Overview of Scope of Practice Initiatives

1. Overview of Scope of Practice Initiatives Sheila Abood American Nurses Association

2. Scope of Practice Issue • Defines each health care providers lawful sphere of activity • Historical context • Multiple stakeholders • Frequent target of organized medicine • Recurring complex issue

3. Federation of State Medical Boards • “Assessing Scope of Practice in Health Care Delivery: Critical Questions in Assuring Public Access and Safety” (2005) • Questions related to Scope Expansion • Resource for Legislators and Regulators • Medicine defining scope of health care providers

4. AMA Environment What did the AMA members want? • Involvement • Advocacy • Communication

5. AMA Priority Issues • Medicare Physician Fee Reform • Pay for Performance • Medical Liability Reform • Medicare Reform • Expanding Coverage for the Uninsured • Disaster Preparedness

6. Scope of Practice Partnership • What is it doing? • Provides financial or in kind support to federation members facing significant scope of practice issues. • Funds studies: • To determine whether allied health professionals truly fill health care voids in rural and other underserved areas. • To closely examine the education and training of allied health professionals and provide this information as a point of comparison for legislators.

7. Scope of Practice Partnership • Serves as an information and advocacy clearing house for the Federation on scope of practice issues • AMA houses and staffs the partnership and provides a basic level of support • Additional support comes from state and specialty medical societies.

8. Scope of Practice Partnership • Each initiative be it a state-specific concern or a research study will be considered by the partnership on a case by case basis. • An Executive Committee: • Reviews the issues • Assists in prioritizing scope of practice concerns • Ensures adherence to anti-trust laws • Focuses on maintaining the highest level of cooperation, coordination, and consensus between Federation members.

9. Scope of Practice • Steering Committee Founding Members • Six State Medical Associations • Massachusetts • New Mexico • Maine • Texas • Colorado • California Now at least 26 state medical associations

10. Scope of Practice Partnership • Six Medical Specialty Organizations • American Society of Anesthesiologists • American Society of Plastic Surgeons • American Psychiatric Association • American Academy of Orthopedic Surgeons • American Academy of Ophthalmology • American Academy of Otolaryngology-Head and Neck Surgery.

11. Scope of Practice Partnership • Targeted Groups Everyone who threatens reimbursement. Medicine Scope of Practice encompasses everything. Medical Specialty Organizations have their own targets.

12. 2005 Texas Resolution 814 • Where did it come from? • What problem is it trying to address?

13. 2006 Texas Resolution 814 • Resolve to study the qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of limited licensure health care providers and limited independent practitioners • Fiscal note- $171,975 • Progress report back by June 2006 AMA HOD

14. 2006 American Association of Anesthesiologists Resolution 902 • AMA policy that state medical boards shall have full authority to regulate the practice of medicine by all persons within a state not withstanding claims to the contrary by boards of nursing, mid-level practitioners or other entities (New HOD Policy); • AMA, through the Scope of Practice Partnership, work jointly with state medical boards to assist law enforcement authorities in the prosecution of unlicensed medical practice by limited or mid-level practitioners (Directive to Take Action)

15. 2006 American Association of Anesthesiologists Resolution 902 • AMA, through the Scope of Practice Partnership, immediately embark on a campaign to identify and have elected or appointed to state medical boards physicians (MDs or DOs) who are committed to asserting and exercising their full authority to regulate the practice of medicine by all persons within a state notwithstanding efforts by boards of nursing or other entities that seek to unilaterally redefine their scope of practice into areas that are true medical practice. (Directive to Take Action)

16. Scope of Practice Partnership • How this is playing out……in the states? • Patients First Campaign in Texas • Bypassing the Legislature

17. AMA Scope of Practice Partnership: State Legislation • Legislation introduced in over 30 states attacking SOP of more than 20 health professions: • Licensure/Certification/Credentialing • General prescriptive authority • Authority to prescribe controlled substances • Opposition to expanding Scope or Authority • Inclusion in health insurance panels

18. AMA Scope of Practice Partnership: Federal Legislation Healthcare Truth and Transparency Act • seeks to outlaw any act, speech, or practice conducted by a licensed health care provider who is not a MD, DO, DDS, or DDM that leads patients or the public to believe that the health care practitioner has the same or equivalent education, skills, or training as a physician or dentist • would bring these activities under the purview of the Federal Trade Commission which would be granted the ability to fine health care practitioners up to $10,000 per violation • Introduced in 109th Congress, what’s in store for 110th?

19. Coalition for Patients’ Rights • Organized by ANA in 2006 • Comprised of over 34 associations representing more than 3 million licensed health care providers • Joint statement released June 2006 “The erroneous assumption that physician organizations should determine what is best for other licensed healthcare professionals is an outdated line of thinking that does not serve today's patients.” www.patientsrightscoalition.org

20. Coalition for Patients’ Rights

21. Coalition for Patients’ Rights • Development of a positive and consistent message and strategy appropriately framed for the targeted audience. • One message or multiple messages?

22. Coalition for Patients’ Rights • Potential Audiences • Nurses • Consumers/Patients • All Media • Payers • Employers • Business Community • Physicians • Legislators/Regulators • Other Health Care Providers

23. Coalition for Patients’ Rights • To ensure that patients have access to quality healthcare provided by the full range of licensed health professionals of their choice.

24. Provider Responsibilities • Know your scope of practice and personal competence. • Be aware of state regulations governing practice. • Stay informed about proposed changes to scope of practice. • Be knowledgeable about employer policy and procedures- They may limit scope but never exceed it.