have a full clinic lobby and see lots of patients and therefore that proves we have safe care --- the video says there's an np and a doctor in that town and both are really full clinics - if there are 2 options/choices on the menu and not enough food to go around for all the people --- just because all the people order something doesn't prove anything to be safe necessarily. It just proves they chose something to order

13. This is not a new thing -----it's totally new. Wanting to practice medicine with no supervision - totally new or there would not be this ongoing conversation

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3. They state there is no supervision but that they have a collaborative practice agreement. Doesn't make any sense.

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So the CPA is an agreement between a doctor and a nurse practitioner to provide consultations and referrals between each other. All this bill is doing is allowing NP's to consult other physicians besides the one in his or her CPA. Unfortunately, the CPA has never required supervision or "signing off" on charts by physicians. Physicians lost this battle long ago, and I'm not sure we even knew it.

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5. Some of our patients are Medicare. Ok but can they be seen by an NP w/o the Cpa?

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Legislation calling for Medicare reimbursement for nurse practitioners regardless of setting was passed by Congress and signed into law by the president on August 4, 1997. The new legislation became effective January 1, 1998. Effective with the passage of the Balanced Budget Act of 1997, all NPs, CNSs and PAs must have their own billing number in order to bill Medicare. This legislation called for direct reimbursement to nurse practitioners for providing Medicare Part B services that would normally be provided by physicians. The bill states that these services are not restricted by site or geographic location.

So basically Medicare doesn't require a CPA for reimbursement of NP's. So that was a myth.

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13. This is not a new thing -----it's totally new. Wanting to practice medicine with no supervision - totally new or there would not be this ongoing conversation

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Unfortunately, this was not a new thing at all. NP's have been able to practice medicine by law without supervision for a while now. Only PA's are required to practice with supervision (doctor's signing off etc.).

The real way that medicine should have combatted other field's encroaching on the field of medicine would have been to long ago increase med school spots, residency positions, and med school/residency funding. Instead, what they did was cap the amount of money (pct. wise) that could be given to residency programs in I think 1997. Now we are faced with a physician shortage and no way to increase the number of physicians in a timely manner. This is where NP's have taken advantage and are reaping the rewards. And we are going to have to live with the benefits and consequences of that until we can make up for our blunders of the past.

Ok thank you for your information, it's all helpful and interesting.

What about the other bullets? They are all significant problems

Past blunders do not dictate that we continue with present and future blunders. If anything, we should stop and go back and fix past mistakes

I think it's time for the anchor.

Now you're just talking to yourself.

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hink it's time for the anchor.

Now you're just talking to yourself.

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Yeah I agree.... No reason for a thread to stay at the top of the page when it's just the same guy talking to himself to bump it to the top....

Let's see. 4 is wrong. Physicians don't have to sign off on an NP's chart.
6. Once again he doesn't have to review charts or oversee the practice. All the physician has to do is be available for consultation.
7. Where's your evidence for that?
8. Good idea. Go to your state legislature and advocate.
9. I would hope so or else what the hell was point of all the school I went through.
10. Probably.
11. Yeah I agree. How do you propose we get more doctors to rural areas?
13. But it's not new. NP's have been practicing without physician supervision for decades whether you like it or not. I don't like it either by the way.