Legislature eases physician assistant rules; nurse practitioners' prescription power, Medicaid prompt-payment bills, others linger

By Molly Burchett and Al Cross
Kentucky Health News

The Kentucky General Assembly has joined other states in easing the restrictions on physician assistants’ medical practice, but has held up a similar move for advanced registered nurse practitioners. Both issues relate to the shortage of medical practitioners in many Kentucky counties, and the quality of medical care.

The Senate added the physician assistant language of Senate Bill 43 to House Bill 104, an art-therapy bill, in order to preserve an agreement between the Kentucky Medical Association and the Kentucky Academy of Physician Assistants. It will repeal the law that bans PAs from practicing for their first 18 months unless a physician is on site; one will still have to be available by telephone. The amended bill has been sent to Gov. Steve Beshear for his signature or veto.

The amendment was used because the House had tacked onto SB 43 an amendment from advance practice registered nurses that would have repealed the need for them to have a collaborative agreement with a physicians to prescribe non-narcotic drugs. The KMA opposes that idea.

"It's looking like the doctors win," said Sen. Julie Denton, R-Louisville, who favors the repeal. "I'm not hopeful" it can pass, she said, but added that some physicians also favor it: "With Obamacare coming in, we're going to need all the front-line physicians we can get." Leading opponents of the measure, Republicans Katie Stine of Fort Thomas and Carroll Gibson of Leitchfield, didn't return a call seeking comment.

Nurse practitioners say that SB 43 is necessary to allow them to fill health-care gaps in rural Kentucky and address the state's shortage of primary-care providers. The Kentucky Coalition of Nurse Practitioners and Nurse Midwives says in an article prepared for Kentucky newspapers that NPs have never been required to practice under physician supervision and 17 states allow full prescribing authority for non-scheduled medications.

The Medicaid prompt-payment bill, HB 5, went to a conference committee after the House refused to go along with Senate changes, and may be considered when the legislature returns later this month, ostensibly to consider any bills Beshear vetoes. The bill would apply prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

In the final crunch to pass legislation before the veto recess, lawmakers attached seven health care-related bills to HB 366, which had focused on identifying congenital heart disease in newborns. It had 10 additional measures "hung on it like a Christmas tree before the free conference committee of House and Senate members," reports Ryan Alessi of cn|2's "Pure Politics."

The bills still hanging on the measure, dubbed the "healthy Christmas tree," are:

• HB 187, addressing a free prescription-drug program for under-insured Kentuckians.
• HB 79, which would exempt licensed health care providers from being disciplined for prescribing naloxone in the event of an overdose.
• HB 387, which aims to provide nutritional supplements for low-birth-weight newborns.
• SB 201, which addresses licensed diabetes educators.
• SB 38, to require Medicaid to accept provider credentialing by a Medicaid managed-care organization.
• SB 108, relating to managed-care contracts with the IMPACT Plus program, a behavioral health program for children.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Poll shows Kentucky health-care providers often fail to discuss HIV testing with patients

A new poll suggests that most Kentucky health-care providers follow guidelines for discussing HIV screening with their patients, despite the the importance of early treatment to prevent its progression to AIDS.

Although the Centers for Disease Control and Prevention recommends routine HIV screenings for most patients, just 32 percent of Kentucky adults aged 18 to 64 report discussing HIV testing with their medical provider, according to the Kentucky Health Issues Poll.

About 40 percent of Kentucky adults reported they had never been tested for HIV. It’s estimated that 4,500 Kentuckians are living with HIV infection and it is estimated nationally that one in five people who have HIV do not know they do.

“It made headlines earlier this month when a little girl - the second person in history - was cured of HIV. As exciting as this development was, for most people, HIV remains a life-long condition that must be managed through medication to keep it from progressing to AIDS. The CDC’s recommendations are meant to improve the overall population health by detecting HIV so treatment can begin,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll.

“It appears that Kentucky providers are either not adhering to the routine screening recommendations or not communicating this message clearly to patients,” she said.

The poll, co-sponsored by the Health Foundation of Greater Cincinnati, was taken Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points

Poll finds four out of five Kentuckians are comfortable seeing a nurse practitioner or physician assistant for routine care

New poll figures indicate the majority of Kentuckians are comfortable seeing a nurse practitioner, physician assistant or mid-level clinician for their routine care, especially if they have been treated by such clinicians. The findings come as the General Assembly considers a bill that would allow physician assistants to practice more independently.

In the Kentucky Health Issues poll last fall, 79 percent of Kentucky adults said they would be comfortable seeing a nurse practitioner for routine health care, and half of those people said they would be very comfortable. Eighty-one percent said they would be comfortable seeing a physician assistant for routine health care, and 42 percent of those respondents said they would be very comfortable.

Reported comfort was higher among people who had received care from a nurse practitioner or physician assistant in the past year; 86 percent of those people said they would be comfortable seeing an NP again for routine care. Eighty-eight percent of those who had received care from a PA in the past year said they would be comfortable doing that again.

The poll also inquired about a proposed new “mid-level” profession: advanced dental hygiene practitioners. These practitioners would provide routine dental care, including diagnostic and preventive services such as filling cavities. Although advanced dental hygiene practitioners cannot currently be licensed to practice in Kentucky, polling data indicated 73 percent of Kentucky adults would be comfortable with such a practitioner providing routine dental care.

"As providers move to create a system of care that includes a range of skill sets and training in its care teams, new strategies emerge that hold promise to increase access to affordable care – not just in urban centers but also in rural and underserved communities,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which sponsored the poll. “The data suggest that the public is very receptive to health care services from different types of clinicians.”

The poll, co-sponsored by the Health Foundation of Greater Cincinnati, was taken Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points. (Read more)

Physician assistants and some doctors urge lawmakers to pass bill that could ease provider shortage in rural Kentucky

Doctors and more than 150 physician-assistant students urged lawmakers Tuesday to pass a bill they stated involves dropping only one requirement in the law and could ease a physician shortage in Kentucky, reports Ryan Nick of cn|2's "Pure Politics."

Passage of Senate Bill 43 would repeal a law that allows physician assistants to treat patients only when a supervising physician is on site for the first 18 months after their certification. If passed, PAs would still be supervised but would be permitted to perform services in a location separate from the supervising physician, as long as that physician can be reached by phone at all times.

No other state requires PAs to have 18 months of on-site supervision. Colorado, the state with the next-longest mandate, requires supervision only for the first 1,000 hours after certification.

The bill's supporters say the burdensome supervision requirement has led to 55 out of Kentucky's 120 counties being medically underserved and has encouraged many PAs to practice in other states, reports Storm. They also say this rule needlessly complicates patient care, especially in rural areas where doctors are stretched thin, reports Melinda Beck of The Wall Street Journal.

The bill's sponsor, Sen. Tom Buford, R-Nicholasville, told Kentucky Health News that he expects the Kentucky Medical Association to seek some changes in the bill, but also expects it to pass because Senate Republican leaders, hospitals and universities support it. "We're educating these PAs at a lot of state expense just to work in other states," he said. House Speaker Greg Stumbo, D-Prestonsburg, told Storm he sees no reason why the bill shouldn't pass. Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee, told KHN that she supports the bill.

PAs are expected to be in even greater demand when the health-care reform law brings hundreds of thousands of Kentuckians into the health-insurance system. Beck notes the state is expected to face a greater shortage of physicians, particularly in primary care and rural areas. Buford said, "We're going to provide all this health care for everybody, and there's nobody to go see." For more from cn|2, including video interviews, click here.