02/03/2020

Physicians Remain Concerned About APRN Scope of Practice Expansion

Minor bill revisions do not do enough to protect physician-led, team-based care

On January 28, the House Health Committee heard testimony on House Bill 177, an alarming bill which would allow advance practice nurse practitioners (APRNs) to practice medicine independently without a standard care agreement with a collaborating physician. Introduced by Rep. Tom Brinkman (R—Cincinnati), HB 177 is a re-introduction of similar bills that were defeated or substantially changed in the last two sessions of the General Assembly.

At the hearing, the committee accepted a revised version of the legislation that replaces the previous version—known as a “substitute bill”—that bill sponsors claim is meant to address concerns by medical and physicians’ organizations around the state. However, despite the modest changes made by its sponsors, substitute House Bill 177 still grants independent practice and prescribing authority to APRNs without a standard care agreement with a collaborating physician.

The original version of the bill entirely eliminated the requirement that APRNs practice under a standard care arrangement with a collaborating physician. Subsequent versions of the bill were revised to say that APRNs have the option of practicing without a standard care agreement as long as they have practiced in a clinical setting for 2,000 hours or twelve months (whichever is longer).

In response to the changes in the latest version of HB 177, the Ohio State Medical Association said in statement, “The latest substitute version of HB 177 contains minimal modifications from the previous substitute bill, and it unfortunately does not address the main concerns the OSMA has previously expressed about the bill. Furthermore, the OSMA has not been given opportunity to participate in any interested party meetings in order to properly discuss this legislation with the sponsor or proponents and work through these concerns.”

Proponents of the bill have claimed that HB 177 would improve access to medical care, particularly in rural and underserved communities. HB 177’s opponents, however, pointed out that nothing under current standard care agreements prevents an APRN from working these areas. In addition, studies conducted by the American Medical Association have shown that granting full, unsupervised practice authority to non-physician providers like APRNs does not create an incentive to locate to rural and underserved communities.

In written opponent testimony, Ohio ACEP President Dr. Brad Raetzke reiterated the medical community’s concerns with the bill, saying, “Any perceived access shortages should not be ‘solved’ by removing access to the highest trained member of the healthcare team, the physician.” Instead, suggested Dr. Raetzke, the state should be looking at options that would meaningfully improve access to care, such as expanded telemedicine services.

In previous sessions of the General Assembly, we were able to help stop or modify nearly identical bills by standing shoulder-to-shoulder with Ohio’s physician community to tell state legislators to preserve physician-led, team-based care. Now that yet another attempt to expand APRNs’ scope of practice is underway, we may need your help again to stop the legislation.

Stay tuned to future editions of the Advocacy Update for the latest on HB 177’s progress, and be on the lookout for action alerts from Ohio ACEP!