Will Florida Senate Republicans embrace Trump’s health care agenda, or quietly kill it to keep greedy docs happy?

by | Apr 16, 2019

 

One of the best and most effective concepts for keeping health care costs low is about to be strangled to death in the Florida Senate by a small group of Republicans who are either in the pocket of, or being bamboozled by, a group of greedy doctors.  These doctors are quietly pushing hard to kill off SB 972, a bill sponsored by one of the most forward-thinking Republicans in the state: Senator Jeff Brandes. His bill would recognize nurse practioners as independent health care providers.

And the doctors are increasingly desperate because Republicans in the Florida House, in solidarity with President Trump’s push to lower health care costs for all Americans, are rapidly advancing a similar bill there.

President Trump’s administration recently backed the concept in a report calling for states to allow “all healthcare providers to practice to the top of their license, utilizing their full skill set.”

The Florida House’s version could pass as early as this week.

Critics claim that allowing nurse practitioners to diagnose certain types of illnesses and prescribe treatments might lead to some patients seeking help from unqualified individuals. But in study after study, statistics say that treatment from nurse practitioners is just as safe as treatment from physicians.

The truth is, many doctors actually charge nurse practitioners exorbitant sums of money to practice under their license – in some cases, as much as $50,000 per year. So it’s little wonder why these docs would fight so desperately to keep nurse practitioners under their thumbs.

For decades, Republicans across the country have advocated for initiatives that would put downward pressure on health costs. One of those initiatives is already in place: high deductible health plans which incentivize the insured individual or family to shop around for less expensive ways to treat health issues.

Obamacare did nothing to lower health costs. Gone are the days when someone could wake up with a sore throat and call the doctor for an inexpensive appointment and prescription to fix the problem. Doctor visits cost money, diagnostic tests cost money, and medical treatment in the United States costs a lot more than it really should.

But a high deductible plan is useless if there are no savings to be found. That’s why Senator Brandes’s bill is so important. It gives consumers more treatment options. More options means more competition and lower costs.

My family of six relies on a high-deductible health care plan that we found far, far away from the absurdly expensive Obamacare exchanges. Our plan protects us against catastrophic illness or expensive medical treatments.

One of the ways we keep our health costs down is by seeking the advice of nurse practitioners for routine diagnostic care and treatment. Nurse practitioners don’t charge anywhere near the same rate as our family physician. While we value our doctor’s expertise, the vast majority of ailments our family deals with on a regular basis can easily be handled by a nurse practitioner. If there were more of them, the costs would be more competitive.

Families across the state would easily see their out-of-pocket medical costs go down if state senators would give Senator Brandes’s bill a hearing.

 

13 Comments

  1. Susan Lynch MSN APRN NP-C

    Nurse Practitioners (NPs) can increase access to health care and drive down costs. Research shows that NP care is safe and of high quality with the same outcomes as physicians. Florida has a physician shortage , especially in rural areas. Again the research shows those states that allow autonomous practice for NPs have increased access to care in rural areas while driving down the cost of state Medicaid programs. It’s time to modernize Florida’s health care laws and let nurse practitioners practice autonomously.

    Reply
  2. Adherbal De Souza Neto

    Generalizations are never a solution as many nurse practitioners (NPs) have great physicians as friends and mentors. However, stating that NPs do not know their limitations, implying that there would be delay in care, or that NPs are poorly trained are unfair excuses to perpetuate the extra amount of money many physicians collect for supervision which is unnecessary. These same physicians, so interested in the well being of the people allow or facilitate unlicensed individuals to provide care unsupervised as happens in many medical spas. NPs in Florida must carry malpractice insurance as a profession we are the most trusted and the ones who really are patients advocate. NPs are eager and willing to collaborate with physicians and assist with all health care professionals in an independent manner to the better of the people we serve. Also, any physician can legally only supervise a small amount of NPs or physician assistants (PAs). We have the means to make this an non-issue, request and support independence to NPs!

    Reply
  3. Dr Elizabeth McCormack, FNP, FPMHNP

    As a nurse practitioner (NP) of 23 years, I have several points to make regarding why NPs should be given independent practice.

