MCNP Continues Its Fight to Remove Practice Barriers for MA Nurse Practitioners

The Massachusetts Coalition of Nurse Practitioners would like to express our gratitude to everyone who participated in our September 24th, 2019 hearing before the Joint Committee of Public Health on the NP SAVE Bill, (H.1867/ S.1330) An Act to Support Access, Value and Equity in Health Care, including our lead bill sponsors Representatives Paul Donato and Kay Khan who spoke in support of the bill. We also want to thank all of our members who sent emails in advance of the hearing and submitted personal written testimony.

MCNP was proud to present two 4-member panels for oral testimony. Comprised of healthcare leaders, nurse practitioner clinicians and physician colleagues, the panelists highlighted how current licensing restrictions on NP practice negatively impact patients and access to care. 

MCNP Past President and State Legislative Policy Director, Stephanie Ahmed, led our first group of panelists (pictured right) emphasizing the need for Massachusetts to contemporize the state’s antiquated nurse practice act and remove requirements that the Massachusetts Board of Medicine jointly promulgate regulations relative to NP practice with the Board of Nursing and remove the mandate for physician oversight of prescriptive practice. She noted in her testimony that by not passing legislation for Full Practice Authority for NPs “Massachusetts is failing to keep pace with national and regional trends, failing to position the NP workforce to contribute to the state’s self-identified goals for access to care and cost-containment and most importantly, failing Massachusetts patients and families.”

Physician panelist, Dr. Damian Archer, a family physician and the Chief Medical Officer at North Shore Community Health, spoke to the critical role of Nurse Practitioners as leaders and clinicians in the Community Health Centers and how NPs are leading efforts to make medication assisted treatment (MAT) for substance use disorders accessible to patients in these settings. In his closing comments urging the committee to favorably release the NP SAVE Bill from Committee, Dr. Archer said “I ask you today to remember what called you to become legislators. I am sure for most of you it was to improve the lives of your constituents, to make your communities and this state the best state to live, work and thrive in. The SAVE bill provides you with an opportunity to easily fulfill your commitment to those goals and allows you to bear witness to being on the right side of the fight for better healthcare for everyone.”

Katherine Forbes Smith, a family nurse practitioner, co-owner of Bridgewater Pediatrics and founder of the The Well, A Center for Hope and Healing spoke about her work providing comprehensive mental health and substance abuse care to hundreds of children, teens and adults who struggle with mental illness in the Bridgewater area. She discussed the overwhelming need for behavioral health services and how the requirement of prescriptive oversight limits her ability to prescribe medications for patients in need who are having difficulty accessing treatment. Jennifer Nugent, a nurse practitioner from the Berkshires shared her experience working in an underserved rural area and how lack of access not only impacts patients, but impacts providers and contributes to burnout from the challenges of working in a system without timely access to behavioral health and specialty care.

Our second panel featured Dr. Thomas Barber, a Primary Care Physician from Boston Medical Center and Commonwealth Community Care, and an Associate Professor of Medicine at Boston University School of Medicine who spoke about the essential role NPs serve in providing access and care to persons with all health challenges, including many persons struggling with mental health challenges and/or substance use disorders. He highlighted the collaborative working relationships between physicians and NPs, how NPs are trained to have independent medication prescription knowledge and skill, and that retrospective prescriptive review is unnecessary and burdensome. He noted, “All clinicians must be cognizant of our limitations and knowledge deficits, and seek advice and assistance when we are unsure of how and what to prescribe or the risks and benefits of a certain drug or procedure. I have found that NPs and MDs both take their responsibilities to be safe prescribers as an almost sacred duty under the terms of their professional licenses. We do so in real time in the care of patients and continually reinforce our knowledge and skill by taking continuing medical education courses on a regular basis.”

