re: SB 435 would allow advanced practice nurses to not work under a physician

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Failure to achieve quality up front actually leads to increased cost, both in terms of dollars and morbidity/mortality.

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I tend to agree.

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The VA has allowed NPs to work independently for years. That policy obviously did not help access or outcomes, and may have actually worsened them

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Vehemently disagree. I was one of the private GI practices contracted to "support" the Houston VA and accommodate it's patients in a private setting. I can not begin to describe just how incompetent every level of VA administration was during that process. They had years of poor outcomes prior to autonomous mid levels. I can't bring myself to blame the providers, or the training environment, for most of their issues. People like me (admins) are the most responsible for the VA's STEEP decline, IMO.

Last thing we need is some nurse with a community college degree on their resume treating humans.

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the industry as a whole is shifting to "value based outcomes".

it's moving at a snails pace for critical access hospitals, I know. But it's happening. This is counter-intuitive

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If I can convince the diabetic/hypertensive to drive 5 miles to see the NP in a medically underserved area 4 times per year, compared to driving 40 miles to see the MD once or twice per year, why wouldn't the population health metrics of that MUA be more favorable to my system?

These value based contracts require more efficient population management than what 1-2 physicians covering a rural facility can provide. And the fear of individual liability incidents doesn't outweigh the need for more encounters, more prevention, more active management of the more at risk populations. System admins are of the belief that teams of mid levels can generate the outcomes needed for the value based contracts to trigger their incentives.

I don't think you will see this as the business model in urban settings, but these rural facilities are dying. Fee for service is dying. And they won't achieve the required quality measures, and the connected reimbursements, without additional provider help.

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NP's ability to practice within their full scope.

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You mean that one month of clinical rotations they do vs. a doctor that completes years of residencies and fellowships?

Good point. Parents and patients in general want their quick fix---I have a sniffle--give me a Z pack and a steroid shot. They are way overprescribed by M.D.'s who won't say no to their patients demanding the quick fix that likely is non-indicated and may cause problems. So, NP's should not be allowed to do that and, for that matter, they need much more education to render diagnoses that are not always straight-forward. Alas, there is a primary health care provider shortage in La. (and likely in all rural areas across the country) and this may be the best fix until it is financially palatable to run a PCP clinic in the rural areas. Our politicians have to fix that while turning their back on the insurance lobbyists--good luck! Insurance companies don't want to pay MD's to look at sore throats when it is cheaper for them to pay the rates of a non M.D. Just my opinion......

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You mean that one month of clinical rotations they do vs. a doctor that completes years of residencies and fellowships?

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The issue is that most of these NPs are already practicing with little to no supervision while the MD just signs off on their documentation. Basically, the MD is getting paid to have malpractice insurance.

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The issue is that most of these NPs are already practicing with little to no supervision while the MD just signs off on their documentation. Basically, the MD is getting paid to have malpractice insurance

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then put the squeeze on the mds not the NPs, limit the amount of collaborative agreements an MD can enter and have them be required to be onsite for so many hours, review 100% of charts , etc make it difficult for the MD's and this will go away

No offense but most nurses ain't smart

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My lady friend is a NP and has her masters.

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but does she have epic boobage?

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This guy gets it.. a damn Z pak is going to be useless in the not so distant future due to overuse.

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They pretty much are already useless. They already don't effectively treat "sinus infections" (BTW, you don't really have a sinus infection, come see me in 10 days if you're still sick).