Nurse Practitioner Case Highlights New Bill Expanding Scope of Practice

Sarasota, FL (WorkersCompensation.com) –- A recent settlement in California brings to life the tension that is brewing over a bipartisan bill that touts increasing access to care. 

Dan Dow, the district attorney for San Luis Obispo County, California filed a complaint in October against a local registered nurse and nurse practitioner for marketing herself as a, “Doctor”. Sarah Erny, R.N., N.P., who had earned her doctorate degree for nursing, promoted herself as “Doctor Sarah Erny” on her professional website and social media accounts from October 2018 until March of this year. According to court documents, Erny often indicated that she was a nurse practitioner, however she did not identify her supervising physician and did not specifically inform the public that she was not medical doctor.

Under California statutes, the term “doctor” or “physician” applies to only those healthcare providers that hold a valid physician’s and surgeon’s certificate. Additionally, the law only allows titles such as “Certified Nurse Practitioner,” or “Advanced Practice Registered Nurse” for those nurses which do not have a physician’s license. 

As a result of the complaint, Erny has agreed to pay out $19,750 in civil penalties. Additionally she has agreed to correct her title on her website and social media.

As pointed out in the press release, according to polls from the American Medical Association, 39 percent of participants thought a Doctor of Nursing Practice was a medical doctor. Additionally, 19 percent indicated they thought a Nurse Practitioner was a physician. 

This particular case highlights the tensions between nurses and physicians surrounding bipartisan bill, H.R. 8812, the “Improving Care and Access to Nurses Act” known as “I CAN Act” presented in September. As physician assistants and nurse practitioners (APPs) are paid at a 15 percent discount below physician rates, the bill touts cost savings while expanding access to care. However, both the American Medical Association (AMA) and the California Medical Association (CMA) fully disagree and have issued formal statements opposing the bill. 

H.R. 8812 expands the scope of practice for APPs. For cardiac and pulmonary rehabilitation, the bill would allow APPs to prescribe exercises. APPs would also be allowed to satisfy the medicare requirement for ordering diabetic shoes, and durable medical equipment. Additionally, the bill proposes that advanced practice providers would be able to refer patients to medical nutrition therapy, as well as home infusion therapy, and referrals to Hospice. 

While collaboration with a physician is mentioned, the bill also allows for supervision of nursing facility residents by APPs. Under the new proposal, inpatient Medicare and Medicaid patients could be under the care of a nurse practitioner. 

The bill also clarifies the roles and payment of nurse anesthetists, to include “pre-anesthesia evaluation and management services”, and “related care”. Additionally authorization to refer, order, or certify services are included, as well as eligibility for reimbursement for evaluation and management services. 

While on the surface the bill appears to free up access to care in a shortage of providers, the AMA and CMA assert that the bill endanger the care of patients by allowing APPs to provide care outside their education. Additionally, they state that the proposed changes would increase utilization of services and costs while lowering care for patients. 

Prior to the pandemic, healthcare saw an increase in the utilization of APPs. The general purpose was to maximize productivity and meet patient demands while minimizing costs. Although CMS reimburses APPs at a 15 percent discount, practices were able to maintain a balance. While APPs were the largest portion of healthcare providers to be furloughed in the midst of the pandemic, in the face of a staffing shortage the large majority have returned in taking up the slack for seeing patients. It will be interesting to see how the bill progresses, and whether healthcare practices can find a balance. 

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