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KMS Update: Call to action on APRN bill and COVID-19 updates

From KMS Executive Director Rachelle Colombo
I’d like to preface this week’s update by noting that this is among the rare times that we are calling all KMS members to action—that is, to send a brief note to one or more legislators as suggested below. But first, I will give you the context from recent developments in the legislature.


This week, two hearings were held on bills proposing to allow non-physician practice of medicine. House Bill 2256 and Senate Bill 174 seek to remove the requirement for a collaborative practice agreement between an APRN and a physician, where the former seeks to treat patients independently with no statutory limits on their scope of practice.

In addition to my testimony, others testifying in opposition to the bills included KMS board member Jennifer Bacani McKenney, MD, Fredonia, President-elect of the Kansas Academy of Family Physicians, (who also spoke on behalf of KMS); Kristie Clark, MD, Jetmore, President of the KS Chapter of the American Academy of Pediatrics; and Christine White, MD, an Overland Park pediatrician. The proponents of such bills in recent years returned, including several nurse practitioners, the National Council of State Boards of Nursing, and the Kansas Chamber of Commerce.

The hearings were quite similar to those in past years. Among other things, the proponents argued that collaborative practice agreements (CPAs) are a meaningless formality, and most often used by collaborating physicians to extract a significant fee from an APRN for signing the CPA. They also argue that eliminating the CPA would increase patient access to care in rural and underserved areas of the state, and that specific statutory limits on their scope of practice are unnecessary because APRNs would only practice up to the limit of their education, training, and certification.

Given that time during each hearing was limited, our focus was to stress the significant differences in education and clinical training between physicians and APRNs—and therefore why physician-led care teams are the best model to safely and efficiently meet the health care needs of our state. We reiterated that we are not opposed to independent practice of nursing—rather, we oppose independent practice of medicine by non-physicians. As in previous hearings, we said that we could potentially be receptive to a bill that either: clearly defines the scope of practice of non-physician providers in order to ensure appropriate education, training, and regulation protecting Kansas patients; or puts regulation of APRNs without a collaborative practice agreement under the purview of the Kansas State Board of Healing Arts. As in previous hearings, proponents of these bills argued that these potential compromise measures were unnecessary. If you would like to view the testimony and question and answer periods, Wednesday’s House committee hearing is available here and Thursday’s Senate committee hearing is available here.

While Senate leadership has indicated SB 174 is not likely to proceed this session, House leadership has indicated that it intends to further consider HB 2256. The committee will consider advancing the bill to the full House next week. This action opens the possibility that the bill—perhaps with amendments—may be approved by the committee for consideration by the full House.

With that background, here is our call to action for all KMS members:

At your earliest convenience, please help us contact legislators to convey your strong opposition to HB 2256, as a practicing physician in your community. We suggest sending two emails: 1) to all House health committee members; and 2) to the representative from your district. Contact information for each is below.

A few suggestions for your email:

  • Be personal, but also be brief and specific.
  • Make clear you strongly oppose HB 2256, as it would allow the unsupervised practice of medicine by non-physicians.
  • Training matters. A physician trains to diagnose and treat patients for 12,000 to 16,000 hours or more; APRNs train for about 1,500 hours.
  • If the bill were to be amended constructively, it should be to place regulation of non-physicians—who have no supervisory or collaborative practice agreement and yet seek to practice medicine—under the regulation of the Kansas State Board of Healing Arts.

 
For email #1, here is the list of all members of the House health committee, formatted such that you should be able to copy and paste for sending to everyone with one email:
 
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For email #2, enter your address on this site to get contact information for your specific representative in the House: https://openstates.org/find_your_legislator/?state=ks 

Thank you in advance for taking time to contact legislators on this issue. We do not often issue calls to action, in part because they are most effective when sent only as truly needed. Now is that time.
For more information on the primary bills that we are following in the Legislature, please see our bill tracker at: www.kmsonline.org/billtracker. Also, if you have not done so already, you may register for Legislative Update meetings for KMS members at: www.kmsonline.org/legislative-updates-registration.



KDHE issues new COVID-19 vaccine reporting requirements
This week, KDHE announced that it is issuing new reporting procedures required of those administering COVID-19 vaccinations. The new requirements are aimed addressing the apparent lag time (or “administration gap”) resulting from the existing reporting method. Following is a summary of the announcement as issued by KDHE:
 
In the immediate term, 3 parallel efforts are launching to address the vaccine administration ‘gap’:

  1. Daily reporting snapshot – Enrolled providers who have received or administered doses since the program began must report aggregate data in the daily reporting snapshot 5 days a week starting on Monday 2/22 to allow for targeted resolution of reporting issues  [Note: this will not replace required KS WebIZ and CDC VaccineFinder reporting]
  2. Flat file fix – Providers with identified reporting issues will receive outreach from KDHE starting next week to submit patient-level administration data via flat file daily to improve data transfer between providers and WebIZ. No action is required at this time from providers until they are contacted
  3. System level solve – KDHE will work to resolve back-end coding between providers and KS WebIZ and the CDC reporting systems, working with providers who have known or to-be-identified issues reporting into WebIZ via HL7 connection 

What you can expect going-forward

  • The Daily Snapshot will launch on Monday 2/22 – provider training and support will be available in regular provider and LHD webinars in the coming week, as well as via updated provider manual content, regularly updated FAQ document, etc.
  • The “flat file fix” and “system-level solves” will be initiated by KDHE outreach to providers in the coming days and weeks
  • These new efforts are designed to solve for data-related reporting issues to fairly reflect the vaccine program success to date, as well as help shape policy decisions for how we can continuously improve our shared performance in Kansas
  • The intention is that they are not long-term actions, but rather are our best way to solve for this challenge in the near term

 

COVID-19 vaccine deliveries delayed
This week, KDHE reported that recent vaccine deliveries have been delayed due to weather. The agency said it is still awaiting notification on when vaccines delivery would resume. Officials said that boost doses can be administered as prime doses, but must be reported accurately.

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If you have questions about this update or other matters, please contact KMS Executive Director Rachelle Colombo: This email address is being protected from spambots. You need JavaScript enabled to view it..