[NPInfo] Retail Clinics/PhysiciansandNursePractitioners/Physician Assistants

Thu Aug 7 11:55:33 PDT 2008

I get frustrated also, but it is hard to get anyone to listen.? Please keep in mind that many national np organizations have specific purposes and agenda, and unless their membership advocates otherwise, the organizations do not feel that they need to address these issues.

There are a lot of options to address issues, problems short of litigation, but the effectiveness of these options is premised on? coordination of our resources and manpower.? When I was at ANA, I used two very successful strategies for changing approaches to advanced practice nursing.? One of the first strategies was to address rulemaking initially proposed by the Drug Enforcement Agency (DEA) which would have required that all nonphysician providers (their terminology, not mind) have their DEA numbers appended to a physician.? The AMA and others supported this structure for certifiying nonphysician providers as it would assure that NPs and PAs would? have to collaborate with physicians.? At that time (1991), ANA gave me the go ahead to get nurse practitioners and nurse practitioner organizations to work with me on a unified response to the comments.? We prepared our comments first and we sent them to every nurse practitioner organization; and because we prepared our comments early and shared them with everyone, we were able to get over 800 comments against the proposal, to include comments from state boards of nursing.? As you know from the existing certification process, the DEA dropped that proposal and instead, went to addressing DEA licensure by following the lead of the state of practice.

Another time, I utilized the FTC and ANA and NACNS provided comments on anticompetition and problems with barriers imposed to the advance--d practice scope of practice.? Again, we informed all advanced practice nursing organizations about our intent to testify and about the FTC process; and we were able to get AANA (nurse anesthetists) to submit testimony as well.? While the FTC mentioned our concerns but really did not address them in the final report on anticompetition in healthcare, I believe that our presence set the stage for the current activities at the FTC.? Specifically,? the FTC held hearings on retail clinics in April 2008; and the positive response the FTC rendered in response to the request of the Massachusetts advanced practice nurses to look at the anticompetitive practices related to retail clinics; and the more indepth and comprehensive response the FTC provided to the Illinois legislator who requested review of the Illinois retail clinic legislation.

In retrospect, I've tried to analyze why these actions were, I believe, effective and came up with the following:

-- First, I understood both nursing and the issues surrounding the problem and instead of approaching the issue from a "nursing" perspective, I looked at the regulatory problem and offered a "solution" which utilized the existing regulatory protections;

--Second, the profession worked collectively.? Instead of second guessing the law or the process, the group worked together and took a chance on using a process which had not been used before to get a positive response.? Instead of us focusing on the inequity of the rules on nursing, we focused on the inability of states to regulate the profession under the federal mandate granted to states to protect the health and safety of its citizens.? With the FTC, we talked about scope and anticompetition because they are the federal agency vested in addressing anticompetition and we knew that they did not understand the issues related to APNs and barriers to practice.??The focii involved getting the agency to use institutional mandates to address our issues.

-- We did not rant and rave.? All testimony written was presented from a scholarly perspective, with plenty of footnotes to publications and articles which we knew the staff (those young people who are not paid a lot of money, but who are smart as can be, will look at).

Instead of all of these different approaches, we have to come up with one good approach, get everyone to buy into the approach, focus on the issues and not our feelings about the issue, identify the best method to address the issue (not the traditional way, but the best way which requires serious legal and regulatory review of the problem) and then address the issue.

For example, I am tired of nurse reimbursement issues and am looking for a good case to bring under the false claims act, however, when I find good cases, nurses don't want to reveal their identities to file the necessary complaints even though there is a track record of the Inspector General taking on nurse initiated qui tam actions.? What nurses don't realize is that one of the largest qui tam cases was brought by a state association of nurse anesthetists and that case set a precedent for an organization to bring qui tam actions on behalf of their membership.

While organizations have an obligation to their members, nurses have an obligation to themselves to create the best practice environment possible.? When organizations don't act, join together to make them act or take action yourselves.? You would be surprised how much you could get done and how much you could influence organizations to act by initiating the act individually.

Winifred Carson-Smith, Esq.
CarsonCompany, LLC
http://www.carsonco.net
nursinglaw at aol.com
202-232-5193
202-232-5194(fax)

-----Original Message-----
From: Marilyn Dean <marilyn.dean at mchsi.com>
To: NP Info <npinfo at nurse.net>
Sent: Sat, 2 Aug 2008 8:49 am
Subject: RE: [NPInfo] Retail Clinics/PhysiciansandNursePractitioners/Physician Assistants

Dena,
It puts a smile on my face too.
Congratulations!
Marilyn Dean

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net]On
Behalf Of Dena
Sent: Friday, August 01, 2008 12:28 PM
To: jeffnp27 at yahoo.com; 'NP Info'
Subject: RE: [NPInfo] Retail
Clinics/PhysiciansandNursePractitioners/Physician Assistants

Once again-- WHERE ARE OUR NATIONAL ORGANIZATIONS?????????? What are they
doing to help/protect us???
Dena Galler
(now, as of yesterday, officially Dr Galler... not that it makes any
difference to me, my co-workers, or my patients-- but it puts a smile on my
mother's face <G>)

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Jeffrey Hazzard
Sent: Wednesday, July 30, 2008 12:24 PM
To: NP Info
Subject: RE: [NPInfo] Retail Clinics/Physicians
andNursePractitioners/Physician Assistants

?? We've tried everything else for 30 years.? No progress.? Time to pursue a
restraint of trade.?? I think it has merit.
????????????? Jeff

--- On Wed, 7/30/08, Havens, Shelby <havens.shelby at mail.dc.state.fl.us>
wrote:

From: Havens, Shelby <havens.shelby at mail.dc.state.fl.us>
Subject: RE: [NPInfo] Retail Clinics/Physicians and
NursePractitioners/Physician Assistants
To: "NP Info" <npinfo at nurse.net>
Date: Wednesday, July 30, 2008, 2:54 PM

Dear Meg:

I totally agree. We've lost ground here in Florida, too. I work in a prison
for the express purpose of having autonomy. There aren't many physicians who
want to practice correctional medicine, so the playing field is more level
behind bars. The working environment sucks, but autonomy is one of the most
important factors for me in job satisfaction, so this type of setting suits
me
just fine.

If anyone files a class action lawsuit, please count me in! I really don't
think this will ever happen, but just in case someone is gutsy enough to try
it,
please let me know!

Best Regards,

Shelby Havens, ARNP

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On 
Behalf
Of
Meg
Sent: Wednesday, July 30, 2008 2:46 PM
To: NP LISTSERV
Subject: [NPInfo] Retail Clinics/Physicians and NursePractitioners/Physician
Assistants

What I see happening is that we've allowed this entire venue to slip
through our fingers here...and it boils down to hard care economics.?If
physicians want to work in Retail Clinics...fine....one wonders what their
salaries will be? surely not $45 per hour right? they are slowly but surely
completely?undermining our ability to earn a living...and this is
getting?serious.??This will always be about the money whether people want to
believe this or not... not about care...not about patient convenience...not
about safety...these are buzz words designed to make people look the other
direction...but... it seems to be working !!.
?
I see a time when we've lost so much ground...there's nothing left for
us to do...except? pack our bags and move on. They have successfully usurped
ever single venue we've tried our hand at......it now comes down to dollars
and cents...my dollars and your dollars. I see a huge class action suit
developing here....a huge court battle...and who will win? They (the AMA)
could
not over throw the Osteopaths nor the chiropractors...we are next...will we
l
give them the fight in court?...or will we simply roll over and say...take
it
(all of it)...it's yours...just my thoughts for the day.
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