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Mega Health Bill Favoring Nurse Practitioners, Trauma Centers and Drs. Without State License Clears House Panel

| April 10, 2014

The doctor will Skype you now. (USDA)

The doctor will Skype you now. (USDA)

The Florida House Health & Human Services Committee passed a megabill Thursday  morning that combines three prickly issues, in the hope that packaging them will make it harder for the Senate to kill or maim any of them.

HB 7113 would protect private for-profit trauma centers, allow for independent practice for nurse practitioners and allow out-of-state doctors to participate in telehealth without a Florida license. The Florida Medical Association opposes the latter two.

Such a package is sometimes called a “train” in legislative parlance. The idea of a train is that it’s a bunch of connected railcars, and it would be hard to remove one of them without causing them all to derail. As a practical matter, it means some lawmakers have to accept a proposal they don’t like in order to get one they really want. One of the creators of the telehealth legislation acknowledged as much.

“It was not my choice for all these things to be in the same bill,” said Rep. Mia Jones, D-Jacksonville. “We’re going to take some good and some bad and move forward.”

A few minutes later, the process was replayed as another combo bill rolled out of the committee. HB 573 heightens oversight of assisted-living centers, allows visitation for grandparents, and enables outpatient surgery centers to expand their services as “recovery care” centers.

The first two parts of that combo brought no opposition to speak of. All the ammo was saved for the third, as both hospitals and nursing homes foresee the loss of some paying patients.

But they didn’t get to say much. HHS Committee Chairman Richard Corcoran, R-Land O’Lakes, limited public testimony to one minute per speaker, saying the committee had a lot to cover during this, its last meeting.

On HB 7113, some of the strongest objections came from Reps. Ronald “Doc” Renuart, R-Ponte Vedra Beach, and Gayle Harrell, R-Port St. Lucie. (Renuart is an osteopathic physician; Harrell is a former winner of the FMA’s award for “legislator of the year.”)

Renuart said physicians study many more years than nurse practitioners, grilling bill proponent Rep. Cary Pigman, R-Sebring, who is also a physician. “What useless knowledge were we given in those eight years (of college and medical school)?” he asked.

Pigman said it is misleading to compare the undergraduate training of physicians and nurses. Would-be doctors can enter medical school with a degree unrelated to medicine, he said, noting that he majored in chemistry. By contrast, he said, nurses have to major in nursing.

Renuart also objected that independent-practice nurses might not work in a “collegial manner” with physicians. Pigman said that’s not something a law can determine.

Data from other states show there is no significant difference in outcomes between physicians and independent nurse practitioners in primary care, Pigman said.  Florida has access-to-care issues, he said, and it’s time for “innovation.”

In discussing out-of-state practitioners engaging in telehealth with Floridians, Harrell objected to the bill’s lack of a requirement that they have a Florida medical license. Without that, Harrell said,  state authorities could do no background check or fingerprinting.

“We must be sure that our patients are getting — whether in person or through telemedicine –the standard of care,” Harrell said.

Bill backers said the doctors would have to have a license in good standing in their own state to register with Florida health officials as telehealth providers.  Few would go through the time-consuming and onerous process of applying for licensure in every state for which they serve as telehealth consultants, they said.

Don’t put up “roadblocks,” Rep. Mia Jones asked fellow committee members. “We need to recognize times are changing. We don’t want Florida to be left behind.”

–Carol Gentry, Health News Florida

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4 Responses for “Mega Health Bill Favoring Nurse Practitioners, Trauma Centers and Drs. Without State License Clears House Panel”

  1. Florida Native. says:

    I had as couple of doctors in the past that shouldn’t have had a license. Nothing to see here folks. Nurses run the medical profession anyway,always have on weekends,nights and holidays.

  2. salid de ella says:

    You go have a nurse take care of you and your loved ones, I want a doctor to take care of me. I’d like to see Dr. Pigman have a nurse practitioner be in charge of his medical care…of course you know that won’t be happening.

    There are very significant differences in training between physicians and nurse practitioners. In addition to four years of college and four years of medical school, a physician must complete between three and seven years of residency/fellowship training. By the time the physician begins to practice, he or she has already devoted the required 12,000-14,000 in patient care hours.

    A nurse practitioner completes a four-year nursing program and a two-to-four-year training program. When he or she begins to practice, a nurse practitioner has delivered only 500-720 in patient care hours. That difference is significant, both in terms of quality and cost of care.

    • nurse bek says:

      I myself am a RN and have been for 6 years. I currently have my BSN and will graduate in December with my Pediatric NP Masters degree. I myself will have more than double the hours of what you mentioned as I have a dual degree in both primary care and acute care and required significantly more hours than what is normally required. I only see ARNPs for my healthcare needs and so does my family. Previously we did have an MD for our primary care provider but there is a huge difference in patient care and time spent with the patient. The ARNP spends more time with the patients where as the doc was always in and out in 5 min or less. Since switching to the ARNP, I feel as though our healthcare needs are better cared for and I feel as though my voice is heard. Other states utilize ARNPs as independent providers with no issues. We aren’t taking the doctor’s jobs. Truth be told, if we wanted to be doctors we would have gone to med school. As far as doctors being in school longer, just because they are in school doesn’t mean they are better prepared. Nurses are required to work in their respective fields for a specified time before starting their Masters prep. This way we have knowledge of how things are ran and have been in the clinical setting before advanced prep begins. We also have more bedside training in patient care. Personally, if you aren’t in healthcare then you really have no idea what we go through as far as training.

  3. FL Man says:

    Lost in all this is why the Florida Medical Association wants to protect for-profit trauma centers and yet wants to deny access to care through ANRPs. I recommend reading the Tampa Bay Times’ series on trauma centers published last month if you’re looking for an answer to that question.

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