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House Professional Licensure Committee Tackles Challenges of Nurse Collaborative Agreements

January 24, 2018

Earlier today, the House Professional Licensure Committee held an informational meeting for legislators to learn more about the mechanics of collaborative agreements between certified nurse practitioners (CNP) and physicians. The meeting was prompted by legislative interest in Senate Bill 25 (Bartolotta, R-Washington) and House Bill 100 (Topper, R-Bedford) which would allow CNPs to care for patients without a collaborative agreement after 3,600 hours or three years working with a physician. HAP commends Sen. Bartolotta and Rep. Topper for their work on this issue and supports both bills.

While HAP did not participate in the meeting, Pennsylvania’s hospital community continues to advocate that CNPs do not need unending physician supervision when caring for patients within the boundaries of their training. Today’s health care professionals are being educated to function as part of a practicing health care team, which is consistent with the team-based care delivery models being used by hospitals and health systems.

Discussion during the meeting was limited mostly to the mechanics of the contractual and prescriptive relationships between nurse practitioners and their collaborating physicians.

Among those participating in the panel discussion were Adele Caruso, a nurse practitioner with Penn Medicine, and Anthony DiMarco, D.O., a primary care physician with Main Line Health. Caruso is the current president of the Pennsylvania Coalition of Nurse Practitioners and Dr. DiMarco is the past president of the Pennsylvania Osteopathic Medical Association.

Members of the committee were especially interested in how prescriptive authority is delegated to CNPs, how often physicians interact with patients under a collaborative agreement, and how agreements impact medical liability costs.

Throughout the meeting, members of the committee indicated their interest in having an additional public hearing to allow for broader discussion on the overall merits of CNPs caring for patients without a collaborative agreement.

HAP supports both bills because the full use of CNPs and other clinical professionals is needed to build strong patient relationships, help patients and families follow care plans, coordinate care across the continuum, improve patients’ health literacy, and provide health education.

Currently, 22 states and the District of Columbia allow CNPs to practice to their full authority. Both Senate Bill 25 and House Bill 100 would allow Pennsylvania to join these states and the District of Columbia, and would make the Commonwealth one of the strictest states in the country allowing practice without the collaborative/written agreement.

HAP has developed a fact sheet on the legislation that includes the significant issues impacting access to care and increasing demand for services, including:

  • Growing insured population
  • Growing aging population
  • Increasing demand for preventive care
  • Challenging rural health needs
  • Growing shortage of primary care providers

For additional information, please contact HAP’s Scott Bishop, senior vice-president, legislative advocacy.

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