SB 2 AND SB 568 OVERVIEW PRESENTED BY

SB 2 AND SB 568 OVERVIEW PRESENTED BY ANN SHEEHAN, DNP, RN, CPNP MI NAPNAP SPRING CONFERENCE MARCH 28, 2014

Advocacy is important to me, personally 11% Disagree 24% Strongly Agree 64% Agree

Advocacy is important to me, professionally 3% Disagree 32% Strongly Agree 65% Agree

Advocacy is important to the continuation of my career 11% Disagree 25% Strongly Agree 64% Agree

Advocacy is my responsibility 8% Disagree 24% Strongly Agree 68% Agree

Advocacy is the responsibility of my professional organization 4% Disagree 42% Strongly Agree 54% Agree

Have you ever been to your state or national capitol to talk to legislators and/or their staff regarding an issue related to health care or APRN practice? 71% No 29% Yes

How often do you contact your state and/or national legislator(s)? Monthly 25% Annually 20% Only when prompted to do so by my professional organization 83%

The Problem Defined Taft, S. & Nanna, K. (2008) “Policy is shaped by how policy makers learn about health care issues and how those issues are defined as problems. ”

Policy Facts Legislation is made by personal stories and anecdotes Regulations are made with facts and figures

Michigan Legislation �Senate Bill 2

SB 2 � Define the Scope of APRN Practice � Allow NPs to provide health care services within their scope of practice � Allow for prescriptive authority within the APRNs scope of practice � Requires APRNs to consult with other health professionals and make referrals

SB 2 Defines APRN Scope of Practice � APRN �Nurse Practitioner �Nurse Midwife �Clinical Nurse Specialist �Nurse Anesthetist (this group of APRNs are not included in SB 2) � The definition WILL NOT expand the scope of practice but WILL define the scope of practice for APRNs in the state of Michigan

Education Training Certification Defines APRN scope of practice

How Nurse Practitioner Scope of Practice Differs from Physician scope of practice, as defined by their education, training and experience N E O N A T A L G E R O N T O L O G Y A D U L T P R I M A R Y C A R E A D U L T A C U T E C A R E P E D I A T R I C P R I M A R Y C A R E P E D I A T R I C A C U T E C A R E P S Y C H F A M I L Y M E N T A L H E A L T H C O M M U N I T Y H E A L T H W O M E N ’ S H E A L T H Nurse Practitioner scope of practice, as defined by their education, training and experience

Consultation and Referrals All health care providers consult with each other No one health care provider is an expert in every field

SB 2 WILL NOT Require new or additional third party reimbursement � Mandate workers compensation benefits � Mandate increased reimbursement rates for health care services from health care insurers � Allow NPs to form PLLC or PC � Interfere with current or future health care insurers requirements for direct reimbursement � Interfere with current or future practice arrangements made with employers and employees �

SB 2 Facts � Update Michigan’s Public Health Code to reflect what is currently going on in practice � 18 states and DC have defined scope of practice with equal or better patient outcomes than physicians � Prescriptive authority and licensure allows for better tracking of patient outcomes and allows for improved transparency in billing and accountability

SB 2 Facts No data from states that impose greater restrictions on APRN practice suggests safer or better patient care or that the roll of the physician has changed or deteriorated � Trends show that APRNs are moving out of states with restrictive practice acts decreasing patient access to care in those states � APRNs support the Patient Centered Teambased Model of Care that integrates interprofessional patient care with the specific needs of the patient at the forefront �

SB 2 Actualizes the RWJ and IOM “The Future of Nursing” Report AND Governor Snyder’s Healthy Michigan Initiate Nurses should practice to the full extent of their education and training � Nurses should achieve higher levels of education and training to promote health care and improve patient outcomes � Nurses should be full partners with physicians in providing health care � Effective planning and policy making requires better data collection and improved infrastructure �

Federal Trade Commission � The Federal Trade Commission supports unrestricted APRN practice acts in every state � The Federal Trade Commission has sent letters to state congressional leaders who have failed to pass unrestricted APRN practice acts sighting restraint of trade

SB 2 Bottom Line � APRNs in Michigan are already providing health care to many patients � 20 years of research shows that APRNs �Do not increase liability claims or costs �Have equal or higher patient satisfaction �Have equal or better patient outcomes �A recent study showed that underutilization of APRNs costs our nation nearly $9 billion annually

