NEWS: Relaxing rules on nurse practitioners could cut health costs, advocates say

By Lindsay Street, contributing writer  |  Giving more autonomy to nurse practitioners will help cut health care costs and improve access to health care, particularly in rural areas, say proponents of a Senate bill pushing for changes.  Others say it’s just not that simple.

In South Carolina, nurse practitioners are licensed primary care professionals who operate under the supervision of a medical doctor. The new legislation, S.C. Senate bill 345, would still require a doctor’s supervision of a nurse’s practice, but would allow doctors to supervise more than three nurse practitioners at a time, remove a geographical radius tied to the doctor’s location and allow nurse practitioners to prescribe drugs. The legislation would expand autonomy of certified nurse midwives as well.

The doctors weigh in

While more than 30 other states have done something similar to increase health care access and limit unnecessary emergency room visits, some of South Carolina’s doctors are pushing against the proposed changes.

During testimony in a Senate Medical Affairs subcommittee this week, representatives of the S.C. Medical Association reaffirmed its stance that all medical care in the state should be “physician-led.”

“If this bill passes, are nurses going to come to the Statehouse to take the Hippocratic oath?” Dr. March Seabrook of Lexington asked rhetorically during his subcommittee testimony.   “This is about education and training, not lobbying.”

But not all doctors agreed with the association’s stance. Bucking their peers, two doctors, Dr. Keith Guest of Beaufort and Dr. Elwood Owens of Florence, spoke to the subcommittee in favor of loosening regulations.

“We’re not talking about throwing everything out. We’re talking about amending laws,” Guest said in his testimony. “I support the bill as written … it doesn’t give (nurse practitioners) complete autonomy.”

Davis

Championing the bill is Sen. Tom Davis, a Beaufort Republican who leads the subcommittee. Davis said he expected the full Senate Medical Affairs Committee to take up a vote on S. 345 in the coming weeks.

“South Carolina, in relation to other states, heavily regulates nurse practitioners,” Davis told Statehouse Report. He added the new legislation would allow nurse practitioners “to render the health care services for which they are trained” and that this could increase health care access in the state and potentially lower costs.

During Wednesday’s subcommittee, Davis pushed back against the testimony of fourth-year medical student Daniel Young of Charleston, who has a nursing education and worked under nurse practitioners. Young said that while many of the nurses are “excellent clinicians,” he did not “recognize them as having an education equal to my own.” Young said he has more hours of training than nurse practitioners and still has more education ahead of him.

“There are simply not enough of qualified physicians to go around,” Davis said. “(We should allow) nurse practitioners the latitude to provide a limited amount of care for which they are trained.”

Saving money

Davis’s premise for sponsoring the legislation is rooted in the senator’s assertion that more medical professionals in the state would increase access and drive down costs — a simple supply-and-demand model.

“It’s like any other commodity of supply and demand,” Davis told Statehouse Report. “If the number of providers is expanded, the costs go down.”

Davis penned an opinion piece last spring saying Medicaid expansion wasn’t needed but loosening regulations on nurse practitioners could fill the void, making health care more accessible and affordable.

But according to Wednesday’s testimony from medical practitioners, that’s not exactly how it will work, though it could end up saving the state some money. Doctors supportive of relaxing regulations said, if anything, it will keep taxpayer costs down by keeping low-income patients out of the emergency room by giving them access to rural-based nurses.

“If you have more and more practitioners and if they see those patients at the home office and keep them out of the emergency room, then you will have a dramatic difference in costs,” Owens said. “One-on-one patient care at the office, nurse practitioners can greatly reduce the frequency of emergency room visits at the nearby hospital.”

Expanding rural care

Nurse practitioner Jackie Baer also gave testimony at the subcommittee. She currently sees patients on Johns Island.  She said her supervising doctor is 71. Baer said she was afraid that if the doctor retired or died, her clinic might have to close because she wouldn’t be able to find another physician within the legal geographical radius to supervise her practice.

“The law is outdated and I ask why,” she said during her testimony. In a later interview, Baer expressed frustration that the wheels of legislation have not moved faster on the issue: “They just need to take a vote and do something. They need to be legislators.”

Corbin

During the subcommittee, Sen. Tom Corbin, R-Greenville, challenged the assertion that nurse practitioners will venture further into the rural areas and serve a greater population. Owens responded that they will and have in other states.

