Nurse practitioners again push for independence

Texas nurse practitioners are once again seeking independence from costly agreements that require them to sign contracts with doctors in order to treat and write prescriptions for their patients. 

State Rep. Stephanie Klick, R-Fort Worth, introduced House Bill 1415 Thursday, saying the bill would get rid of so-called prescriptive authority agreements that require nurse practitioners — who have advanced degrees in a nursing speciality — to pay up to six-figure fees to "delegating" doctors. 

Currently, nurse practitioners are regulated by both the Texas Board of Nursing and the Texas Medical Board. Under Klick's bill, nurse practitioners would be regulated solely by the nursing board. 

Doctors' groups in Texas have said these nurse-physician contracts are necessary to ensure patient safety, because physicians have more expertise in treating patients. Primary care physicians must complete four years of medical school and three years of residency training, while nurse practitioners must complete four years of nursing school and usually two years in a graduate-level training program. 

Nurse practitioners are often the primary health providers in many rural and low-income Texas communities. Under current regulations, the physicians they contract with don’t need to be in the same city as the nurse or see the patients the nurse treats. Experts say the contracts drive up clinic prices or push nurses to other states.

During a Thursday press conference, Klick said the contract fees can be as high as $120,000 per year in Texas, which is why many nurses opt to work in neighboring states that don't require delegating physicians. New Mexico’s government, Klick said, has even appropriated funds to recruit Texas nurses.

"This puts Texas at a competitive disadvantage,” Klick, a former nurse, said. “Texas simply cannot afford to waste precious dollars spent educating our healthcare workforce just to have them move out of state and help with healthcare providers elsewhere."

The bills  — Klick’s and Sen. Kelly Hancock’s Senate Bill 681 — are not the first seeking to end these nurse-doctor contracts. Similar bills over the past few legislative sessions failed to become law. 

This time around, however, the bills don't call for an expansion of a nurse’s scope of practice, and they are backed by a coalition of 20 organizations representing consumers, healthcare businesses and advocates, including the AARP, the Texas Association of Business and the Texas Public Policy Foundation.

"It's a powerful bunch, and it's not a bunch that you frankly see doing a lot of things together very often," said Bob Jackson, AARP’s state director.

Jackson said the bills have a better chance of passing because they focus on removing fees rather than on increasing what nurses are allowed to do when treating patients.

Don R. Read, president of the Texas Medical Association — which represents more than 50,000 of the state's doctors and medical students — said his group still believes that the "team care" approach agreed upon by physicians and nurse practitioners in 2013 "serves patients best."

"We are bringing record numbers of physicians to Texas, yet we have a fast-growing population," Read said. "We must work together to address care access issues for our patients.”

Klick said she hopes her bill's terms will make it easier and cheaper for Texas patients to access care while maintaining quality.  

“We need every single health care provider in this state and we need them operating to the full extent of their training and education,” Klick said. “HB 1415 is about patient access, it's about expanding options for care in rural and underserved areas, it's about patient choice and high-quality, cost-effective care.”

Read related Tribune coverage:

• In 2015, medical groups tracked more than a dozen bills that would give more autonomy to professionals like nurse practitioners and physical therapists to operate independently of medical doctors. 
• Nurse practitioners said state regulations, which link them to supervising physicians, limit their ability to treat patients in a state with a looming shortage of primary care physicians. 

Disclosure: AARP Texas, the Texas Association of Business, the Texas Public Policy Foundation and the Texas Medical Association have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors is available here.