The APRN Proposals for SB 23

Update #4 mentioned the Senate Finance Subcommittee and its hearings regarding policy changes to save money in Medicaid and other health programs overseen by the Health & Human Services Commission (HHSC). Subcommittee members discussed the four policy changes (numbered 153 – 156) directly relating to APRNs at the hearing last Wednesday.

 

The following is a brief summary of the four proposals.

• Policy change #154 would increase utilization of APRNs in state hospitals and is estimated to save $1.2 million annually.

• Policy change #155 would establish a pilot program for independent practice by APRNs. While initial savings is estimated to be approximately $35 million in reduced ER visits, this is offset by an increase in the number of primary care visits. HHSC calculated total savings to be $400,000 annually. However, HHSC has not yet calculated the potential savings in hospital admissions if APRNs were permitted to diagnose and prescribe independently.  
• Policy change #156 proposed by Senator Tommy Williams (R – The Wooldlands, SD #4) on behalf of APRNs. instructs the Health and Human Services Commission to analyze the cost savings related to allowing Nurse Practitioners and other Advanced Practice Registered Nurses to have plenary authority. It is our understanding that Senator Williams’ proposal includes authorizing APRNs to diagnose and prescribe/order under our own license, so obviously, we strongly support this. No cost savings has yet been calculated for this policy change.

 To hear the discussion on these policy changes, go to the Video/Audio Archives for February 23, 2011, and click Part 1 http://www.senate.state.tx.us/75r/Senate/commit/c542/c542.htm. The discussion of APRN policy changes is only about 6 minutes. It starts at time marker 39:30 and is the last discussion in Part 1 of the hearing. The subcommittee is scheduled to meet next week to consider additional proposals and determine which proposals will be included in S.B. 23.

If you live in the district of one of the subcommittee members you should have received an email urging you to contact your senator and ask for his/her support for policy change 156. This needs to occur before 10 a.m. Monday, 2-28-11.

 

Nursing Bill: SB 192

SB 192 by Senator Jane Nelson (R – Lewisville, SD #12) is scheduled for a hearing in the Senate Health & Human Services Committee on Tuesday, March 1st. This bill is supported by all nursing organizations and is part of TNA's legislative initiative to improve protections for nurses who advocate for patients.  The bill addresses lessons learned from the case of the two Winkler County nurses who were terminated and criminally indicted for reporting a physician to the Texas Medical Board. 

What would the bill do? SB 192:

• Protects  nurses from criminal prosecution for reporting unsafe care;
• Increases fines against persons who retaliate against nurses who engage in protected patient advocacy activities; and
• Protects nurses who advise other nurses about their patient advocacy rights and protections.

A similar bill was filed by Rep. Donna Howard (D–Austin, HD #48) in the House. H.B. 575 was referred to the House Public Health Committee. That committee had its first meeting last week and will hold its first meeting to consider bills this Wednesday.

In the News: Texas APRN Legislative Struggles

APRNs in Texas cheer San Antonio Express business reporter, David Hendricks, for his February 23rd Article, “It’s Time to Pass Texas Nurse Bill.” The subtitle, “Access to care would improve; consumers would save money,” summarizes our message perfectly.  Mr. Hendricks identifies the bills by Representatives Garnet Coleman and Kelly Hancock, and closes by saying, “Giving advanced nurses the power to diagnose and prescribe is sensible and humane. The Legislature should hesitate no longer.”

Much further from home, British medical journal, The Lancet, highlights the multi-state struggle for better laws to allow APRNs to practice to the full extent of our education. The article hits close to home as it sites Texas as one of the most restrictive states in the U.S. The Lancet article also notes the growing public support from the Institute of Medicine, AARP and others for changing restrictive APRN laws, including the recent editorial by Jeff Susman, M.D. in which he characterizes family physicians’ struggles against APNs as damaging and unsustainable. Dr. Susman’s editorial appeared in the December 2010 issue of The Journal of Family Practice.