SB 2 on the Senate Floor November 13, 2013

SB 2 Amendments 1. Prohibit APRNs from opening independent practices after the bill becomes law. This does not apply to non -profits such as NMHCs 2. Extends a mentorship agreement for new APRN grad from 2 years to 4 years. The mentor can either be a physician or a licensed APRN 3. Adds 2 physicians to the newly created APRN taskforce (this taskforce will provide disciplinary action for APRNs when necessary) 4. Holds APRNs that practice independently (without supervision of a physician) to the same standards as physicians in cases of malpractice

On to the House of Representatives House Health Policy Committee Members � � � Currently sitting in the House Health Policy Committee � Still called SB 2 � � � � Gail Haines (Chair) 43 rd District Mike Calton (Maj. Vice-Chair) 87 th District Hugh Crawford, 38 th District Bob Genetski, 80 th District Mike Shirkey, 65 th District Thomas Hooker, 77 th District Ken Yonker, 72 nd District Dale Zorn, 56 th Disctrict Joseph Graves, 51 st District Klint Kesto, 39 th District George Darany, (Min Vice-Chair), 15 th District David Knezek, 11 th District Kate Segal, 62 nd District Thomas Stallworth, 8 th District Winnie Brinks, 76 th District Phil Cavanagh, 10 th District

1. Voted out of House HP Committee 5. Goes to the Governors desk for signature All of this has to be accomplished by December 31, 2014 or this bill dies and the process starts all over again 4. Committee to reach a consensus 2. Vote on the House Floor 3. Must come out of the House the same as it came out of the Senate

MSMS Propaganda http: //www. youtube. com/watch? v=q. Dot. JFk. Pw 6 Y

MSMS Propaganda � Under SB 2, "Nursing care provided by a CNP includes ordering, performing, supervising, and interpreting laboratory and imaging studies. " This is effectively the definition of a pathologist and a radiologist. These specialties generally require between 8 -10 years of specialized training and often perform extremely complicated genetic and molecular tests. � Under SB 2, Advance Practice Nursing includes, "diagnosing, treating, and managing patients with acute and chronic illnesses and diseases. " This definition is extremely broad and could potentially encompass any patient that would walk into my office or through the hospital doors. � Under SB 2 , Certified Nurse Midwives could offer "treatment of male partners for sexually transmitted infection, and reproductive health. " Reproductive health is extremely broad, and could include extremely invasive procedures.

MSMS Propaganda � Are you willing to put Michigan citizens at risk? � Together, physicians and nurses work for the general welfare of patients in Michigan, and their partnership fosters the development of groundbreaking advances in medicine. � It's a partnership focused patient care. It's a partnership that's working. It's a partnership worth preserving

Michigan Legislation � Senate Bill 568

SB 568 � Introduced by Senator Marleau as a counter to SB 2 �Introduced in October 2013 � Senator Marleau is the Chair of the Senate Health Policy Committee � Supported by physician groups � Bill currently sits in the Senate Health Policy Committee �It has not had a first reading in this committee yet

SB 568 Will � Replace the regulatory boards and disciplinary subcommittees with separate task forces for allopathic physicians, osteopathic physicians, PAs and APRNs � Allow health professional licensees to form a patient care team and require the team to have a practice agreement � Create the Michigan Patient Care Board and require it to establish a model practice agreement for the patient care teams � Require a PA or APRN to be a care team member in order to practice

SB 568 Will Eliminate references to CNM and CNP specialty fields and provide for the licensure of CNMs, CNPs, and CNSs as APRNs � Extend to APRNs certain provisions that apply to PAs � Include a PA and an APRN in the definition of “prescriber” in the Pharmacy Practice and Drug Control Act � If a licensee organized as a PC or PLLC with other licensees, each stakeholder of the corporation or member of the company must comply with all applicable requirements to engage in his/her health profession �

SB 568 and Michigan Business � Includes APRN and nurse anesthetist in the definition of professional services � Authorizes a physician to organize a PC or PLLC with any other licensed individuals �Expands this option to more than just PAs � Allows a licensed physician to organize a PLLC with one or more CRNA � Eliminates ban on PAs from forming PCs or PLLCs without other professionals

SB 568 and Patient Care � Creates a Michigan Patient Care Board with the Department of Licensing and Regulatory Affairs (LARA) � 3 allopathic physicians � 3 osteopathic physicians � 3 PAs � 3 APRNs � 7 public members � Board would establish a model practice agreement for use by physicians and PAs and APRNs who organize a patient care team

