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New nurse practitioners law will benefit consumer

The pending demise of a cooperative agreement between UPMC and Highmark grabs our attention. It fills us with a sense of dread.

The uncertain future of basic medical care is one thing; add to this uncertainty the prospect of a catastrophic event — a heart attack or vehicle accident — outside the coverage area of your primary care network. The expense could be astronomical.

Whatever happened to the good old days, when a family doctor made house calls and took cash for payment? Sadly those days are gone forever — quantum advancements in medical science preclude their return.

Nonetheless, there is hope for a revised return to the simplicity of those days, at least in part.

Last week in Harrisburg, the state Senate advanced a proposal to let qualified nurse practitioners open their own medical practice independent of a doctor’s direct, on-site supervision.

Senate Bill 25 would modernize the Professional Nursing Law to let qualified Advanced Practice Registered Nurses-Certified Nurse Practitioners (APRN-CNPs) practice independent of a physician after they fulfill a three-year, 3,600-hour collaboration agreement with a physician.

The bill’s sponsor, Sen. Camera Bartolotta, R-46th, and other advocates say it could expand health care availability especially for rural Pennsylvanians.

But the medical market might be encouraged to go another way to serve the public effectively.

For many years, the medical community has studied the idea of placing a walk-in medical practice inside a retail pharmacy, where patients can receive immediate care for simple ailments or conditions and have prescriptions filled at the same time. One 10-month study, reported in the March 2012 Journal for Nurse Practitioners, concluded that “In a community clinic, a pharmacist and nurse practitioner jointly improved medication use across four categories: reference to clinical guidelines, potential adverse drug events, alternatives based on treatment failure, and medication cost. They also improved patient care by reviewing treatment guidelines and modifying the drug alert algorithms of a new electronic health record system.”

In addition to the sensibility of such a collaboration, in many cases, the visit with the nurse-practitioner calls for a generic prescription — the diagnosis and drug can be paid for with cash out of pocket, allowing the patient to sidestep the health insurance provider for basic medical needs.

On the other hand, covered patients would have the option to pay with insurance for their medical consultation, as they always have for prescriptions.

This concept of nurse practitioners serving independently in a retail pharmacy setting would constitute a revolutionary step toward affordable, street-level medicine.

The innovative thinking shown in SB 25 should be welcomed and studied thoroughly by our House representatives and governor. As bureaucratic megaliths sway against each other and threaten to topple in ways that seem beyond the control of the consumer market, it is refreshing to see consumer-friendly legislative options emerge that challenge the status quo.

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