by Douglas Walter
A legislative bill that would have given nurse practitioners more opportunities to provide primary care to patients in Colorado was killed in a Senate committee on April 4, cooling high hopes by the Colorado Nurses Association.
House Bill 1023, Enhancement of Advanced Practice Nursing, was sponsored by the Colorado Nurses Association (CNA) and passed out the Colorado House of Representatives last month with nearly unanimous support.
It would have allowed nurse practitioners to be at least partially reimbursement from insurance companies for patients using them as primary care providers.
It also would have allowed them to have some of the similar authorities that doctors have, such as being able to excuse people from jury trials or signing school forms for juveniles.
Though the bill had wide support in the House, it was killed in the Senate Health and Human Service Committee after concerns were brought up of expanding nurse practitioner’s scope. The Colorado Society of Anesthesia, South Denver Anthesiology, American Academy of Pediatrics - Colorado chapter and the Colorado Association of Family Physicians opposed the bill.
Tay Kay, a nurse practitioner in the Denver-metro area that was volunteering with the CNA to work on the bill, said senators wanted to take up expanding nurse practitioners’ responsibilities and influences in a review of the Nurse Practice Act in 2008, not a bill.
Kay said the CNA will work with lawmakers in the review process, but that they believe the proper way to address these issues is with a legislative bill.
While nurse practitioners are legally recognized and qualified to provide primary care to patients in Colorado, officials at the Colorado Nurses Association say barriers still exist that ensure access to this care.
"This (would have) helped remove some of the barriers," said Paula Sterns, CNA executive director.
Residents in rural areas would have benefitted most from the bill’s passage, Sterns said.
"There are many places that are staffed only by nurse practitioners, not doctors," Sterns said.
For example, Otero, Bent and Crowley, all rural Colorado counties, have seen a decline of 10 family physicians in the last 20 years, according to the Colorado Nurses Association.
But eight family nurse practitioners have located into these same areas to provide primary care.
The thought behind HB1023 was that providing some reimbursement from insurances companies and granting more authority to nurse practitioners would encourages others to set up clinics in rural areas seeing an exodus of medical doctors.
Kay was considering opening a clinic in Park County, where she and her husband own land, but she’s now holding off on those plans because of not being able to get reimbursed from insurance companies.
"It’s not financially practical for us to have a practice down there now," Kay said.
Sterns said nurse practitioners are perfectly equipped to provide primary care in private clinics, which includes referring patients out to specialists when needed, similar to a doctors. Nurse practitioners have masters degrees and complete clinical rotations in their area of expertise. Current legislation also already recognizes nurse practitioners as primary care providers.
But while nurse practitioners already assume the role as primary care givers in many communities, some insurance companies don’t recognize their clinics for reimbursement or for in-network coverage, leaving some patients, particularly in rural areas, with little choice in seeking adequate health care covered by their insurance provider, Sterns said.
Kay said they’ll return to the Colorado State Legislature next year to with a new bill and re-state their case.