Closer Looks takes a deeper dive into bills that are trending on BillTrack50. Today we are looking at Virginia House Bill 793 – Practice Agreements for Nurse Practitioners. The bill allows for nurse practitioners with certain levels of education and experience to practice without oversight from a physician. Nurse practitioners are usually required to have a practice agreement, which is a contract that outlines the supervision of a nurse practitioner by a physician. While nurse practitioners in Virginia could already diagnose illnesses, prescribe medications and manage chronic conditions such as diabetes and high-blood pressure, they could not do things like admit a patient to a hospital without a doctor’s consent.
I chose this bill for my first Closer Looks post because it was recently signed into law in the Commonwealth of Virginia, where I currently call home. I am also very interested in this bill because I often deal with legislation that changes the scope of practice in the medical and dental fields. I have been working on these bills for years, often trying to strike a balance between ensuring patient safety and increasing access to competent quality healthcare professionals. Given the shortage of physicians and dentists, expanding scopes of practice and loosening barriers to practice for mid-level providers might be the only way to ensure access to quality, affordable healthcare. However, since every state has different needs, every state manages these situations differently.
A map by the American Association of Nurse Practitioners shows Virginia’s currently in the red or restrictive. HB793 should change that.
HB793 became public law when Governor Ralph Northam signed the bill on April 4, 2018. The bill sailed through the Virginia General Assembly garnering unanimous support in the Senate and passing the House of Delegates in its final version 97-2. The bill’s chief patrons (the Virginia equivalent of lead sponsor or champion) were Delegates Roxanne Robinson and Dawn Adams. The bill had strong bi-partisan support and had many patrons from Northern Virginia, including my representative, Delegate David Bulova.
I believe interest in this bill was spurred by a recent Washington Post article. The article references the new law, but also focuses on Federal changes from 2016 that already allows some nurse practitioners practicing in VA hospitals to practice without the supervision of a lead physician. The article highlights two nurse practitioners that work at the VA hospital in Hampton, VA, one with full-practice authority and one half-way through the process . It also mentions the past opposition by the American Academy of Family Physicians. AAFP had opposed the changes at that time in the name of patient safety. While health professional groups often oppose scope of practice changes of their competitors for what they see is a true threat to patient safety, that opposition by is is often seen by legislators and regulators as legislative or regulatory capture (a term that means an organization or industry protecting its financial interest or market share through the legislative and regulatory processes).
In Virginia, the Medical Society of Virginia issued a fairly neutral statement about the newly signed bill -“The Medical Society of Virginia (MSV) believes team-based care is best for patients. Given the continued pressure for independent practice, MSV supports the Garrett substitute that requires 11 clinical components that preserve the minimum conditions to uphold quality care and patient safety.” To me that says there was probably initial opposition to the bill, and the final bill is the result of legislative compromise language introduced by Delegate Scott Garrett.
And I tend to believe that compromise policy makes the best policy.
There are over 1600 bills from the states’ current or most recent sessions that mention “nurse practitioners.” For a closer look at all of the bills, check out our BillTrack50 interactive stakeholder page.
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About the Author – Michael O’Brien is the founder and principal of MOB Advocacy. He has more than ten years experience as a state and local lobbyist. Michael has lobbied governors, mayors, legislators, state and local agencies and regulators in more than 40 states.
About MOB Advocacy – MOB Advocacy is a full-service, nationally-scoped state and local government relations firm. We design and implement legislative, regulatory and procurement solutions tailored to meet any organization’s unique needs and specific goals.
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