Scrapping Mandatory Agreements Won't Impair Collaboration, Advanced Nurses Argue - Gongwer News Service

A House panel spent an hour and a half Tuesday probing legislation that eliminates the requirement for advanced practice registered nurses to obtain collaboration agreements with supervising physicians in order to practice.

The measure (HB 177), which received its second hearing before the House Health Committee, would eliminate the agreements, which supporters argued provide no value to patients but are increasingly hard to arrange due to the shrinking physician population.

Joscelyn Greaves, president of the Ohio Association of Advanced Practice Nurses, said changes in the healthcare landscape necessitate an update of Revised Code. This area of state law, she said, received its last significant update 20 years ago during the 123rd General Assembly.

It was that legislative move, she said, that created the collaborative arrangements which were intended to ensure adequate oversight of APRNs. But the increase in the elderly population and those with insurance along with the declining number of primary care physicians means the state must adapt, Ms. Greaves said.

"It is our belief that the time to revise this outmoded law is now," she said. "HB177 will simply remove the mandatory contract between physicians and Certified Nurse Practitioners, Certified Nurse Midwives, and Certified Clinical Nurse Specialists. Ohioans deserve improved access to care in an efficient system where all health care providers use their knowledge and skills to ensure quality outcomes."

Rep. Niraj AntaniĀ (R-Miamisburg) questioned why the change is needed considering that lawmakers two sessions ago passed a compromise measure (HB216, 131st General Assembly) expanding the number of nurses a physician may oversee from three to five.

Ms. Greaves said the number of physicians, particularly in rural areas, continues to decrease. "We're not having the ability to have those collaborators and continue that practice," Ms. Greaves replied.

"Why not seek an expansion as 216 did rather than this which is completely severing (those agreements)," Rep. Antani followed up.

"Respectfully, it's not really severing that collaboration," Ms. Greaves answered. "The collaboration would remain. It would just remove that standard care arrangement that is there."

Ms. Greaves emphasized the measure would not expand the scope of practice for those nurses but instead removes the burden of having a legal contract with a physician who is often not present when the nurse is providing service.

Ms. Greaves also told the panel that a survey of nurses showed some paid up to $5,000 a month to their supervising physicians for such agreements. She said she believes there would be little change in liability insurance or related costs if the measure were enacted.

Thomas Zaciewski, a physician collaborator for two nurse practitioners in Northwest Ohio, said 27 states have already retired this type of contract.

"HB177 will add more efficiency to the delivery of care by APRNs and more access to care for Ohio's patients. It is a no-cost, no-delay solution for increasing health care access," he said.

Nurse practitioner Marie Grosh described her own experiences with these agreements. When the partner of her first physician died, the doctor took a job with a health system which prohibited such agreements, resulting in her arrangement ending.

After much searching, Ms. Grosh said, she found a new physician who later retired, putting her back at step one. Now, her current physician is planning to retire in the near future and the search has begun anew.

"The landscape is even drearier now than it was when I opened my practice," she said.

"My story is not rare," Ms. Grosh said. "As I work alongside many other nurse practitioners I hear these stories every day. Most of my fellow faculty has never met the physician who signed their SCA."

Written proponent testimony was submitted by Ohio Association of Area Agencies on Aging, AARP Ohio, PsyCare Inc. and Americans for Prosperity Ohio.