Bill to relax rules on nurse practitioners awaits House vote

Pennsylvania’s nurse practitioners could operate practices without collaborating with a physician if the state House approves a bill by the end of next year.

The House is waiting to vote on a bill approved by the Senate in June that proponents say would give the state’s nursing practitioners more freedom to operate their own medical practices.

Twenty-six states, including Pennsylvania, require their licensed nurse practitioners to have a physician in their practice through a collaborative agreement. The collaborative agreement rule allows nurse practitioners to practice and write prescriptions for patients in their own practices only if they are partnered with a physician.

Late last year, Sen. Camera Bartolotta R-Beaver, Greene and Washington counties, reintroduced Senate Bill 25, legislation that would remove the stipulation keeping nurse practitioners from opening practices without collaborative agreements.

The bill has yet to make it through the House, which has until the end of session 2020 to take a vote on the issue.

Proponents of the bill argue that removing the restrictions would give nurse practitioners the ability to practice without the administrative burdens associated with paying physicians and conducting monthly physician reviews.

Removing the rule could also have a positive effect on rural health care, according to Adele Caruso, president of the Pennsylvania Coalition of Nurse Practitioners,  eliminating an impediment that keeps providers from opening practices in areas that often lack physicians.

“Nurse practitioners could practice in rural areas unencumbered and really provide the health care services that we talk about to more patients in the commonwealth,” she said. “We are looking to expand into those areas and modernizing the nurse practitioner laws is the way to do it.”

If the bill passes in the House, it would allow nurse practitioners who meet a three-year, 3,600-hour physician collaboration requirement to practice and write prescriptions without a physician.

Some health care providers oppose the the bill, noting that physicians are better trained to see nuances a nurse practitioner may miss when treating a patient.

“Collaborative agreements allow nurse practitioners to reach out to physicians when their training doesn’t extend to what they need guidance on,” said Lawrence John, president of the Pennsylvania Medical Society and a practicing family physician in Pittsburgh. “We feel that the collaborative, team-based approach is better for the patient and brings with it the most safety.”

The bill’s 3,600-hour requirement is a far cry from the average 12,000 hours of training physicians complete in their first three years after medical school, said John. Those additional hours, generally completed in a tertiary care hospital in a teaching environment, exposes providers to unusual and rare conditions that someone may not see outside of a residency.

“We feel strongly that nurse practitioners bring a tremendous amount of value to the table and we have a tremendous amount of respect and rely on their work,” he said. “But when you get out of the team-based model we certainly have a lot of concerns.”

The opposition from medical societies has proven to be an effective barrier against legislation in the state, but the quality of nurse practitioners in the state and regulators like Pennsylvania’s State Board of Nursing will allow the new providers to modernize their care without increasing risk, said David Hebert, CEO of the American Association of Nurse Practitioners.

“It’s unfortunate that there is such opposition by some medical societies because there doesn’t need to be,” Hebert said. “Consumers and patients need to really have conversations with their legislators and let them know that they demand direct access.”

Correction: The story previously stated that the Senate had not yet voted on the bill. The bill was passed through Pennsylvania Senate in June.