More people began consulting their doctors online during the pandemic. (Photo by Marko Geber/Getty Images)
For years, Beth Partin has practiced medicine in rural Kentucky through a collaborative agreement with a physician.
Because her husband is a physician, Partin – who has a Doctor of Nursing Practice degree – said she hasn’t had an issue getting a provider to sign an agreement with her in compliance with a state law requiring advanced practice registered nurses to partner with medical doctors to prescribe medicines.
“But if something were to happen to him,” she told the Lantern, “I don’t know where I would find somebody to sign one for me.”
Beyond finding someone to partner with them, an APRN pays for collaboration with a physician – a price tag that could reach $5,000 a month, said Partin, who runs Family First Health Care in Adair County.
New legislation could ease some of that burden and bolster Kentuckians’ access to primary care.
Senate Bill 94, which would give qualifying advanced practice registered nurses the chance at more independence in Kentucky, passed the Senate on Feb. 24 and the House on March 10. It awaits Gov. Andy Beshear’s signature or veto. Should he veto it, the legislature can override him.
Sponsor Sen. Julie Raque Adams, R-Louisville, negotiated the bill between the Kentucky Association of Nurse Practitioners and Nurse Midwives and the Kentucky Medical Association.
Other states that let APRNs practice fully have seen increased access in rural areas, said Partin. She expects similar results in Kentucky, which ranks high for illnesses like heart disease, diabetes and cancer.
What does Senate Bill 94 do?
“The biggest thing is that APRNs will be able to establish practices without the fear of losing the physician,” Partin said.
Some will be able to see more patients. Many will save money that can now go back into the practice.
“That’s a barrier to opening a practice,” she said, “because if you have to pay a high fee, then that’s part of the decision-making as to whether or not you can afford to open the practice.”
Here are some key takeaways on what SB94 does:
- Allows an APRN who has prescribed controlled substances with a Collaborative Agreement for Prescriptive Authority (CAPA) for at least four years to then request the requirement to maintain that agreement be removed.
- States that the Kentucky Board of Nursing will make sure the license in question is in good standing before proceeding.
- Says the APRN must have a current Drug Enforcement Administration (DEA) registration and has maintained that registration within the KASPER system.
- Says that APRNs are still subject to random audits by the Kentucky Board of Nursing.
- Establishes a 15-member Controlled Substance Prescribing Council under the Office of the Inspector General that will meet quarterly and prepare annual reports for the governor and the Legislative Research Commission.
“It’ll take the worry away. It will enable people to establish practices,” said Partin. “One of the things that’s a little bit different (between) physicians and nurse practitioners is that nurse practitioners tend to stay in their communities just like nurses tend to stay in their communities. And so I think (that we) will see more practices being established.”
Relief for Kentucky’s primary care shortage areas
Large amounts of Kentucky lack enough primary care providers. In fact, the Kentucky Primary Care Association said in 2022 that 94% of the state’s 120 counties don’t have enough primary care providers.
Advocates of Senate Bill 94 say APRNs, who outnumber primary care medical doctors in the state, can help address that problem.
Raque Adams said on the Senate floor that her legislation “will increase access to quality health care across Kentucky.”
Though the measure easily passed both chambers, not all were supportive. Sen. Donald Douglas, R-Nicholasville, for example, spoke against the bill on the floor.
“My concern is that (patients) are getting optimal health care,” said Douglas, who is a physician. “Not just good health care. Or, not just health care that’s available. But optimal health care.”
A 2022 national report from Morning Consult found more than 80% of patients polled supported nurse practitioners being able to practice to “the full extent of their clinical education and licensure.”
West Virginia, Alabama, Pennsylvania and others limit nurse practitioners’ practice scope, according to the American Association of Nurse Practitioners.
Many states, including Nevada, Arizona, Montana and New York, let nurse practitioners practice fully.
Kentucky is joined by Pennsylvania, Utah, Alabama and others in reducing APRNs’ practice abilities.
“A big deal”
Some legislators expressed concerns about the ongoing opioid epidemic and any role SB94 could play in it.
“I come from rural Kentucky. I have seen firsthand the devastation that opioids brought not only on my communities, but on my family,” Sen. Phillip Wheeler, R-Pikeville, said. “What we do not need to do is to provide another mechanism to provide greater access to pain medications and opioids in rural areas.”
He added: “if I could restrict the prescribing abilities of doctors more on narcotics and opioids, I would do it here today.”
However, the idea that the law adds more prescribers is a misconception, Partin said.
“APRNs have been prescribing scheduled drugs since 2006,” she said. “So, we’re not adding prescribers.”
Partin called the legislation, so close now to becoming law, “a big deal.”
And, she said: “It takes a weight off my shoulders.”
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