Bill Reignites Debate Over Independence For Advanced Practice Nurses

Less than two years removed from the passage of legislation expanding their scope of practice, advanced practice registered nurses again are seeking independence from collaboration agreements with physicians.

Backers said the proposal (HB 726) introduced this week by Rep. Theresa Gavarone(R-Bowling Green) would expand access to care, particularly in underserved areas.

The Ohio State Medical Association, meanwhile, reiterated concerns about the safety and efficacy of allowing APRNs to practice without collaborating with a physician.

Rep. Gavarone touted the proposal as an effort to enhance primary care services across the state.

"Improving access to healthcare for people in Wood County and the state has always been a priority of mine," she said in a statement. "The demand for primary care services is projected to increase much faster than physician supply over the next few years. There are several reasons for this, but it is clear that enacting the 'Better Access, Better Care Act' is one step we should take to ensure that the physician shortage doesn't diminish access and quality of healthcare services to Ohioans."

The Ohio Association of Advanced Practice Nurses said the existing collaboration agreement is essentially a fee APRNs pay to a physician in order to practice. The group called the regulation "outdated" and said no actual collaboration regarding patient care occurs through those agreements.

The association said many areas of the state face a dearth of primary care providers.

"We applaud Representative Gavarone for addressing the critical need of all Ohioans to gain access to health care in communities across the Buckeye state," OAAPN president Jesse McClain said in a release. "Today, more than 1.4 million Ohioans lack necessary access to vital primary care services. In fact, the federal government has designated 141 health care provider shortage areas across the state, meaning that just 55% of patient need is met."

The state's 16,000 APRNs have post-graduate degrees, advanced training and education and are trained to diagnose illness, treat patients, order tests, prescribe medicines and deliver babies, the association said.

"We call on the Ohio Legislature to pass HB726, the Better Access, Better Care Act to ensure that Ohioans receive access to the care they need and deserve," Mr. McClain said. "Outdated regulations limit the healthcare Ohio APRNs can provide while undermining needed access to high-quality, accessible care statewide. We can and must do better."

The OSMA pointed to a proposal legislators passed late in 2016 (HB216, 131st General Assembly) that expanded authority for APRNs. Original drafts of that legislation eliminated the requirement for collaborative agreements. Later versions reinstated the requirement, but eased it by allowing doctors to have agreements with more APRNs and providing protections for APRNs whose agreements are terminated by a physician. (See Gongwer Ohio Report, December 8, 2016)

"Our concern there was, as it is now with this bill, that this is a very dangerous proposal that actually will do very little to improve patient access and in fact has the potential of harming patient care," OSMA spokesman Reggie Fields said in an interview.

Mr. Fields said medical care teams should be led by a physician.

"We've never questioned the need and the ability of nurses to be able to provide a very vital role in providing appropriate medical care," he said. "We're just saying that we should not assume that any individual who has not gone through the extensive training and education that a physician has should then play the role of being a physician."