Doctors, nurses battle over roles in health care Ohio becomes a focal point in a national debate
By Laura A. Bischoff, Staff Writer, Dayton Daily News
Saturday, March 6, 2010
SPRINGFIELD — Candy Rinehart schedules a patient at her practice every 20 minutes, seeing people from age 4 to 93 for everything from sinus infections and abdominal pain to diabetes.
Rinehart was a pioneer of sorts in Ohio when she opened her growing practice in 2004, and it’s still a rarity in the region. That’s because Rinehart is a certified family nurse practitioner, not a doctor.
Nurse-led practices are expected to become more common amid an aging population and a shortage of primary-care physicians. Patients nationwide already rely on advanced practice nurses (APNs) for 25 percent of primary care, according to Lori Herf, lobbyist for the Ohio Association of Advanced Practice Nurses.
But that shift has set off a sometimes testy debate between doctors and nurses over the limits on care that APNs like Rinehart can provide. Nurses frame the issue in terms of providing better access to primary care for patients, while doctors cite concerns about patient safety.
Intensifying the debate in recent months are two Ohio bills — one that would expand APNs’ ability to prescribe certain medications, and another that would create pilot programs to test a kind of family medicine that incentivizes preventive health care.
“The more nurse-led practices we have, the more we’ll be able to set it as a standard,” Rinehart said. “If it’s become a turf war, it’s not from the nurse practitioners’ aspect. We have to put out front what we’re capable of doing.”
Physicians go through four years of medical school followed by a residency that lasts three to six years, more extensive training than that required of nurses, said Tim Maglione, senior director for government relations at the Ohio State Medical Association.
In contrast, recognition as an APN in Ohio requires a registered nurse to hold a master’s degree in nursing and pass a national certification exam in their specialty area. “To us, it’s about defining and distinguishing the professions,” Maglione said.
Read Full Article at http://tinyurl.com/ylankj5
Bill To Expand Nurse Practitioner Duties Advances in Kentucky
Louisville Courier-Journal
March 4, 2010
FRANKFORT, Ky. — A bill that would lift some lmits on the ability of advanced registered nurse practitioners to
prescribe medicine and perform other tasks passed the a House committee Thursday with both doctors on the panel voting against it.
House Bill 556 is staunchly opposed by the Kentucky Medical Association. Dr. Bob DeWeese, R-Louisville, was joined by Dr. David Watkins, a Democrat from Henderson, in casting two of the three no votes.
“Are we going to let nurses have the full privileges of someone who’s gone to medical school?” DeWeese asked members of the Health and Welfare Committee. Rep. Brent Housman, R-Paducah, was the third vote against the bill.
During the discussion of the bill, several members demanded to know why some physicians now charge high fees for their signature on an agreement that nurse practitioners must have to prescribe medicine. “One thing I found most disturbing is that nurses are charged fees,’’ said Rep. Addia Wuchner, a nurse and Republican from Burlington.
Rep. Darryl Owens, D-Louisville, asked KMA representatives who spoke against the bill whether the fees are ethical. William Doll, a KMA lobbyist, said he couldn’t respond directly but “I think there would be a process we would employ to take a look at this.”
Nurse practitioners already have authority under the law to practice independently without supervision of a physician. But to prescribe medicine they must obtain a signed agreement with a physician —even though they don’t always work with that physician or consult with him.
In some cases, nurse practitioners must pay high fees just to obtain a physician’s signature on the forms filed with the state Nursing Board, supporters of HB 556 told the committee. Fees range from $1,500 a month to a percentage of income from a practice, said Beth Partin, a nurse practitioner from Adair County.
And that is preventing nurse practitioners from expanding into areas with little access to health care, she said. HB 556 seeks to eliminate the need for the agreement for nurse practitioners who prescribe non-controlled drugs such as antibiotics and blood pressure medication. It also would allow nurse practitioners to do some routine things such as signing children’s immunization forms or forms excusing someone from work because of illness.
