Scope of Practice - Teams Work!
During the Ohio Legislature’s 130th General Assembly, lawmakers and other key stakeholders began an important shift towards team-based patient care. In Ohio, that team is led by a physician. The Ohio State Medical Association (OSMA) fully supports this effort as an evolutionary transition for assuring high-quality patient care. Under the team-based model of care, multiple health care professionals—including nurses, therapists, and others—are led by a physician and collectively determine the best plan of treatment for a person suffering from an illness or injury. This process is efficient and effective and minimizes the chances of fragmented or inappropriate treatment.
Physician-led, team-based patient care is not unique to Ohio. Several states in recent years have adopted this model of patient care to not only develop and implement more effective patient treatment plans but to also reach more patients, especially those in rural or underserved areas.
House Bill 216/Senate Bill 279: APRNs
Status: Passed, effective April 4, 2017
OSMA Position: Neutral
Summary: The OSMA continues to support a physician-led, team based approach to patient care and believes that there are aspects of HB 216 that could enhance this relationship. For this reason, the OSMA has recently adopted a position of neutrality on the legislation as it now stands.
The OSMA agreed to the following changes to HB 216 that the Ohio House approved:
- Elimination of the inclusionary formulary for prescribing, replacing it with an exclusionary formulary with a committee comprised of an equal number of APRNs and physicians;
- Modification of the ratio from 3 to 5 APRNs that a physician can collaborate with when prescribing;
- Expansion of the pool of collaborating physicians that mental health clinical nurse specialists may collaborate with to include family and primary care physicians as well as pediatricians;
- Establishment of a grace period of 120 days to allow the APRN to continue practicing without a collaborating physician if the physician is no longer able to collaborate;
- Addition of residential care facilities to the list of facilities where APRNs can prescribe schedule II drugs;
- Deletion of restrictions on furnishing samples of drugs;
- Revision of certain insurance and Medicaid statutes to cover follow-up care directed by an APRN;
- Allowance of testimonial privilege to APRNs;
- Creation of an Advisory Committee to the Board of Nursing on APRN issues; and,
- Modification of licensure and continuing education requirements.
The OSMA originally opposed this proposal because it contained a provision that abolished the current requirement for APRNs to collaborate with a licensed physician and granted APRNs independent practice authority. This would have upset the cooperative and collaborative effort already underway between physicians and APRNs in Ohio and threatened patient care. HB 216 would have allowed APRNs to order and interpret diagnostic tests, prescribe addictive narcotics, and develop treatment plans for patients without consulting a physician. A patient suffering from an illness or injury could have received medical treatment without ever actually being helped or seen by a physician.
With months of work, the OSMA was fortunately able to push back the dangerous provision for independent practice authority present in the bill, and it was removed. The version of the bill that passed through the House and signed into law contained the negotiated-upon changes listed above and did not contain the independent practice provision.
House Bill 169: Physical Therapists
This legislation would modify the scope of practice of a physical therapist, permitting them to evaluate, diagnose, and determine a plan of therapeutic treatment for a patient. HB 169 would also allow a physical therapist to order tests, including diagnostic imaging and studies that are performed and interpreted by other licensed health care professionals. Under current law, a physical therapist can evaluate and assess, but not diagnose, a patient’s disability or medical condition.
The OSMA, along with many other organizations, opposes this proposed change to current law. Other groups opposing this legislation include:
- The Ohio Orthopedic Society
- The American Academy of Pediatrics, Ohio Chapter
- Ohio Occupational Therapy Association
- Ohio Osteopathic Association
- Ohio Foot and Ankle Association
- Ohio Chiropractic Association
- American Academy of Family Physicians, Ohio Chapter
House Bill 421: Pharmacists
Status: Passed (Amended into SB 332), effective April 4, 2017
HB 421 would grant pharmacists the authority to inject certain drugs if they are working under the direction of a physician. The legislation would authorize a licensed pharmacist to administer the following drugs:
- An opioid antagonist used for treatment of drug addiction and administered in a long-acting or extended-release form;
- An antipsychotic drug administered in a long-acting or extended-release form; or
- The synthetic hormones hydroxyprogesterone caproate or medroxyprogesterone acetate.
HB 421 also allows a pharmacist to administer epinephrine or diphenhydramine, or both, to an individual in an emergency situation resulting from an adverse reaction to the authorized drug administered.
In order to be granted this authority under the law, a pharmacist would need to:
- Complete extensive additional training in both the administration of drugs and life support,
- Practice in collaboration with a licensed physician,
- Practice in accordance with a protocol established by that physician. This protocol must also be approved by the State Board of Pharmacy.
The OSMA believes this bill gives proper attention to patient safety and physician oversight and represents positive progress in a growing trend that emphasizes more physician-pharmacist collaboration in managing patient care. The changes in this bill would increase accessibility of the above listed injected drugs, which will help to improve rates of medication adherence by patients, as well as enable providers to better facilitate adherence intervention.
House Bill 276: Chiropractors
Status: Passed, effective April 4, 2017
This legislation authorizes chiropractors to engage in certain activities involving nutrition-related items and therapies, nonprescription drugs, and medical goods and devices.
A chiropractor will be permitted to administer, sell, distribute, recommend, or provide advice regarding any of the following to restore or maintain the health of the chiropractor's patients:
- Glandular extracts
- Botanical substances
- Herbal therapies
- Homeopathic remedies
- Drugs available without a prescription
- Durable and nondurable medical goods and devices
Senate Bill 300: Psychologists
Summary: SB 300 would authorize certain psychologists to prescribe psychotropic drugs and other drugs for the treatment of drug addiction and mental illness. The OSMA believes that this legislation represents a dangerous overreach of scope, as psychologists do not possess the proper training and education to prescribe drugs to patients, and the required training for psychologists to prescribe proposed by the bill is inadequate.
House Bill 548: Nurse Anesthetists
Summary: This bill would allow CRNAs to select, order and administer drugs, and to direct certain other personnel to administer drugs or perform clinical support functions. Under the physician anesthesiologist-led anesthesia care team model, the OSMA fails to see the patient care need for this bill, and has various concerns about patient safety and CRNA training limitations.