“You need somebody to go into the hinterland and treat those sparsely populated patients,” Owens said.

Baer said nurse practitioners’ low student loans and low overhead mean they can afford to serve fewer patients per day in the rural areas, whereas a doctor may need to see many more in an urban area.

“It’s not worthwhile for them to be out there,” Baer told Statehouse Report. She added that where she practices, there hasn’t been a physician who has stayed for the long term in the 15 years she’s served the area. “It’s not a financial win for them and I can see why they leave … We’re much more cost effective.”

Baer said that if the physician-led model being pushed by the S.C. Medical Association worked as is, then there wouldn’t be such a void in the rural area.

“We’re losing this game and we need a different plan. What they’ve been doing for 30 years is not working … It’s nice to have physician to lead the team but they’re not out here,” Baer said. “Let the people who are out here do it.”

Dr. Gerald Wilson, a past president of the S.C. Medical Association who practices in Columbia, said during the subcommittee meeting that serving rural parts of the state should depend on recruiting doctors from that area. And that starts with education, he said.

Editor’s Note, 3/14/17: Online comments to this news story have been closed.  We thank the 39 people who provided their opinions.

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39 Comments

  1. Laura Morris says:

    Wow, I remember the trouble I caused when I suggested this 20 years ago. Hope enough of our legislature has matured since then.

  2. Mary Giovannetti says:

    The geographical limitation of the supervising Dr being 45 mikes away or less is arbitrary in today’s society. A phone, face time, email, etc are available if consult is needed from anywhere. The limit of 3 NPs to a physician is limiting our practice. A physician can pretty much supervise a 109 RNs per day by his orders on the floor. Why limit an NP further than you limit an RN? NPs are filling in the gaps in care. There is a shortage of primary care physicians. Currently patients cannot get an appointment with their physician for months.

  3. Amy Brewer Young says:

    This bill is vital for improving the health care of Sc. We currently have a “f” in health care and have fallen from 40th to 42nd in health care delivery. The states with the best health care grades are states that already have given nurse practioners the ability to practice to full scope of their education and training.

  4. Stephanie Averette says:

    Senate Bill 345 was developed to increases access to healthcare in South Carolina. By removing barriers that are in place that limit nurse practitioners from being able to function at the full scope of our training there would be enhanced capabilities to increase access to health care. S.C. is a proud military state, but often with military service comes mental health issues.
    I am a Navy Nurse Corps Gulf War veteran and was married to a Navy pilot with several deployments to Afghanistan and I am unfortunately very much aware of this fact. Psychiatric providers are also very scarce in SC. There has been an increase in use of civilian medical and mental health providers to provide care to military members, veterans, and their families. Removing barriers to practice will allow Nurse Practitioners to establish practices, manage patients in outpatient settings, and reduce ER visits for medical and mental health care. Studies have shown that Nurse Practitioners have excellent outcomes with chronic disease management. The Department of Veteran Affairs has recently granted nurse practitioners independent practice due to these findings and the state of S.C. should follow the VAs lead.

  5. Justin L. Geddis says:

    I appreciate the services of at Angel Oak Family Medicine, it provides consistent, cost-effective, convenient healthcare for Johns Island when no one wants to stay. Ms. Jackie treats patients like they were her own family! Allowing NPs to keep and open private practices has increased people’s access to health care. When there are no healthcare providers in an area, people do not get basic affordable health care
    It would be great if there were physicians in all areas of SC, rich or poor, rural or urban. It is not feasible to have a physician in a rural area as numbers are low. An NP like Ms. Baer can provide this excellent quality care. Not allowing NP’s to practice because they might “miss something,” seems illogical because without them, rural communities would have no consistent healthcare at all, and then all sickness would be “missed.”

    NPs provide accessible healthcare, avoiding ER costs and saving the State millions of dollars!! In fact, Mrs. Baer provides a personal, thorough care and this is exactly what low income communities need. Patients feel safe, and they know they will be treated with dignity.
    People have a right to be provided with healthcare and treated with dignity no matter who they are. Patients get that with Angel Oak Family Medicine and in other clinics like it across the country. NPs are licensed professionals with post-graduate education and indemnified. Therefore, I believe that they need to treated as autonomous professionals and not subjugated to outdated laws.

