On May 26, 2016, the Ohio House of Representatives passed House Bill (HB) 216, a bill that makes revisions in the nurse practice act, but no longer grants advanced practice registered nurses (APRNs) independent practice. View a summary of the major provisions introduced in HB 216 and how those provisions changed before the bill passed the Ohio House of Representatives.
The Ohio Academy of Family Physicians, along with a strong coalition of physician associations, was able to convince the House Health Committee that APRNs should continue to be required to have a standard care arrangement with a collaborating physician. A key argument was APRN independent practice undermined the states efforts to advance the patient-centered medical home model of care delivery by fracturing the physician-led care team.
The bill will now move on to the Ohio Senate for consideration.
- A provision that would grant APRNs a 120 day grace period in which an APRN could establish a new collaborating physician relationship if their current collaborating physician severed the relationship
- A provision that raises the APRN-to-physician collaboration ratio from 3-to-1 to 5-to-1
- A provision that would allow a psychiatric APRN to collaborate with a physician who specializes in family medicine, pediatrics, or psychiatry which should address any existing difficulty with the states 400 psychiatric APRNs finding psychiatrists with which to collaborate
- Continuation of the Committee on Prescriptive Governance, but with a new, smaller committee structure three physicians, three APRNs and a pharmacist; the pharmacist would not have a vote
- Changing the current inclusionary formulary to an exclusionary formula.
- Independent practice for additional health professionals undermines team-based care creating silos and further fragmenting patient care.
- Physicians have at least 11 years of education and training while APRNs have 5.5 to 7 years. The training of an APRN is more equivalent to a third-year medical student than a primary care physician who has completed an undergraduate degree, four years of medical school, and a three-year residency program. Patients highly value the additional education and training that physicians receive. Surveys show that 90% of patient respondents feel a physicians additional years of medical education and training are vital to optimal patient care.
- APRNs would have you believe that independent practice is about access to care and that if given independent practice, APRNs will flock to underserved areas to provide primary care. The truth is there is nothing, under current standard care arrangements, preventing an APRN from going to a rural community right now. Only 12% of APRNs practice in out-patient settings. Most APRNs are practicing in sub-specialties, not primary care; only an estimated 30% to 35% of APRNs practice primary care.
- If granted independent practice, APRNs would be able to order and interpret diagnostic tests, prescribe addictive narcotics, and develop treatment plans without consulting a physician.
- The roles of a physician and a nurse are not interchangeable.
- Deadline to Submit Comments on Proposed VA Rule to Grant APRN Independent Practice is July 25; Act Now (Weekly Family Medicine Update, July 19, 2016)
- Oppose Proposed VA Rule to Grant APRN Independent Practice (Weekly Family Medicine Update, July 12, 2016)
- Urgent Request Stop Independent Practice for Psych APRNs (Weekly Family Medicine Update, May 17, 2016)
- Concerns Remain with New Version of HB 216 (Weekly Family Medicine Update, May 10, 2016)
OAFP to Participate in IP Meeting on HB 216 (Weekly Family Medicine Update, March 15, 2016)
SB 279, Companion APRN Independent Practice Bill, Referred to Committee (Weekly Family Medicine Update, March 1, 2016)
SB 279, Companion APRN Independent Practice Bill, Introduced (Weekly Family Medicine Update, February 16, 2016)
Medical Professionals Express Opposition to House Bill 216 (Weekly Family Medicine Update, February 16, 2016)
- Companion APRN Bill Will Be Introduced in Ohio Senate (Weekly Family Medicine Update, February 2, 2016)
- Contact Your Legislators to Oppose APRN Independent Practice (Weekly Family Medicine Update, January 26 and February 2, 9, 16, and 23, 2016)
- Proponent Testimony on APRN Independent Practice Bill Scheduled for Tomorrow; Contact Your Legislator (Weekly Family Medicine Update, January 19, 2016)
APRN Claims about Rural Access Disputed (Weekly Family Medicine Update, November 3, 2015)
- Physician-Led Teams Work: Legislators Should Oppose HB 216 (Weekly Family Medicine Update, September 22, 2015)
Interested Parties Meeting on APN Independent Practice Bill Held (Weekly Family Medicine Update, July 14, 2015)
Physician Organizations Oppose APN Independent Practice (Weekly Family Medicine Update, June 23, 2015)
Physician Organizations Oppose APN Independent Practice (Weekly Family Medicine Update, June 16, 2015)
Physician Organizations Oppose PT Scope Bill (Weekly Family Medicine Update, June 9, 2015)
- Right Care, Right Professional, Right Time (The Ohio Family Physician, Spring 2013)
- Non-Physician Provider Policy Statement (April 10, 2011)
- Physician-Led, Team-Based Care Webpage
Other Information and Resources
- Letter to the Editor “Nursing Practice Bill is Flawed,” (The Columbus Dispatch, February 6, 2016)
- Op-Ed: “Take Advantage of Advanced Practice Nurses” (Akron Beacon Journal, January 28, 2015)
- HB 216: Myth vs. Fact
- Teams Work…for Patients; Ohio House Bill 216 Undercuts Team Approach
- Education and Training: Family Physicians and Nurse Practitioners (American Academy of Family Physicians)
- Relying on NPs and PAs Does Not Avoid the Need for Policy Solutions for Primary Care (Robert Graham Center, 2013)