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ciple hasn’t changed. All we are changing is how we supervise it,” he said. At the same time, the bill recognizes the important role al- lied practitioners play as partners in care delivery. “This cre- ates a vehicle to develop that team-based approach and de- velop trust in each other,” Dr. Floyd added.


Coming to the table


Equally significant is the fact that after years of feuding over scope-of-practice issues, a bill on the topic garnered support from the various professionals involved, all of whom endorsed it. Supporters include TMA, the Texas Academy of Family Phy- sicians (TAFP), the Texas Nurses Association (TNA), the Coali- tion for Nurses in Advanced Practice, Texas Nurse Practitioners, the Texas Association of Nurse Anesthetists, and the Texas Academy of Physician Assistants (TAPA). Nurse groups, for example, argued over the years that


their level of education and training prepared them to safely and effectively care for patients without restrictive physician oversight. They point to other states allowing expanded or independent practice as examples. Freeing them up could help mitigate access-to-care shortages, they say. But TMA data shows only 12,000 APRNs and 7,500 PAs work in Texas, compared with more than 60,000 physicians. Those professionals are not concentrated in underserved areas, and only half or fewer serve in primary care. TMA leaders maintain that physicians, because of their ex- tensive medical training, are uniquely qualified to diagnose and treat patients. That’s reflected by the fact the legislature set up the Texas Medical Board (TMB) to oversee medical practice. Without a physician to guide the health care team, patient safety is at risk and utilization is likely to increase un- necessarily. The agreed-to legislation, SB 406, not only represents a sig- nificant step forward from the old site-based care model, but also sets a cooperative standard for addressing future scope- of-practice issues, Dr. Floyd says. Key Senate and House leaders provided the impetus for the legislation partially with that goal in mind.


Rather than battling one an-


other, Senator Nelson asked the physician, nurse, and PA groups to come together and work on a mutually agreeable solution. “The agreement to move for-


ward in a collaborative way, allow- ing each highly skilled professional to maximize his or her abilities to contribute to patient care, was significant,” and will help make primary care more accessible, she said.


The legislation was the cul- mination of nearly two years of negotiations.


The House Committee on Public Health explored the issue


in a May 2012 hearing. Testimony by TMB reinforced physi- cians’ concerns that the inconsistencies in the various prescrip- tive delegation statutes and rules — which vary by site and practitioner type -— make it difficult for doctors to comply. A subsequent report by the committee urged the legislature to work with physicians, nurses, and PAs to revise and replace the current “opaque” prescriptive delegation scheme with a “simpler regulatory framework based upon physician-led col- laboration … to allow more flexibility and increase patient ac- cess to primary care and address geographic disparities.” Rep. Lois Kolkhorst (R-Brenham), House Public Health Committee chair, sponsors the companion legislation to SB 406, House Bill 1055.


“Members of the House and Senate sat down with stake- holders at all levels to find a workable solution. Hopefully, we’ll see a policy shift that expands care to more Texans in a way that’s both safe and sensible,” she said. The legislation also is the result of TMA’s persistence in


warding off attempts by nursing groups to achieve full inde- pendent practice, says TMA Director of Legislative Affairs Dan Finch. “Diagnosing and prescribing is the practice of medicine. We never wavered from that core principle.” Nurses acknowledged at the February Senate committee hearing that “we did not obtain everything we wanted in this bill,” said Jean Gisler, a nurse practitioner representing TNA and other nursing groups. But TNA told Texas Medicine the collaborative effort to date


has been productive in addressing the acknowledged deficien- cies in Texas’s current site-based delegation model. The measure “will facilitate better utilization of APRNs in meeting Texas’ health care needs, and TNA is pleased that nursing was able to reach agreement with medicine on this bill,” the organization said. “Only by permitting APRNs and also physicians to practice to the full extent of their licenses will Texas begin to address its shortage of health care provid- ers, and SB 406 is a step forward.” Todd Pickard, a PA at The University of Texas MD Anderson


TMA LEGISLATIVE NEWS HOTLINE KEEPS YOU INFORMED


Keep up-to-date with Senate Bill 406 and other legislation important to medicine through the TMA Legislative News Hotline. The electronic newsletter delivers news on the Texas Legislature’s


latest actions on bills affecting you, your practice, and your patients. A weekly recap is also available each Friday. This year, the hotline includes weekly video updates from TMA lobby-


ists, health care experts, and even state legislators. To sign up and stay informed, email Hotline Editor Pam Udall at Pam


.Udall@texmed.org, or contact the TMA Knowledge Center at (800) 880- 7955 or knowledge@texmed.org.


May 2013 TEXAS MEDICINE 17


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