    First, if the public believes that physician oversight means close collaboration then I need to provide some information. A collaborating agreement is only a piece of paper that says that we can practice. For a signature on that paper, someone has to pay the physician (above noted $50,000). For the nurse practitioner, it is like this analogy. I have a car, I have been educated on how to safely drive the car, I have a license to drive the car, and I have insurance to drive a car. But, I still have to ask my husband (the doctor) whether I can drive. It is insulting and an outdated discriminatory tactic that has been used to suppress our ability to function. We are suppressed, that is until physicians realize they can use us as money makers. The more NPs involved in practice the more the wealth from our labor is spread. The collaborating agreement is also for control, it is not for providing any physician oversight. The doctor signs the agreement, bills for the agreement, the NPs drive the car and the physicians reaps the benefit of added income from our services.

    Second, for seven years, I owned and operated a house calls practice (Nurse Practitioner on Call / NPOC) in Pensacola. During this period I employed at least 3 different physicians, 10 nurse practitioners, 3-4 LPNs, 8-10 LPNs, and 3 different office managers. We also were a site for NP and MA students. I brought amazing jobs to the community, helped others provide for their families and helped others obtain valuable education. Patients were very satisfied with the care that they received.
    My NP Company promoted access to care to patients who could not independently leave home for their primary care appointments. At one time my patient population was 30% Medicaid. Without our care, their only option was to call 911 to transport them to the ER for evaluation. As a nurse practitioner, I was able to evaluate the patient in the home, order tests and procedures which could be done in the home and develop plans of care. As a nurse, I was able to identify not only medical needs but also focused on health promotion and disease prevention. We prevented unnecessary ER visits and hospitalizations as well as promoted quality of life.

    My company provided high paying jobs to the Pensacola area. The company saved Medicare and Medicaid money. Our care provided access to care to a “lost” population. Our company was able to refer and take referrals from other companies which depended on our relationship. The business was a win/win for the patients and the community.
    Because of the cost of the collaborating agreement, other unfair Florida Laws and the hostage state that I was in I decided to close my practice.

    Reply
    • Coleen Dooley

      What a tragedy having to close your invaluable services! I do hope if the Senate does their job to ensure affordable accessible healthcare services to Floridians, you could again offer your services to the “lost” population.

      Reply
      • Anonymous

        Thank you! It was so difficult in many ways. Good luck with your business – hope this bill will passes and alleviate some unnecessary burdens!

        Reply
  4. Brad A. Briscoe, DNP, APRN, CNS, CEN, Commander, Nurse Corps, United States Navy (Retired)

    As a nurse pracititoner, I always find it fascinating to hear the arguments from some physicians and physician groups in Florida, that Nurse Practitioners are not safe to practice independently; or that we are important memebers of a healthcare team – but that team needs to be physician led. Really? As a retired Navy Nurse Corps Officer with over 26 years service; I practiced independently as a nurse practitioner. My “supervision” as it were – came from my Commanding Officer, Director, Department Head and/or Division Officer. In many cases, as a nurse, I filled several of these roles myself. These various leadership positions could often be staffed with a nurse or advanced practice nurse, a dentist, a healthcare administrator or a physician. I humbly ask our state senators to consider this in their deliberations. If independent nurse practitioners are good enough for our war fighters on active duty and within the Veteran’s Administration Healthcare System; why then are they not good enough to help improve healthcare access and reduce costs for Floridians? Today, as a Florida Advanced Practice Registered Nurse, I truly hope to see our Senators finally stop listening to physician special interests; and take up Senate Bill 972. Do the right thing for our patients and your constituants – Please support independent practice for Nurse Pracititoners!

    Reply
  5. Dayle Cheshire APRN, MSN, FNP

    Heath are costs today are soaring and while the number of insured has risen, there is still an extreme shortage of providers available to care for these patients. In the current state of Florida legislature our practice is not collaborative in that physicians are providing oversight of our practice. Often times, APRNs do not even know their collaborating physician, let alone do they discuss the care that they are providing their patients. APRNs are essentially practicing independently with identified restrictions limiting our ability to do many simple things that are necessary to provide quality care to our patients.

