Tuesday, April 12, 2016

Nurse Practitioners: Medical Licensure board renegs

 Update: The MBML withdrew the amendment that is the subject of the story below and submitted a revised one on April 4.  The agency stated it withdrew the original amendment due to a "technicality".  The revised amendment is posted below. 

The battle over allowing nurse practitioners to operate more freely in Mississippi may not be over.  Watchdog.org reports the Mississippi Board of Medical Licensure might be changing the terms of an agreement it reached with the legislature this year.  Steve Wilson writes:
While the Mississippi Board of Medical Licensure has extended the tether for nurse practitioners from 15 to 75 miles with updated regulations, the Mississippi Association of Nurse Practitioners isn’t exactly popping bottles of celebratory champagne.

Ricki Garrett, executive director of the MANP, said the board violated the terms of its deal with the Mississippi Legislature by changing more than the tether rule. Under the original deal between the Legislature and the board, the Legislature killed a committee substitute offered by state Sen. Terry Burton, R-Newton, in exchange for the board loosening the 15-mile rule regulations. Burton’s bill would’ve allowed nurse practitioners with 3,600 hours of clinical practice to work without an agreement with a collaborating physician.

Garrett said the unwanted changes to regulations included eliminating exemptions to the tether rule for NPs working in free-standing clinics, state health department sites, community health clinics, volunteer clinics and hospitals. Also, nurse anesthetists were placed under the tether rule after not previously being part of it.

“We have been told the legislative leadership is going to get the Board of Medical Licensure to go back to the drawing board and go back to the original agreement for the expansion to 75 miles,” Garrett said. “The problem is they are not deferential to anyone. It’s been a constant battle to keep what they’re doing in the light of day and work with them.”

Dr. Virginia Crawford, interim director of the Board of Medical Licensure, did not return a call for comment.

Even though the deadline has passed for general bills in the Mississippi Legislature, nurse practitioners still have one final chance to unshackle themselves from the licensure board. An amendment to House Bill 41 — which would add Mississippi to the Interstate Medical Licensure Compact that allows physicians to hold medical licenses in multiple states — would stop the board from exercising regulatory power over nurse practitioners and their collaboration agreements with physicians. The bill is headed to a conference committee after the House declined to pass the amended bill.

Garrett said one of the reasons why the board is loathe to allow nurse practitioners to practice independently is the money involved for the collaborating physicians. Under present regulations, the collaborating physician reads 10 percent or 20 of the charts per month (whichever comes first) from the NP under their supervision. This service, Garrett said, ranges from $1,000 to $7,000 per month per nurse practitioner.

“That’s all that physician is doing: Looking over 20 charts at the most every month,” Garrett said. “That’s one reason they (the board) don’t want to lose that. The other is the Board of Medical Licensure wants to be in control.”....

According to the notice filed with Mississippi Secretary of State Delbert Hosemann, the updated regulation would take effect 30 days after it was submitted March 28.

The need for more primary care for Mississippians is great, as the Magnolia State is one of six that has 30 percent or more of its population residing in areas with a primary care shortage, according to a study by the Kaiser Family Foundation. According to a 2015 workforce study by the Association of American Medical Colleges, Mississippi has the lowest number of physicians per 10,000 residents, with 184.7, while the national average is 265.5.

Kingfish note: Update to story.  The Board submitted this language on March 28 as part of the amendment:

 Advanced Practice Registered Nurse (APRN)” means a person who is licensed or holds the privilege to practice under Miss. Code Ann. §73-15-5, and who is nationally certified as an advanced practice registered nurse or in a specialized nursing practice, including certified nurse midwives (CNM), certified nurse anesthetists (CRNA), clinical nurse specialists (CNS), certified nurse practitioners (CNP) and doctors of nursing practice (DNP).
There was no separate definition for "Nurse Practitioner".  However, someone must have gotten the Board's attention because the amendment was withdrawn one week later on April 4 and this language was submitted for the definition of Advanced Practice Registered Nurse:

 “Nurse Practitioner” means any person licensed to practice nursing in the state of Mississippi and certified by the Mississippi Board of Nursing to practice in an expanded role as a nurse practitioner.

F. “Advanced Practice Registered Nurse” includes all nurse practitioners, certified nurse midwives and certified registered nurse anesthetists.
 The new amendment makes clear distinctions in protocols for the supervision of Nurse Practitioners and Advanced Practice Registered Nurses. 



This is the original amendment.


16 comments:

Anonymous said...

You don't piss off the Senate Pro Tempore. After the comments he personally made on the Senate floor that the Board had assured him that all would be well without the legislation Burton won't take kindly to the double-cross. Fierce blowback in 3 ... 2 ... 1. BOOM.

Anonymous said...

Kingfish, the MSBML withdrew the original rule changes from the SOS and has since refiled. The new proposed rule change ONLY changes the "15" to "75" with regards to the collaborative relationship, with no other changes. Steve's article was written prior to that refiling. Please update your article to reflect that. Thank you.

Kingfish said...

Updated. New language is posted as well as the amendments themselves.

Anonymous said...

Refiled only because they got caught. Damn new media.

Anonymous said...

Collaborative agreements limit NPs ability to practice, let them do what they are trained to do. I support Amendment 3 on HB41. Thank you for the attention to this issue.