  6. Clara Lobo BSMT(ASCP) says:

    Both MD’s and NP’s in family practice rely on vastly improved diagnostic testing to treat a patient. Technology rules the day . The days of relying on the extensive education and experience of the family practitioner as the primary diagnostic tool are gone. The visit to an NP is cheaper than an MD. The science has shown that within the scope of practice the NP outcomes are the same as MD’s. None of the Doctors have refuted this with data driven science. There have been many anecdotal arguments about the advantages of a “team based approach” led by doctors but where are the studies? The NP’s have cited scientific study after study supporting their view. I have read many of them. They are compelling. Medicine is a field based on science. The doctors must back up their claims with verifiable evidence but I have yet to see it. 30 states have already moved in the direction of autonomy for NP’s. Why is it that none of those states have reversed course? I think the evidence is clear. The question is will our legislators stand up for patients and allow them to make their own choice with regard to their primary care provider.

  7. MAUREEN CAHILL says:

    Would removing the barriers to the practice of APRNs in SC save money for the state? The economic studies of several other states would suggest so. Studies have been done in TX, OH, WV, FL, CA, and NC. Overwhelmingly they suggest financial benefit to states who remove such barriers.

  8. sally berwick says:

    http://www.aacn.nche.edu/government-affairs/APRN-Policy-Paper.pdf
    Policy Perspectives Competition and the Regulation of Advanced Practice Nurses
    Federal Trade Commission 2014
    This is an excellent 53-page study by the FTC which gets to the heart of the matter
    “When faced with proposals to narrow APRN scope of practice via inflexible physician supervision and collaboration requirements, legislators are encouraged to apply a competition based analytical framework and carefully scrutinize purported health and safety justifications. In many instances, legislators may well discover that there is little or no substantiation for claims of patient harm. If, however, health and safety risks are credible, regulations should be tailored narrowly, to ensure that any restrictions on independent APRN practice are no greater than patient protection requires”

  9. Dannell Bradwell says:

    I am so glad Ms. Jackie has her clinic out here and we would be lost without her. Also she is a blessing to the community as a health care provider. Ms Jackie is always kind, compassionate and make you feel like you can walk-in at a moments notice! This means the world to our rural community and we need to recruit more NPs like her to fill the gaps in healthcare esp. in SC. We are getting and F in quality and need laws that work for the people and not against them…
    Who wants to sit at Sea Island Clinic (FQHC) for 4 hours and then go to the ER to be seen. Over the 15 years, MDs have come and go off the island to more glamorous places. However, Ms. Jackie provides accessible cost-effective care that keep our families out of the ERs so that we can be productive citizens in our community- NPs are educated, licensed, and indemnified- lets start saving State monies by providing Millions of dollars for SC with modern laws–I believe this is called value-based care-