    APRNs, while we have not had 10 +years of education, have completed at or above the amount of clinical hours and work hours necessary to qualify to be independent practitioners. We bring new insight and perspective to the field of medicine and are taught, from the very beginning, the value of collaborative care and health promotion to provide the best possible outcomes for our patients. While physicians are often hesitant to “ask for help” when they come up to something they aren’t familiar with or to allow another provider to provide input or care for “their patient”, APRNs do not shy away from collaboration with other providers. Studies show that APRNs are are excellent at coordinating care for their patients and collaborating with other providers in order to achieve the best possible outcomes for the patient. Granting full practice authority to APRNs Will not degrade the quality of care that patients receive but will enhance the quality, improve access, and decrease both the out of pocket costs for patients and the national healthcare costs. Please support independent practice and Senate Bill 972.

    Reply
  6. Stephanie Nunes, FNP, BC

    As a Nurse Practitioner (NP) who specializes in geriatrics, I find that there are not many doctors wanting to take care of this population. When I see new med students coming through for their rotation, not a single one will say, “This is where I want to practice”. They are going into Internal Medicine or high specialty practices. Collaborating physicians do not collaborate and are just there in name only. It makes our ability to practice difficult when we need certain obscure protocols signed by a physician. I came from New Mexico where NPs had full practice authority and ironically, I saw more collaboration with physicians than I see here in Florida. Nurse practitioners provide excellent care and it is often in populations the doctors do want anything to do with. I hope the legislative bodies realize the value of NPs, look at the evidence-based data, and avoid the rhetoric from associations that are afraid NPs will infringe on their practice.

    Reply
  7. Moises Dobarganes, APRN

    I am a Nurse Practitioner practicing solo in my own medical practice in Miami, FL, serving an under-served Latino population of people over 65 years old. We have been practicing for more than 5 years getting reimbursed 85% of regular physician fees by all insurers. We experienced the Physician protocol burdensome BON/AMA approval requirements, which finally was removed form Florida legislature. Now we have the opportunity to obtain a full practice recognition which will allow us NPs to serve our patients without restrictions. I am OK with the lower reimbursement, even happier like that as we provide valued care with lower cost. Full practice will also untie the restrictions to be direct providers for HMO’s and Obamacare. I see for free many Obamacare holders just because I cannot become a provider for the insurers due to my NP protocol requirements. Lets support this legislation now and become independent within our scope of practice.

    Reply
  8. Laura Smith

    I have been a Certified Family Nurse Practitioner since 1997. The collaborative agreement has never been utilized. When a patient problem was brought to legal counsel, the physician I worked with was not even named in the suit. The case went to trial and I was not found liable as the patient was seen by several MD specialists who did not identify what later became an apparent problem. This was eye opening to how physicians want to dictate NP care, but do not want to be a part of the practice.

    Reply
  9. Mike MacKinnon

    The reason they are against this is entirely monopolistic and anti competitive. Its all summed up by this quote:

    “It is hard to convince a man of something when his SALARY depends on him NOT being convinced of it” – Upton Sinclair

    Reply
  10. Donna Sanchez

    Mike,
    so well said. The only thing restrictions upon APRNS does is make sure that the “Physcian collabators” continue to make money without doing the work. If they really care about patient safety then provide that care for the underserved, the medicaid and medicare patients. DS

    Reply
  11. Coleen Dooley

    I am a psychiatric nurse practitioner in the Florida Keys. For the last 25 years, I have provided psychiatric services in our rural community in my solo practice. As currently required, I do have a collaborating physician, who annually signs my protocol but otherwise, I function independently.I am able to provide affordable, accessible health care services. Not only do my services help to address soaring health care cost but prevent unnecessary ER trips and hospitalization. Over the years, I have had to consider closing my practice due the difficulty of finding a collaborating physician. By passing SB 972, I can continue to function autonomously, within my scope of practice, providing affordable accessible health care services and no longer be at risk of having to close my practice and those in need of my services being without the healthcare they need.

    Reply

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