SB 568 and Patient Care Task Force Patient Care Taskforce designed to regulate various health professions � Make recommendations to the Patient Care Board regarding improvements for patient care � Create separate Regulatory and Disciplinary Task Forces for each health profession � � Sets forth rules for implementation of its power and duties � Sets forth rules to establish the requirements for education, training and/or experience of a health profession for licensure in MI � Establishes criteria for the evaluation of programs for educating and training the individual health professions to determine whether grads of programs have the knowledge and skills necessary for practice

SB 568 and Patient Care Teams � Licensees can form patient care teams to collaboratively provide patient care in the best interest of the patient’s health � Patient Care Team is made up of at least 2 licensed health professionals, including at least 1 physician � The team’s practice agreement has to be available to the Board at any time �Make physician continuously available to other members of the team

Patient Care Teams and APRNs � In order to engage in practice, a PA or APRN would have to enter into a practice agreement as a member of a patient care team � Bill would require referral to a PA or APRN in his/her capacity as a patient care team member, rather than a person performing a delegated task under a physicians supervision

Other revisions and SB 568 � Defines a prescriber as a licensed dentist, podiatrist, optometrist, veterinarian, or other licensed health professional acting under the delegation and using, recording, or otherwise indicating the name of the delegating physician � Refer to APRNs rather than CNMs and CNP

SB 568 Facts Michigan Patient Care Board is physician dominated � Patient is defined as an individual who is under the care of a physician or a patient care team � Definition of APRN does not include CRNA � Only APRNs and PAs are required to be part of a patient care team � RNs and CRNAs would continue to be regulated under the BON while CNS, CNPs, and CNMs would be regulated under the new Patient Care Board and new APRN taskforce and the BON for the RN license �

SB 568 Facts � Definition of collaboration means that communication and decision making process occurs among members of a patient care team � Definition of patient care team means a team of 2 or more licensed health professionals including at least 1 physician � Physicians are not required to practice in a team, while APRNs and PAs are subject to practice in collaboration with a physician in a patient care team

SB 568 Facts � Allows for a 19 member patient care board to establish a model practice agreement � Patient care teams must have a practice agreement in place as previously described � APRNs and PAs must enter into a practice agreement as a member of a patient care team � APRNs and PAs can ONLY provide medical care services as a member of a patient care team

SB 568 Facts � APRNS and PAs may make calls or go on rounds, in collaboration with a physician � APRNs and PAs may prescribe drugs if they are a member of a patient care team

Each APN needs to � Talk to YOUR House Member � Especially if your member sits on the House HP Committee � � � � Create Talking Points Create an Elevator Speech Repeat your talking points and elevator speech to everyone so it rolls off your tongue when you are asked about NPs and legislation related to NPs Stick to your points, don’t get caught up in arguments that don’t have merit or evidence Ask for evidence when you are presented with challenges Collect Personal Stories Join a Professional Organization

Creating Michigan’s APRN Future A change in health care delivery will not be realized until APRNs become comfortable advocating for themselves and their profession The days of silently standing by as other professions prescribe nursing’s fate should be long gone Need to create opportunities for nurses to participate in advocacy activities with or without a mentor

Opportunities Stay Informed Mentorship Empowered Advocates

Preparation for a Legislator Visit � Review your talking points/the points you want to make �Create a leave behind one-pager � Research the legislators voting record and know what committees he/she sits on �Thank him/her for support on legislation you are interested in Bring examples that demonstrate how your APRN role is a critical part of the health care for your legislator’s constituents � Be prepared to tell personal stories to illustrate your points �

During your Legislator Visit Introduce yourself, where you work and where you live � Ask if the legislator has knowledge or personal experience with an APRN (or more specific: NP, NMW, CNS) � � What does he/she know about NPs? � Does he/she know any NPs? Briefly describe your practice and what a typical work day is like for you, the type of activities you do in assessing and managing your patient’s care � Ask what the legislator’s main priorities and/or concerns are for his/her constituents related to health care, then start your conversation there �

Building Legislative Relationships Rule of 5’s � Attend a “meet the candidate” or “open house” event � Organize an event with several APRNs for your legislator Donate time and/or money to support a candidate that is running for office � Write a note of congratulations to the candidate that wins and remind them that you can be a consultant on health issues or other expertise you have � Send a thank you note when he/she does something good that has nothing to do with health care � Copy news articles that might be of interest related to a bill you are for or against �

The Last Words Educate, Educate Many Legislators don’t know the difference between an LPN and an NP � What will happen if you ignore or don’t participate in this discussion? � �You could be educated for a career that does not exist any longer in Michigan � It took DOs 100 years to get their scope of practice issues worked out �The NP profession is 49 �We are about half way there! � Participate in this health care reform TODAY

It is a long walk to the Capitol by yourself!