  10. J. Falkner Wilkes says:

    I attended the meeting as a proponent of the bill. Some of the Senators showed interest in the issue. Senator Davis asked excellent questions as to the effect of certain provisions of the proposed bill. Senator Corbin asked the question of whether there was evidence that NPs will move out into the rural areas or open their own clinics if unchained from physician’s offices and large institutions located in large part in the highest income/population areas in SC. It was a good question. Senator Corbin said that he had seen something that suggested that this might not be true. He did not say what that something was, but clearly he did not have the benefit of the numerous studies showing that NPs are are in fact more likely to practice in rural or underserved areas than physicians. It was interesting being from Greenville Senator Corbin asked that particular question since his constituents probably include doctors and people that have decent access to health care. The fact that he is interested in the 95% of the state that doesn’t have decent access to health care is commendable. To answer Senator Corbin’s question, numerous studies have found that in independent practice states where no physician supervision is required, NPs do actually practice in areas that physicians will not. In addition, study after study, hundreds and hundreds, over forty years worth, that have considered every variable, have consistently shown that NPs provide care at or above that of physicians. Physicians hate this. They made it through two sub-committee meetings without ever being asked about, or mentioning the fact, that hundreds of studies show NP care equal or above that of physicians. To date in this debate physicians have not presented anything to the contrary. Forty years of research and surely they could at least come up with one independent study to show that NPs aren’t competent to deliver independent care, or that having a physician supervising has any effect whatsoever on the quality of NP care. Not that one study would stand against hundreds upon hundreds, but at least physicians could make the effort to look for something. As far as I am aware, there has never been a study to the contrary. I have read so many that I am confident to say that if physicians can find a study, I’ll match them and raise them fifty for every one they find. Given the overwhelming evidence, the quality of NP care independent of a physician’s supervision is simply no longer intelligently debatable. Physicians keep saying that they have more education and training than NPs. That hasn’t been shown to make any difference in the ultimate delivery of care. Regardless of how much more education physicians may have, studies show, and patients report, that NPs still provide care at or above physicians in every aspect. This drives physician’s mad, but it is simply the undeniable truth. For a great independent analysis look at the National Governor’s Association report at http://www.aacn.nche.edu/government-affairs/NGA-Nurse-Practitioner-Paper.pdf By the next meeting, the sub-committee will have that information, along with hundreds of other studies. They have already seen evidence of the access to health care crisis. Now lets see what they do about it. You can see a great visual to understand the lack of primary care in this state. Take a look at the DHEC map at http://www.scdhec.gov/Health/FHPF/…/ShortageMaps/ and you will be shocked at what you see. Doctors are staying concentrated in high income areas (little white spots on the map) where they make the most money. This is great for the people in those few small white areas on the map, but what about the other 95% of the state? Nurse practitioners under the current law have to work under the supervision of a physician, so guess where all the NPs are? In offices with a physician or big institutions (in the little white spots on the map). This limits NP opportunities. Studies show that physician supervision of NPs stifles growth rate for NPs in a state by as much as 25%. This prevents NPs from opening their own clinics where they are needed most. This prevents NPs from providing health care at lower cost than doctors (also proven by repeated studies and research). South Carolina has the top NP school in the nation. Sadly, they can’t graduate and open their own clinics to help the people that need it most. This is because physicians of the South Carolina Medical Association are keeping them locked into doctor’s practices blocking any change to laws that are forty years old. Why would they do this when overwhelming evidence shows that physician supervision has no measurable effect on the outcome of NP care? Its all about the money. Primary care physicians make a huge amount of money on NPs. A physician can make fifty thousand dollars or more profit per NP. (I dare the SCMA to say differently and back it up with proof). Under the current law each physician is allowed to supervise three NPs, plus they can also have physician’s assistants (PA). They have repeatedly asked the legislature change the law so that they can each be able to have six NPs. With six NPs and a few physician assistants a primary care physician can make hundreds of thousands of dollars of profit a year. Some more and some less, but in any case, a physician makes a boat load of money off NP and PA employees. That’s where the bulk of a primary care physician’s income is derived. The same is true of the big institutions. Primary care physicians of the SCMA and big institutions that are opposing the NP proposed legislation are doing so to protect their money and limit competition, all at the expense of the other 95% of this state (the blue area on the map if you looked at it) that is suffering a crisis in access to health care. Before the next meeting of the sub-committee the members will have been provided the research, studies, articles, data, and facts. The next meeting should be informative. If you are the other 95% of the state (in blue) or care about them, you should talk to everyone you see about this issue. Read the articles, the research, the data. Read what the Institute of Medicine has to say, the Rand Corp., the New England Journal of Medicine, Journal of American Medicine, U.S. Dept. of Health, and hundreds of other researchers and experts in medicine. If you are tired of driving hours to Greenville, Greenwood, or Columbia or Charleston for a doctor’s appointment. If you are tired of waiting two months for a doctor’s appointment; If you think the cost of a basic primary care doctor’s visit is too high; If you think being seen by the doctor for seven minutes isn’t adequate; then get informed about the facts and get involved. Don’t just listen to what NPs say, or to what doctors say. Look up the facts. Senator Davis is a sponsor of the proposed legislation. Help Senator Davis in his efforts to bring positive change to health care in this state. If you look at the research, the evidence, the facts, I believe that you will support the NP efforts to change laws that are over forty years old and out-dated. Please contact all of your legislators and support nurse practitioners. Senator Davis only has the ability to move this bill on to the full committee if he has the support of others on the sub-committee. Please contact sub-committee members and ask them to join Senator Davis in his attempt to bring primary health care to the other 95% of this state. Sub-committee members are listed at http://www.scstatehouse.gov/CommitteeInfo/senatemedical.php

  11. Prentiss Findlay says:

    Jackie Baer has a clinic on Johns Island and is a nurse practitioner who serves a diverse population of those who might otherwise be without health care.

