From the March 2014 issue of HealthCare Business News magazine


However, nurses performing their duties from outside of a physician’s practice can run afoul of other requirements. Some physicians may be barred by their malpractice liability insurer from entering into an agreement unless the NP is actually working within their practice.

With the loose structure and minimal oversight, a common assumption is that the dust up is due to bruised egos, but that’s not the case according to Tay Kopanos, vice president of State Government Affairs for the American Association of Nurse Practitioners. She says the requirements needlessly put stress on nurse practitioners especially with certain aspects of the requirements completely beyond their control. “If a physician retires, sells his or her practice, is disciplined by the medical board and loses their license, for instance, even if it has nothing to do with the nurse practitioner, that oversight requirement is no longer being met,” she says. Kopanos acknowledges that physicians can also pull their agreement for other reasons without having to provide justification.

Semantics generating the mess we’re in?
For the nurse, there’s generally little benefit unless a patient’s needs are beyond the scope of practice the nurse has been trained to handle. “Any person in independent practice will develop a referral network,” says Hicks.

NPs need to make connections with family physicians and specialists and know who to send a patient to and when they should be sent, says Hicks. For their part, doctors aren’t required to take the referrals, so in order to have the ability to refer patients, the NPs have to have social skills that expand beyond their clientele.

Referrals are an area Blackwelder is concerned about. “For some, when a patient arrives with a heart issue, they might be referred to a cardiac specialist immediately,” he says. “But as a family practitioner, we’re often able to handle those issues.”

Blackwelder says that although heart issues may be beyond the scope of practice for NPs, they can often be addressed by family physicians.

Still, he is reluctant to get into a debate about NP independence and feels it’s an issue health care professionals need to move beyond. “What we’re learning through different practice models is that it’s all about team-based care,” he says. “Our focus needs to be about adopting the best care.”

In that at least, Hicks agrees. “Providing effective health care requires the right treatment at the right time, for the right cost in the right place,” he says.

Whether the “right person” will be a nurse practitioner or some other health care professional still remains to be seen.

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