A new law in New York State does not expand nurse practitioners' scope of practice, but it does eliminate the need for a written collaborative agreement between a physician and an NP, which in reality is little more than a financial agreement.
The piece of paper that has for years tethered nurse practitioners to physicians will no longer be required in New York State as of January 1, 2015 thanks to the passage of the Nurse Practitioners Modernization Act.
Specifically, the law eliminates the written practice agreement between physicians and nurse practitioners who have more than 3,600 hours of practice experience.
According to Stephen Ferrara, DNP, FNP, FAANP, Executive Director of the Nurse Practitioner Association New York State, the law doesn't eliminate the natural collaboration that occurs between nurse practitioners and physicians, nor does it expand NP's scope of practice.
NPP Demand Rising Under Value-Based Care Models
He also doesn't expect there to be a rush of NPs opening their own practices. But the new law does remove the need for the written collaborative agreement, as well as eliminate the requirement for a retrospective chart review every three months, Ferrara says.
"For those nurse practitioners who do want to have their own practice, it gives them peace of mind that they don't have to have their own practice that's hinging on another provider that has nothing to do with those patients," he says.
Indeed, collaborative agreements between NPs and physicians in New York currently seem to amount to little more than a financial agreement. "Nurse practitioners who do have their own practice pay a practicing physician to collaborate with them," Ferrara says. "Existing laws do not require the physician to be on site."
Not having to be onsite means that collaborating physician aren't necessarily providing any close "supervision" over an NP's practice. Still, the new law received pushback from groups such as the Medical Society of the State of New York.
"Organized medicine was our pushback. They have touted that nurse practitioners need to be under the supervision of a physician, which is not how we practice today," Ferrara says. "It's about control. It's about a whole lot of things. It's about maintaining status quo; it's about subscribing to a model of care that obviously isn't working."
And it's also, at least somewhat, about money.
"It does come down to finances," Ferrara says. "Our basis has been that this collaborative agreement has become sort of a financial transaction that does nothing for quality of care… it really makes no sense to do that."
Although this law makes it possible for NPs who have more than 3,600 hours (which Ferrara says equals about two years of work) to practice without the written collaborative agreement, he's careful to temper the idea that NPs in New York State will be practicing "independently," calling that a "loaded word."
The word "'independent' really irks a lot of people. That's not what we're trying to do," he says. Instead, NPs, like all primary care providers, work collaboratively with other healthcare providers, referring when they need to, and co-managing patients. "We're saying that really nothing changes as far as the relationship goes."
"It's codifying what we do already and mirrors how practices happen today," he says. "We know that a lot of nurse practitioners are working in primary care…They're functioning as primary care providers already and I think this will enable even more to do so."
Over the years, bills like the Nurse Practitioners Modernization Act have passed in more than a dozen states and the District of Columbia. The New York State law will also sunset in 2021, providing the opportunity to review data collected and make tweaks to the law as needed, which the Nurse Practitioner Association New York State sees as a positive thing.
Ferrara says there are 180,000 NPs in United States, and that allowing them to practice without the need of a written practice agreement is a good thing for patient access and healthcare costs.
"This is clearly where it's going across the United States," he says. "Those are 180,000 potential solutions to access issues that every patient faces in healthcare today."
The law is set to expire on June 30th, 2021.
Alexandra Wilson Pecci is an editor for HealthLeaders.