Nurse practitioners had sought to eliminate a second signed agreement they must obtain to prescribe controlled drugs, such as sedatives or narcotic painkillers. But Rep. Mary Lou Marzian, the sponsor of HB 556, dropped it from her bill, as did Sen. Gary Tapp, R-Shelbyville, sponsor of Senate Bill 75, a companion measure pending in the Senate, because of opposition from physicians.
The bill, which passed by a vote of 8-3, now goes to the full House.
Article by Deborah Yetter • dyet...@courier-journal.com • March 4, 2010
To see the full article, go to http://tinyurl.com/y92r56b
Doctor Shortage Fuels Nurses’ Push For Expanded Role
Excerpts from an article by Andrew Villagas, Kaiser Health News, Feb 22, 2010…
Nursing leaders say large numbers of practitioners will be needed to fill gaps in primary care left by an increasing shortage ofdoctors, a problem that would intensify if Congress extends health insurance to millions more Americans. Advocates say nurse practitioners have the extra education and training needed to perform a variety of services, including physical exams, diagnosis and treatment of common ailments and prescribing drugs.
But the American Medical Association and doctors’ groups at the state level have been urging state legislators and licensing authorities to move cautiously, arguing that patient care could be compromised. This battle has been waged for years, even as nurse practitioners grew rapidly in number — there are 125,000 or more — and expanded their responsibilities. What’s different now is the increasing conflict as pressure grows to use nurse practitioners and other so-called physician extenders, including physician assistants, certified nurse midwives and pharmacists. The Association of American Medical Colleges estimates that there will be a shortfall of as many as 46,000 primary care doctors by 2025.
Nurse practitioners are gaining support. In a Jan. 14 report, the Center for American Progress, a liberal think tank, said maximizing use of the “entire health care workforce” would also “increase quality while decreasing costs.” Ellen-Marie Whelan, senior health policy analyst at the center, said in an interview that nurses “should be part of managing chronic illness, helping a patient navigate the system, helping coordinate among providers.” ”The fear that there’s a safety concern, I think we just have to look at the evidence, look at the numbers,” Whelan said. “Nurse practitioners have been trained to know where their limit is. Since the beginning — now it’s been over 40 years — there’s just been so much evidence to say that there’s nothing to fear and in many cases, there’s higher quality.”
ANA Asks Nurses To Take A Stand and Get It Done!
The following is a letter from ANA Government Affairs:
With his much anticipated bipartisan Health Care Summit with Congressional leaders on the horizon, this morning President Obama released his proposal for a way forward on health care reform. Trying to break the impasse in Congress and get meaningful health reform passed this year, the President’s proposal attempts to bridge the gaps between the House and Senate health care reform bills, find the middle ground, and get the process moving again!
We need to show Congress that we agree with the President – health care reform shouldn’t be a partisan issue, and it needs to be passed NOW! Show your support by signing the “Let’s Get It Done!” petition to Congress, urging them to pass meaningful health care reform!
What does it mean for you?
The President’s proposal puts consumers first by focusing on affordability, access, and insurer accountability. It ends discrimination against Americans with pre-existing conditions, provides health insurance for over 31 million Americans who currently don’t have insurance, and makes it more affordable for those that do by providing the largest middle class tax cut in health care history.
The President’s plan directly calls for an increase in the number of nurses in the United States. It also aims to address the critical problems facing nursing today – workforce shortage and nursing retention.
Sign the “Let’s Get It Done!” petition to Congress – and tell your friends and colleagues to sign it too!
To read more about the President’s proposal go to our toolkit.
We Need Your Help!!
Lend your voice to the millions of Americans who know that now is finally the time for health care reform. Sign our “Let’s Get It Done!” petition and let your Members of Congress know that the cost of inaction is too great – we need real, meaningful health care reform NOW!!!