Connie Flynn, a nurse practitioner from the Berkshires who leads an inpatient Substance Use Disorder Consultation Service caring for patients hospitalized with medical complications of substance use disorders, spoke about the opioid epidemic and its devastating personal toll on patients and financial impact on the health care system. She noted the lack of access to medication assisted treatment in the primary care setting and how NPs are prevented from filling this void given the need for NPs in Massachusetts to have a 1) a supervising physician who “allows” them to prescribe MAT as part of their prescribing practice, and 2) that this same supervising physician has completed MAT training or has other specified experience to be deemed “qualified” to oversee MAT. Flynn implored, “If we are to stand any chance at winning this battle against the opioid epidemic, we have to remove barriers to treatment.”

Our last 2 Nurse Practitioner panelists highlighted the challenges facing psychiatric nurse practitioners and clinical nurse specialists who are having difficulty finding, retaining and replacing supervising psychiatrists for prescriptive oversight and moving to neighboring states with Full Practice Authority. Rosemarie Paolini, an adult NP and psychiatric clinical nurse specialist with a private practice in East Bridgewater, MA spoke about the lack of access to pychopharmacology services and the often desperate circumstances of patients who are having difficulty finding a psychiatric prescriber who takes insurance. Facing the planned retirement of her supervising psychiatrist in 18 months, Paolini expressed concern for the approximately 400 patients she cares for and thousands of others cared for by advanced practice psychiatric nurses supervised by the same retiring psychiatrist if he cannot be replaced.

Julia McDougal Roncini, a psychiatric nurse practitioner who had been practicing in Greenfield, MA with a large behavioral health caseload of adult outpatients, often dually diagnosed with substance use, spoke about her decision to open a private practice in Vermont rather than staying in Massachusetts so that she could practice in a state with Full Practice authority and avoid the added expense of a collaborative agreement. Based on the dynamics of the relationship with her previous supervising psychiatrist which was more collegial than impactful on patient care, she noted “A supervising physician agreement does not meaningfully add to nurse practitioner practice. It is a practice barrier that stagnates entrepreneurship and, as in my case, results in the migration of qualified clinicians from underserved areas of Massachusetts.”

In addition to the testimony presented by the MCNP organized panels, supporting oral testimony was provided by representatives from Atrius Health, Baystate Health, and ANA of Massachusetts. Several MCNP members were also in attendance at the hearing, and MCNP members Sheryl Derderian andKatie Costa were the last two to present individual testimony before the hearing adjourned after more than 5 hours. We are grateful for this support.

As expected, opposing testimony was presented by 2 independent physicians who misrepresented the SAVE Bill as an expansion of existing scope of practice and cited unfounded safety concerns that were unrelated to prescriptive oversight. The first of these was a family physician who presented testimony challenging the assertion (and published data) that NPs will fill gaps to access to care in rural areas, described a very disturbing malpractice case involving an NP which she generalized to safety concerns regarding the practice of all NPs, and referenced “transparency” issues related to DNP prepared NPs referring to themselves as Doctor and other NPs misrepresenting their credentials. The second physician was a psychiatrist who stated she found advanced practice psychiatric nurses to be a valuable part of the behavioral health team but asserted they do not have adequate training in internal medicine and neurology to identify psychiatric manifestations of potential underlying medical conditions and “do not know what they do not know.”

The Association of Radiology Technologists also presented testimony about the language of the bill specific to the ordering of tests and therapeutics and felt that there should be a provision to prevent NPs from administrating ionizing radiation in diagnostic procedures.

In closing, the MCNP leadership wants to thank the members of our lobbying team, former House Speaker Tom Finneran from Finneran Global Strategists, and Matt Irish, Lindsay Toghill and Cayenne Isaksen from O’Neill and Associates for their efforts related to the hearing. We would also like to thank the Government Affairs team at the American Association of Nurse Practitioners for their guidance and support.

And lastly, our thanks to the members of the MCNP Legislative and Political Action Committees for their engagement, and the members of the MCNP Legislative Steering Committee, Stephanie Ahmed, Leah McKinnon-Howe, Laura Black, and Cathy McKinnon who worked incredibly hard to prepare for the hearing.

We are hopeful that the SAVE Bill will be given a favorable release from the Joint Committee on Public Health and will update you when this happens. As previously noted, this is just one of many steps before our bill can become law, and we thank you in advance for your continued support and engagement in the process. 

The time could not be more right to get this legislation passed, and with your help we will succeed!