Reform Update: N.Y. law lets experienced NPs practice without supervising doctor

Experienced nurse practitioners in the state of New York will no longer need to be formally tethered to a physician in order to practice medicine starting Jan. 1.

The Nurse Practitioners Modernization Act was introduced last year and was included in the state budget enacted last week. The law will allow NPs with more than 3,600 hours of experience to practice without a written practice agreement with a supervising physician. It does not expand NPs' scope of practice or allow them to provide additional services, according to the 3,500-member Nurse Practitioner Association New York State.

The bill was promoted as a way to preserve access for patients who may otherwise not be able to see a physician after previously uninsured state residents gain coverage through the health insurance exchange or expanded Medicaid.

“Given the education, training and advanced certification of NPs, written collaborative agreements no longer serves a clinical purpose,” stated a memo on the State Assembly website. “Instead, the requirement serves as a barrier to practice and a disincentive to advanced certification, and it restricts access to healthcare for individuals and families in underserved areas of the state.”

Seventeen states and the District of Columbia no longer require NPs to have a written practice agreement with a physician. The state of Nebraska's unicameral Legislature is considering a similar bill.

Proponents of the patient-centered medical home have long advocated for NPs and physician assistants to “practice to the top of their license” to ensure the effectiveness and efficiency of team-based care.

But physician associations have pushed back hard against granting NPs and PAs further degrees of independence or scope of practice. They also argue that granting more independence will not increase access because NPs and PAs are no more likely to practice in underserved areas than doctors.

Elizabeth Dears, Medical Society of the State of New York senior vice president and chief legislative counsel, spoke against the bill during a legislative hearing (PDF).

Dears testified that the “MSSNY strongly opposes the independent practice of a nurse practitioner without a collaborative agreement with a physician.” She also cited studies that showed that increasing the use of NPs does not lower costs as the patients of NPs tended to have higher rates of medical service utilization.

Healthcare organizations need to be ready for Sept. 30, the date when the CMS will post data on drug and medical device manufacturer payments to physicians and teaching hospitals, speakers at the American Medical Group Association annual meeting warned.

The posting of these data is called for by the Physician Payments Sunshine Act, which was incorporated into the Patient Protection and Affordable Care Act.

“You can be sure the media has a significant interest,” said John Randolph, vice president and chief compliance officer for the UMass Memorial Health Care system. “You need to be aware of relationships your faculty are getting into.”

It's possible that officials at some teaching hospitals will become aware of some of their physicians' industry relationships only after being asked about them by reporters, Randolph cautioned.

“It's not comfortable, and it's happened to us,” Randolph said. He recommended that someone within an organization be given responsibility for payment data that appear in the CMS and state databases. Someone should also be assigned to speak with the media once this information is posted.

Randolph gave the teaching hospital perspective at the AMGA program, while Terra Shewchuk, vice president of ethics and compliance at devicemaker Medtronic Spinal, gave the manufacturers' views.

“I'm the industry rep, so I have a bull's-eye on me,” Shewchuk said, adding that she was looking forward to richer transparency requirements because they will expose the bad behavior of bottom-feeder companies.

Companies will be required to report “transfers of value,” including meals, payments, books and other items, awarded to physicians and teaching hospitals. Shewchuck advised attendees that there will be errors on both sides—if only because of the sheer volume of reports.

The CMS began collecting company information last August. Between Aug. 1 and Dec. 31, her company submitted data on 100,000 transactions, Shewchuk said to illustrate the volume of information being collected.

Follow Andis Robeznieks on Twitter: @MHARobeznieks