Bipartisan group of lawmakers, nursing groups, re-filed the SAVE Act Tuesday. Doctors groups oppose the measure, helping to block its passage for years.
Posted 2023-02-28T22:36:01+00:00 - Updated 2023-02-28T22:36:01+00:00
Nursing groups and a bipartisan coalition of lawmakers on Tuesday kicked off their annual push to give advanced practice registered nurses more authority – a move they say saves money by cutting down on needless red tape in the healthcare industry.
The issue, addressed in the long-discussed SAVE Act, is part of high-pressure negotiation not just on this bill, but over a multi-billion-dollar expansion of the federal Medicaid program in North Carolina as well as proposed rollback of hospital industry regulations that, all of which is caught up in the Medicaid debate.
Right now APRN’s, who have a master’s degree and, in some cases, a doctorate, need a supervising doctor before they can offer patients some services in North Carolina. The SAVE Act loosens those rules
For nursing groups, it’s a no-brainer: Allowing APRNs, including certified registered nurse anesthetists, to handle everything they’re licensed to do without supervision from doctors that, they say, is often supervision on paper alone.
Bill supporters say that some doctors supervise nurses from out of state, or by phone. State Sen. Gale Adcock, a nurse by trade, said Tuesday that the required supervision “amounts to a permission slip to go to work.”
Doctors can charge tens of thousands of dollars for these services, and bill supporters say that APRN’s look for jobs in other states – most of which don’t have this requirement – to avoid the cost.
Doctors groups oppose the bill, saying it risks patient safety. The North Carolina Medical Society said Tuesday that nurses are “essential members of a patient care team but are not trained to practice independently.
SAVE Act supporters pitch the bill as a way to boost health care offerings in rural areas and other places without enough doctors to serve patients now. The Medical Society argues it would give patients in these places short shrift.
“Ignoring the need for additional training when providing additional authority puts patients at risk,” the group has said. “Patients in rural and underserved areas deserve to have access to quality care.
Adcock, D-Wake, and other bill supporters scoff at the characterization. They say 26 states have some version of the SAVE Act in place and that none of the states that passed it have repealed it. Nurses, Adcock said Tuesday, “know where the edge of our knowledge is” and when to refer patients to specialists.
“For physicians to say that they are actively involved in the care that we give is a figment of imagination,” she said.
Lawmakers filed two identical versions of the measure Tuesday, Senate Bill 175 and House Bill 218. It’s common to file the same bill in both chambers, and supporters predicted wide, bipartisan support in both the House and Senate.
Last year’s version of this bill had enough co-sponsors signed on to pass both bodies, but it never came to the floor in the House, signaling leadership didn’t want to hold a vote.
Asked about this Tuesday, Sen. Ralph Hise, a bill sponsor, part of Senate GOP leadership and an influential lawmaker who helps write the annual state budget, singled out one profession in particular for blocking passage.
"Anesthesiologists, if I had to underline one word,” said Hise, R-Mitchell. "Can't say there aren't other barriers, but that's my one-word summary."
Dr. Labron Chambers, president of the N.C. Society of Anesthesiologists, said in a statement that the SAVE Act “would eliminate physician involvement in anesthesia care.”
“Removing physician involvement compromises patient safety and is opposed by the vast majority of North Carolina voters who want a physician to respond to an anesthesia emergency during surgery,” Chambers said.
Speaker of the House Tim Moore, who controls the House's voting schedule, responded to Hise's “one word” analysis with two words on Tuesday.
“Patient safety,” he said.
The Senate hasn’t passed the SAVE Act, either, as a standalone bill, but Hise and other GOP leaders combined it last year with a long-debated Medicaid expansion bill, as well as with a rollback in state certificate of need rules that limit competition among hospitals by requiring state approval for expansions. Senate Republicans said these changes were needed to boost the overall supply of health care in the state, which would be tested by expanding Medicaid and providing taxpayer-funded health insurance to hundreds of thousands of people. The Senate passed the merged bill with bipartisan support.
Doctors opposed the SAVE Act, hospitals opposed the certificate of need reforms, and so both groups opposed the Senate’s overall expansion bill despite favoring expansion itself. House Republicans supported Medicaid expansion but insisted on a bill without the reforms that doctors and hospitals opposed.
That led to a standstill on Medicaid expansion, which would bring billions in federal funding in to the state. That stalemate largely continues today, though House and Senate leaders are expected to negotiate on these issue as this legislative session continues.
Senate Republicans have not yet released this year’s version of their Medicaid expansion bill, but Senate Republican Leader Phil Berger has continued to argue for including the SAVE Act and certificate of need reforms.
Hise said Tuesday that support for the SAVE Act has grown each year and that it’s “inevitable” it will pass.
“It might just be a matter of whether [opponents are] out of the way or in front of the train,” he said.
