Nurses seek independent practice
Top of the list for this week is HB 88/SB73 – Modernize Nursing Practice Act, which the NCMS opposes. This is the perennial attempt to expand advanced practice nurses’ (APRN) scope of practice by eliminating physician supervision. APRNs contemplated in these bills would include Nurse Practitioners (NP), Certified Nurse Specialists (CNS), Certified Nurse Midwives (CNM) and Certified Registered Nurse Anesthetists (CRNA). Passage of this legislation would break apart the current team structure that allows all APRNs to practice at the top of their individual scope of practice.
Proponents of the bill argue that this is not a scope expansion bill. That message falls far short of fully describing the beneficial supervision relationship under which APRNs can currently practice. As we focus for the future on team-based approaches to health care delivery, breaking up these relationships would not be forward thinking. APRNs’ scope currently is limited only by their shared understanding of their personal training and skills with their supervising physician. Independent practice would require a detailed scope of practice in the law, targeted to the lowest common denominator, which would severely limit some of these practitioners’ current patient care activities.
We believe that the APRNs ask a good question: How do we get more providers into rural areas? Currently, physicians and APRNs tend to be located in mostly similar areas of the state. We need a coordinated effort to encourage all health care providers to move into more rural communities. Destroying the thing that brings teams of providers together is not an incentive to relocate or expand services away from the major highway corridors of North Carolina.
NCMS is committed to solving this problem, but we oppose the elimination of supervising physician agreements that currently affords NC citizens access to the best abilities of each individual APRN.
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Optometrists push hard to do surgery
The other scope of practice bill you’ll be hearing a lot about is our continued opposition to HB36, Enact Enhanced Access to Eye Care Act, in which optometrists are seeking to expand their scope of practice to perform eye surgery with both scalpels and lasers. We expect this bill to be heard in the House Health Committee sometime soon. Please use our Action Alert from last week to communicate with your NC House member to express your opposition to this proposal.
We oppose this bill on patient safety grounds since optometrists do not have the requisite training or experience to perform these procedures. Ophthalmologists, who are physicians and surgeons, possess years of extensive medical education and experience through residency and fellowships. Optometrists only receive surgical training during certification and continuing education courses, which are woefully inadequate to provide safe, high-quality care.
Rural Providers Visit Legislators on Rural Health Advocacy Day
Over 100 directors and staff from rural health centers across the state converged in Raleigh on Tuesday to speak with their legislators and policy makers about how best to sustain the state’s health care safety net. These clinics provide much needed health care services for the rural areas of the state. After visiting their representatives, they gathered at the North Carolina Medical Society (NCMS) Center for Leadership in Medicine over lunch to debrief and share what they learned from legislators. Ben Money, MPH, President and CEO of the North Carolina Community Health Center Association (NCCHCA), led the discussion.
Care Share Health Alliance, which helps communities develop collaborations to integrate and improve health care in communities across the state, sponsored the lunch.
Overall, those who spoke with legislators reported positive interactions. Several policymakers showed interest in visiting the centers in their district to better understand what they do and the patient’s experience. They also liked to hear about ways the various safety net providers collaborate among themselves and with other stakeholders to serve their communities.
Legislators also seemed unwilling to commit to policies at the state level when faced with the current uncertainty at the federal level. They also were not interested in revisiting the state’s decision to move the state’s Medicaid program to managed care.
Later in the day, the NC Rural Health Leadership Alliance, which supports partnerships and strategies that improve health outcomes in rural North Carolina, also held a meeting at the NCMS headquarters. The NCMS’ Franklin Walker, Director of Rural Health Initiatives and Conor Brockett, Associate General Counsel, spoke to the group about Carolina Complete Health, the patient-centered, physician-led, health plan, which the NCMS in conjunction with NCCHCA and Centene Corporation are forming in hopes of serving Medicaid patients under the state’s Medicaid reform legislation. Learn more about Carolina Complete Health.