Anonymous said...

Nobody posting on this subject has shit for sense.

Anonymous said...

as someone said in a previous posting... if they want to be like doctors... just go to medical school.

Anonymous said...

The BoML -- scurry like cockroaches when you turn on the lights. They've been ruling by fiat for some time now. It's great to watch their comeuppance.

Don't fuck with the legislature when you make a deal. Generally, they don't forget.

Anonymous said...

Really, curse words are unnecessary - facts convey much more! The BOML says it is a safety issue. Show me one respected study that says it is. I can show you many that says it is not an issue. There is a physician shortage in MS even with more money available and the addition of a DO school - Why is there such a small number of new physicians who choose to practice in MS year after year - could it be because the BOML would rather cut the physicians off at the knees if they collaborate with Nurse Practitioners? Is it because the BOML bullies and intimidates physicians who collaborate? The news of what the BOML has done has traveled fast and far! If only the BOML would tend to and nurture their own, focus on recruiting and keeping physicians in MS rather than spending so much time trying to control Nurse Practitioners through their own, adding brick after brick to the wall that prevents access to care for so many - and for what purpose - power, control, money? The BON does not try to control physicians because it is a safety issue! We just want to do what we are trained and qualified to do - be Nurse Practitioners. We want to bridge that wall and improve access to care for all Mississippians and for the BOML to cease and desist restricting our practice. The chorus in Helen Reddy's song "Leave Me Alone" is quite catchy! Dear BOML, please take care of your own and leave us alone.

Anonymous said...

an advanced degree NP was initially intended for nurses who had worked for many years and had achieved a certain level of experience and excellence in their field to be able to take it the next level and directly decide on how to treat and care for patients. a very reasonable and noble undertaking. but now it's a career path that nurses take with little working experience in nursing. what i have seen lately is a flood of NP's from schools that do not prepare the NP for what they will be seeing in the clinic. some of these are online "distant" schools as far away as Illinois. The NP's they put out are generally unskilled and in some cases outright dangerous. there are always always exceptions, some NP's i have come across would thrive in medical school but chose a different path. but on average, the overall quality of NP grads in this area is suspect. i recently met a patient that was treated 17 times in a year for "walking pneumonia" with antibiotics. what she really had was common seasonal allergies.

Anonymous said...

And I know of a physician who treated a woman 7 months for sinusitis with numerous antibiotics with no improvement. When she came to me, she only had right frontal sinus pain with no other signs or symptoms since the onset. I ordered a sinus x-ray and she had a met - lung cancer. I know of another who treated a child for recurrent OM over and over with multiple antibiotics and when I saw the child, TMs were "red" yes but it was not OM. The parent claimed the child had been complaining of fatique, visual light sensitivity, headache and hurt wherever he was touched for weeks and the ATBs had not helped . When I performed a QBC, his blood was like strawberry kool aid in the capillary tube and all values were low. Sent the kiddie to the ER and he was sent straight to Children's in New Orleans - he had AML! Yes, he did survive. Another patient complained of a severe HA like none he had ever had and on exam had papilledema. I handed the patient over to my collaborator and he sent the man home with the diagnosis of Migraine and an Rx for a narcotic. The man died that night of a brain aneurysm. I have seen so much more. Talk about outright dangerous. There is good and bad in every profession. Look at the percentage of physicians named as primary defendents in medmal cases every year in comparison to Nurse Practitioners - isn't it like 27% :: 1.7%?

Anonymous said...

I am just an ordinary person. I have visited many physicians and nurse practitioners in my 60 years. I have been much more pleased with treatment from nurse practitioners as opposed to physicians. I feel like I am listened to, treated and educated about my condition as an individual rather than a insurance claim by NPs. Nurse practitioners should be allowed to practice independently as they are allowed in 20+ other states. MS needs to get out of the dark ages and stop the "good ole boy" system that Dr. Easterling thrives upon!

Anonymous said...

@12:32
my post was not to defend physicians. i have seen many horror stories just like your examples. and i agree with your statement of "good and bad" in whatever profession. my post was meant to explain my (arguably somewhat limited) experience with the education and experience of NP's i have come across. i stand by my statement that NP school was not originally intended to be a career path straight out of college... but it has evolved into that. perhaps we should be discussing educational standards instead.

Anonymous said...

@2:54: My wife is a nurse who wanted to get an APN degree, but has so far decided against it. When she was graduating nursing school, she was very critical of the ability to and percentage of students (friends included) who were jumping right from BSN to graduate nursing school with no on the job experience. She felt there should be an admissions requirement for at least 3 years of practical experience before being able to go back and get an advanced practice degree.

Anonymous said...

Points To Ponder
1. Dr. Easterling is President of BOML.
2. The BOML consistently reinterprets and reimagines
the rules.
3. Has a vested interest in limiting competition by
controlling NPs through collaborators and
telemedicine. Let me see - do I want a portal
or a Nurse practitioner to care for me.
4. Is the director of Marian Hill Chemical Dependency
Unit in Vicksburg.
5. How many of his patients are admitted to Marian
Hill?
6. Does every town have a pill mill?



Anonymous said...

Interesting "Points to Ponder".....

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In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.


In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

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If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

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