Kind Regards,
ANA Government Affairs
NJPA Files Lawsuit Against State Health Benefits Commission, Horizon Healthcare Services and Magellan Health Services
FOR IMMEDIATE RELEASE
Psychologists Say New Jersey’s Largest Health Plan Violates Patient Privacy, Restricts Access to Care and Wastes Taxpayer Money
West Orange, NJ – February 23, 2010 – The New Jersey Psychological Association (NJPA), the professional organization representing more than 2,100 psychologists who treat hundreds of thousands of people throughout the state, announced today that it filed a lawsuit against the New Jersey State Health Benefits Commission, Horizon Healthcare Services, Inc. and Magellan Health Services alleging violation of patient confidentiality rights provided by the New Jersey Practicing Psychology Licensing Act.
The complaint alleges that the Commission, Horizon and Magellan improperly require mental health providers to turn over protected confidential mental health records of patients enrolled in the New Jersey State Health Benefits Program as a pre-requisite to authorizing treatment by a psychologist, continuing a course of treatment, or paying for services already provided. NJPA seeks a declaratory judgment that these practices violate state law.
“People who seek mental health services trust that their personal information will be held in strict confidence,” said Lisa Jacobs, Ph.D., president of NJPA. “Any violation of the patient’s right to privacy by the insurance industry or a government agency can have a devastating impact on the mental and physical health of the patient, and can deter people from getting the help they need.”
The New Jersey Practicing Psychology Licensing Act, in section 45:14B-28, provides broad privacy protection of confidential communications between psychologists and their patients. Psychologists are prohibited from disclosing confidential communications and treatment notes and records to anyone, other than through written authorization from the patient detailing specific confidential health records be disclosed, and the purpose for the disclosure. Under Federal law psychologists may only provide the minimum patient information necessary to make coverage, benefit and payment determinations.
“In a misguided attempt to contain costs, insurance companies and state officials are making it increasingly difficult for people to access outpatient mental health services. This mis-management of care harms patients by delaying or denying access to counseling services shown to improve health and save money,” said Barry L. Helfmann, Psy.D., director of professional affairs for NJPA and a plaintiff in the complaint.
NJPA also announced today a patient advocacy campaign called “Speak Your Mind NJ: Improving Access to Mental Health Services.” New Jersey residents can learn more about the impact of restricted access to therapy and speak their minds by visiting the campaign web site at www.SpeakYourMindNJ.org.
For more information:
Jane Selzer
Interim Executive Director
The New Jersey Psychological Association
njp...@psychologynj.org
973-243-9800
Jennifer Devine
SmithSolve LLC
On behalf of the New Jersey Psychological Association
jennifer.devine@smithsolve.c 973-442-1555 ext 102
Jennifer Devine: jenn...@smithsolve.com
Evidence Based Anxiety Treatment: Exercise
The new issue of *Archives of Internal Medicine* (Vol. 170, No. 4,
February 22) includes an article: “The Effect of Exercise Training on
Anxiety Symptoms Among Patients: A Systematic Review.” by Matthew P. Herring, MS, MEd, Patrick J. O’Connor, PhD, & Rodney K. Dishman, PhD.
The analysis in this study revealed that exercise training significantly decreased anxiety scores among patients with a chronic illness. The magnitude of the overall mean effect is similar to the effect of exercise training on fatigue symptoms among patients and on cognitive function among older adults.
“Increasingly, efforts are being made to provide mental health treatments consistent with the available scientific evidence in primary care settings. The present results provide clinicians with solid evidence to recommend exercise training to patients as a means for reducing anxiety symptoms with minimal risk of adverse events. Exercise training may be especially useful for patients who prefer nonpharmacologic treatments because such preferences may influence the magnitude of the treatment outcomes. Perhaps most importantly, the results show that anxiety reduction is a favorable, adventitious outcome of exercise interventions that were designed as a primary treatment or adjuvant for medical conditions other than anxiety.”
Obama to Seek Federal Oversight of Insurance Industry
The Obama administration has been coming down hard on health insurers over rate increases and will propose giving the federal government new power to block excessive increases.
The administration’s proposal for health overhaul set to be released this morning would create a seven-person board that would establish what sort of premium increases are reasonable, the Washington Post reports. The federal government, in collaboration with the states, would then be able to reject excessive rate hikes.
