[NPInfo] Retail Clinics/PhysiciansandNursePractitioners/Physician Assistants

Thu Aug 7 12:26:25 PDT 2008

Windy, wow, very interesting and informative....is there anyone at ANA now who is doing what you did when you were there and, if not,  please go back!
Kate Hammill

--- On Thu, 8/7/08, nursinglaw at aol.com <nursinglaw at aol.com> wrote:

From: nursinglaw at aol.com <nursinglaw at aol.com>
Subject: Re: [NPInfo] Retail Clinics/PhysiciansandNursePractitioners/Physician Assistants
To: npinfo at nurse.net
Date: Thursday, August 7, 2008, 2:55 PM

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 commen!
 ts 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.
_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

__________
_____________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************