Let advanced nurses prescribe drugs, save millions in health care, watchdog group says

Let advanced nurses prescribe drugs, save millions in health care, watchdog group says

Christine Jordan Sexton, 11/03/2011 - 01:26 PM

As much as $339 million can be achieved in health care “savings” if the Legislature would authorize highly trained nurses and physician assistants to prescribe controlled substances, according to a "briefing" released today by Florida TaxWatch.

The Tallahassee-based organization called on the Legislature to amend state law to allow nurses and physician assistants to either prescribe in collaboration with a physician or to practice independently of a physician. The Florida Medical Association, which represents physicians, blasted the briefing, calling it "flat-out wrong."

The recommendations also include allowing the professionals to direct-bill insurance companies and managed-care facilities as well as participate in the Medicaid program. According to the TaxWatch release, Florida law neither prohibits nor requires insurance companies and managed-care companies to allow direct billing, and that procedures “vary widely” and are specific to each company.

TaxWatch, which advertises itself as “an independent nonpartisan taxpayer research institute and government watchdog,” conducted no original research for today's briefing. Instead, it relies on a Dec. 30, 2010 research memorandum issued by the Office of Program Policy Analysis and Government Accountability called “Expanding Scope of Practice for Advanced Registered Nurse Practitioners.”

Specifically, the OPPAGA research shows that the potential cost-savings of expanding the scope of practice for ARNPs and PAs ranged from $7 million to $44 million annually for Medicaid, $744,000 to $2.2 million for state employee health insurance, and $339 million across Florida’s healthcare system.

Florida is one of only two states that bans ARNPs and PAs from prescribing controlled substances, even if the providers are under the direct supervision or collaboration of a physician.

The TaxWatch briefing recommends that the Legislature could amend current malpractice laws to address what could be additional lawsuits filed against those medical professionals.

Florida Nurses Association Executive Director Willa Fuller said in a prepared statement lawmakers should move on the recommendations, especially given the increasing number of people enrolling in Medicaid.

“With more people entering Florida’s Medicaid program, lawmakers must consider new ways to deliver health care services while maintaining quality patient care," Fuller said. “Nurse practitioners have the skills and training needed to provide high-quality primary care services to patients at a lower cost.”

The Florida Medical Association called into question OPPAGA's findings, noting that the savings are based on an assumption that 100 percent of the primary care in Florida would be provided by nurses. Additionally the FMA says the bottom line is that patient safety could be jeopardized should nurses and physician assistants be allowed to prescribe.

"These are not simply administrative and legislative barriers," FMA spokewoman Erin VanSickle said. "The key issue is one of education and training. Although nurses play an important role in our health care system, it is critically important to understand that they are not medical doctors. They are not required to have the same level of education and training as a physician. We must protect the safety of Floridians, particularly our children and our seniors, and ensure that they receive the best medical care by the person best trained to deliver that care."

No bills had been filed at press time. Sen. Mike Bennett's office said the Bradenton Republican will sponsor legislation to allow prescribing privileges but that the bill still is being drafted.