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January 22, 2014

Medics, meds and monkeys

There are a few precious milestones I thought I might not live to see, but my soul is a little more rested now that a nurse practitioners’ bill is on a fast track for passage by the state legislature. Last week, Senate Bill 7 was among the first measures to clear a committee and the upper chamber. Judy Piazza of the Senate Majority Leadership Office hopes it will be the first bill enacted this session.

It’s close to our bypassed hearts. According to testimony, Piazza’s “excellent advice” helped shepherd it through the Senate. Three years ago, I wrote a LEO cover story on the issue — “Mad medicine: Doctors, nurses resume fight over bill killed amid lavish lobbying, greed and smears.”

The measure takes aim at the “collaborative agreement” requiring a physician’s signature in order for a nurse practitioner to legally prescribe non-scheduled drugs such as insulin, antibiotics and blood-pressure meds.

In testimony before the House Health & Welfare Committee last Feb. 26, Sheila Schuster, a longtime advocate for nurse practitioners, explained how “collaborative agreement” is mostly a misnomer: “It’s a piece of paper that, in most cases, gets filed away. Physicians are charging, in some cases, high prices for that. There’s no liability on the part of the physician. They never see the patient. They never look at the prescriptions that are written. It’s a piece of paper that is keeping nurse practitioners from establishing practices …”

That’s a precarious problem in a sick state with about 90 medically underserved areas — especially as access opens to newly insured Kentuckians under the Affordable Care Act.

At the same hearing, Julianne Ewen, president of the Kentucky Coalition for Nurse Practitioners & Nurse Midwives, said, “We have a 17-year track record of safe prescribing in Kentucky, and we’ve never been required to work under a physician’s supervision. It makes no sense to maintain this requirement and continue this obstacle to patient care.”

When the battles began with the first bill’s first hearing on Feb. 16, 2010, veteran Adair County family nurse practitioner Beth Partin testified, “We have reports of NPs who pay $6,000 a year. One noted she pays $1,500 a month and another who pays 7 percent of her net income.”

The next year, Louisville Rep. Darryl Owens, D-43, asked longtime Kentucky Medical Association lobbyist Bill Doll about the apparent “exorbitant demands.”

Doll replied with a straight face, “I think, in certain instances, you can probably justify — based on administrative and overhead costs or some enhanced liability charge relative to perhaps insurance — some sort of charge.”

Lexington Rep. Susan Westrom, D-79, confirmed that NPs may practice far from their physician “collaborators.” Marty White, then a KMA lobbyist, replied, “We want to put more teeth into that collaborative agreement, to be quite honest.”

But as Louisville Democrat Mary Lou Marzian, D-34, told me, “To the KMA, it’s all about turf and money. They pretend it’s about quality.” For four years, the battles raged. The KMA won and the nurse practitioners lost. But last year, at the end of a House Health & Welfare hearing, KMA lobbyist John Cooper foreshadowed last week’s breathtaking breakthrough. “We understand that the whole health-care delivery dilemma of manpower and accessibility has got to be addressed,” he said. “And we’re all tired of beating each other over the head over turf, quite frankly.”

Late last fall, as I fantasized of casting the KMA if it didn’t relent as a caged gorilla amid a Samsonite conniption, the Coalition for Nurse Practitioners hailed a colossal compromise and praised all participants, including Republican Sen. John Schickel of northern Kentucky “who stepped into the negotiating process at a critical point in time and exerted leadership in moving us forward to a positive conclusion.”

Schuster offered cn/2’s Nick Storm a peek: “We had probably four meetings of a large number of NPs physicians and NPs and lobbyists and so forth, and then Sen. Schickel, as chair of the committee, stepped in and said, ‘This is too big a group; we’re gonna have one representative of the nurse practitioners, one representative of the physicians, we’re gonna sit down with the bill’s sponsor, Sen. (Paul) Hornback from Shelbyville — and we’re gonna pound this out.’”

The compromise, Senate Bill 7, allows a nurse practitioner to prescribe non-narcotic meds without a collaborative agreement after maintaining one for four years.