Task force would tackle health care provider regulation

A legislative proposal would create a task force to bring together physicians and advanced nurse practitioners to evaluate how best to change how the state regulates who provides, and oversees, care.

Sen. Becky Massey and Rep. Jeremy Faison want to establish a 19-member committee to make recommendations about how changing scope of practice laws could improve "Tennessee residents' health by providing access to quality and cost effective care."

The bill, SB1979 and HB2088, calls for a report to make recommendation on how to allow "health care providers to work to the full extent of their education, training, experience, and certification."

Health reform has advanced practice nurses in spotlight

The debate over scope of practice is on-going across the country at a time when how and where people access health care is changing and the focus is on cost.

Changing insurance structures and consumers' thirst for convenience finding ways to provide efficient, affordable care dominates policy and industry conversation. The state will need more than 1,100 new primary care physicians to ensure the current level of care in 2030, according to a report from the Robert Graham Center.

In Tennessee, the scope of practice rhetoric is several years old and contentious — pitting primary care physicians against advanced practice nurses, which can be nurse anesthetists, nurse practitioners, nurse midwives and clinical nurse specialists.

Changing the laws that govern advanced practice nurses is an avenue to securing access to affordable health care in around the state, particularly in rural or under-served areas, said Sharon Adkins, executive director of the Tennessee Nurses Association.

Nurse practitioners are primarily the providers who patients see at retail clinics, such as The Little Clinic in some Kroger Stores or Minute Clinic at CVS. Some states allow advance practice nurses to run independent practices. Tennessee does not.

Retail clinics in rural areas would widen primary care

The Tennessee Medical Association and Tennessee Nurses Association, while partners on other issues, are at odds over changing the regulations.

Dave Chaney, spokesman for the Tennessee Medical Association, said his constituents want a "physician-led, team-based" approach that allows all team members, including advanced practice nurses and physician assistants, to deliver health care. He said physicians want a "stronger collaboration among health care providers" on a team that is led by physicians to ensure patient safety.

The task force is designed to bring an equal number of physicians and advanced practice nurses together with nursing and medical school leaders, state and local public officials to look for new answers to the questions that have so far created a divide, said Massey, R-Knoxville.

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Proposals in the 2015 session were tabled and conversations between all sides have been on-going.

"I wish we had thought of this earlier," said Massey of the task force.

The task force, if created, will cost about $3,500 a day that it meets, according to a fiscal note, and would be required to have a report with policy recommendations before the 2017 legislative session starts in January.

Reach Holly Fletcher at 615-259-8287 or on Twitter @hollyfletcher.