|| Amy Young-Governmental Consultant
Preparing for a Rough and Tumble Session in 2014
We certainly have our work cut out for us leading up to the 2014 Legislative Session which convenes on Tuesday, March 3. In preparation for the Regular Session, we have been meeting every month since October in committee hearings in the State Capitol. We already know that legislation to limit the purview of Florida Birth Related-Neurological Injury Compensation Association (NICA) is being “shopped” in the State Capitol by the trial bar and we have been meeting with Legislative Leadership to remind them of how effective NICA is and convince them not to sponsor the legislation.
One of the most important issues we will be facing is the attempt to expand the scope of practice for Certified Nurse Midwives (CNM) and ARNPs in general. The first meeting of the Select Committee on Health Care Workforce Innovation, which is contemplating independent practice for certified nurse midwives, met for three hours on Wednesday, November 6 in Tallahassee. They did not take any testimony, but did present a great deal of demographic information. I have provided the link to the extensive package here: http://ow.ly/sCAOQ.
I have been meeting with each member of the committee individually since the committee was organized over the summer. I have been discussing the dangers of independent practice for CNMs as well as the fact that District XII has approximately 2,900 members and we estimate that approximately half of those still practice obstetrics. As of last week, we have 1,138 doctors participating in NICA. There are significantly lower numbers of CNMs in Florida the last time data was compiled:
- As of September 2012, there were approximately 720 certified nurse midwives with ARNP licenses in Florida, according to the Florida Department of Health.
- In 2011, CNMs attended 22,985 births in the state of Florida. This accounts for 10.7% of all births.
The Select Committee will not be meeting again until January 2014. Furthermore, we have not seen any specific language on the proposal; however there is every indication that House Leadership is very interested in repealing the requirements for CNMs to have written protocols with physicians as well as unfettered prescriptive authority. One of the issues that staff brought up to me in meetings was that nurses were paying large sums of money to doctors for their protocols. They cited an example of one nurse paying $90,000 to the physician who signed her protocols. I am seeking input from each of you regarding this assertion. If you have feedback I can use on this issue, please feel free to e-mail me directly at firstname.lastname@example.org.
One of the many concerns expressed by the Legislature and the Governor’s Office is that Florida is facing a shortage of primary care doctors. Governor Scott has noted that the state was ranked 42nd in the number of resident-physicians and medical school graduates finishing training- per 1,000 residents. An additional 2,700 more physician residents are needed for Florida to reach the national average.
The 2013-2014 budget included $80 million to expand Graduate Medical Education or the GME programs. It provides for 700 slots for residencies, however only time will tell whether or not these monies are effectively utilized. One of the staff presentations at the House Select Committee on Health Care Workforce Innovation meeting also indicated that Florida has 50,600 doctors but 5,600 are expected to retire within the next five years and the state’s population is at 19 million and is expected to increase.
Stay tuned—I believe we will know much more once the language is published and we know their true intent. I am working closely with the Florida Medical Association (FMA) and other specialty medical societies including anesthesiology and family practice to defeat these proposals.
2014 Legislative Session
The 2014 Legislative Session officially begins on Tuesday, March 4, 2014. The FMA has provided ACOG District XII with some important fact sheets and informational tools relative to the major legislative issues that will be addressed during the upcoming session.
1. Fact Sheet on Nurse Practitioners/Independent Practice
2. A Scope of Practice Comparison Wheel of Health Professionals
3. Fact Sheet on the FMA’s Insurance Reform Package Legislation (HB 1001)
4. A copy of the FMA’s Insurance Reform Package, House Bill (HB) 1001 by Rep. Jason Brodeur
District XII will keep members updated on important legislative news via email, fax and through the District XII Facebook page throughout session. If you have not already LIKED our page, please do so.