Tightening regulation of the insurance industry is a new element that has not been included in the House or Senate bills. But the recent industry profiteering as evidenced by premium increases of up to 39 percent announced by Anthem Blue
Cross of CA has caused outrage and will be hard to fight by Republicans without appearing complicit.
Senator Feinstein, in an interview, pointed to the $12.2 billion in profits reaped by the five biggest private insurers in 2009. “When you look at the profits in ’09, up 56 percent over the year before,” she said, “you begin to understand that something is going on that is not in the interests of the American people.”
Isn’t it time we all stand up to this? Isn’t it time we get involved ? A grassroots movement to stop the industry greed and abuse is what is needed. As long as healthcare is for profit, it is like a metastasizing cancer rapidly consuming the life force of American Healthcare.
TIger Woods and the Proposed DSM 5
Tiger Wood’s has brought into public consciousness the pain and suffering of “sex addicts” and their families. The concept of sexual addiction arose from clinical observations of those of us in the trenches with people under the compulsive grip of uncontrollable sexual behavior.
This drive is so compelling that it overrides the normal psychic risk control mechanisms over loss of all that is important to them…family, reputation, success. While it has been left out of the category of “behavioral addiction” in the proposed American Psychiatric Association’s DSM-V, it is non the less categorized as the new mental disorder “hypersexual disorder”
There’s a need for clinicians to recognize this group of individuals, according to the American Psychiatric Associaiton’s workgroup on sexual and gender identity disorders chaired by Kennith Zucker. Many of these individuals exhibit repeated “out of control” sexual behaviors, but the behaviors are otherwise considered to be normal, not deviant, the committee says.
To be diagnosed with the proposed new disorder, individuals must have engaged in uncontrollable repeated and intensive sexual fantasies, urges and behaviors for at least six months. These fantasies or acts have to consume significant periods of the individual’s time and have negatively impacted their lives.
Woods, In his apology yesterday, said that he had been unfaithful and that his behavior was the result of thinking that the rules didn’t apply to him.
According to the proposed criteria for hypersexual disorder, people engage in these behaviors in response to various dysphoric moods, such as anxiety, depression and boredom.
While there are a number of treatment modalities that claim success in treating “sex addiction” including individual talk therapy, addiction based 12-step programs and residential treatments there is no definitive research on the efficacy of these modalities.
Click To Watch
Is There Something About the Academic Environment?
Every profession carries it’s own risk of stress related mental illness, but are there unique factors in the academic environment that elevate that risk to potentially dangerous levels? The shooting deaths of three biology
professors at the University of Alabama at Huntsville last week, allegedly by a colleague deserves closer scrutiny of the perils that exist in academic workplaces.
“Academic culture really neglects issues of the psychological health of its workers,” says David Yamada, a law professor at Suffolk University and founding director of the New Workplace Institute, a nonprofit research center. His particular expertise is bullying. While the the increased stress level seldom result in murder, there are countless anecdotal accounts of disruptive and psychologically damaging behavior.
There is a paucity of research on the mental health stressors in academia, though some insurance companies have reported that people who work in these environments are more likely than other sectors to go out on disability for psychological reasons.
Perhaps this horrific incident will spur Colleges and Universities to take a closer look at their culture and take steps to identify and ameliorate the risk.
For more information: http://tinyurl.com/yb4zuhk
Patricia Barnett, RN, JD named CEO of NJSNA
The New Jersey State Nurses Association announced that Patricia A. Barnett, a nurse and
attorney with three decades of public policy experience, has been selected as the new Chief Executive Officer of the Association by the Board of Directors. Barnett will begin her work at NJSNA on March 1st. She replaces Dr. Barbara Wright, who has been serving as interim CEO following the retirement of longtime NJSNA CEO Andrea Aughenbaugh.
“We could not be more excited about the selection of Patricia to head our association,” said Barbara Chamberlain, President of NJSNA. “Her skill-set and experience make her uniquely suited to lead NJSNA through what we are sure will be challenging times ahead in the rapidly changing world of health care.”