  12. Prentiss Findlay says:

    Jackie Baer has a clinic on Johns Island and is a nurse practitioner who fills the void in healthcare. It’s cost-effective; we need to be innovative since the old physician led model is not working for those most in need- decades of data and solid evidence from the IOM; NCSBN; and the FTC provide support

  13. Wendy Holmquist says:

    Lindsay, Nurse practitioners already have prescriptive authority and are asking for Schedule II authority. And the vast majority of nurse practitioners will tell you they are not currently supervised but have to pay their physicians high sums of money to “supervise.” We are asking the legislators to change the language not our practice.

  14. Jon Grandin says:

    As a self-employed father with two kids living on Johns Island we are blessed to have a family nurse practitioner closeby. With the traffic being insane, this saves both time and money. The cost of health care must go down and Ms. Jackie provides a great alternative to costly ER visits. As a primary care provider she helps our community. I believe that we need to support legislation that will help save taxpayers money like myself. Competition is any industry is good for the consumer. We need new laws that allow for such and laws that work to protect NP practices like this and many others.
    SC can benefit greatly from competition as we have and F in healthcare for health outcomes and the 2nd costliest health premium in the country!!

  15. garyham876@gmail.com says:

    Having been coming to the clinic for a long time because it is convenient,saves time, and I can bring all my grand-kids here. Ms. Jackie has been a big help to get me to get to the specialist and help me improve my diet with her weight loss program. She is always gettin on us about exercising and to stop drinking sodas. This has help me and my family stay healthy. My knees don’t hurt as much and can move better. Since I have no car, she is a blessing to our community. We need more NPs like Ms. Jackie to help us in our rural community and keep us out of the ERs.

  16. garyham876@gmail.com says:

    Awesome clinic. Coming here and she is the best!She saves us time and money and I bring all my grand-kids here. Ms. Jackie has been a big help to get me to get to the specialist and help me improve my diet with her weight loss program. She is always gettin on us about exercising and to stop drinking sodas. This has help me and my family stay healthy. My knees don’t hurt as much and can move better. Since I have no car, she is a blessing to our community. We need more NPs like Ms. Jackie to help us in our rural community and keep us out of the ERs. We need laws that #help the people with NPs

  17. Renee Wheeler says:

    We need to keep Ms. Jackie here- we don’t need to replace Ms. jackie with FQHC!
    We need to change the law so that we have more clinics like hers the serve the people in our community like hers. She has taken awesome care of my 5 kids, families, and friends! Our community is blessed and healthier for her- So many counties in SC are rural and could use dedicated NPs to help us, when MDs have not been able to stay or choose to fill the gap. We need healthcare and NPs like Ms. Jackie help us. We need to stop with outdated laws that hold back healthcare from the people, and follow the lead of the VA and 30 other States that have not reversed course! Lets save millions of taxpayer monies by creating just laws that work for the people and not be prideful, arrogant, and greedy-
    #New Laws That Work for the People; #We love our NPs.

  18. Germonta Brisbane says:

    We need new laws to help Ms. Jackie continue to provide healthcare for our rural community. She has the 3P’s: properly educated; properly licensed ;and properly indemnified.

    She is fill in the gaps of rural healthcare! We have the data analytics- let us learn from the evidence and put it into practice without waiting any longer. This will million of tax-dollar and improve the health of our rural communites…

    #New laws for the people
    #We love our NPs

  19. Helen Ngigi says:

    We need this kind of legislation that supports the work of nurse practitioners such as Ms. Baer, who work in rural areas and help improve the health of their patients.

  20. Taylor boyd says:

    Competition in patient choice is a good thing. Let’s get SC ON THIS PATH.

  21. Loretta Boyd says:

    We need affordable healthcare- Nurse Practitioners are competent, licensed, and indemnified.
    Competition drives down cost- Patients like me should be allowed to choose their own primary care provider- This is called value based healthcare-
    SC– What do we have to lose?

  22. joshua johnson says:

    Consumers should be allowed to choose their own providers whether it is NPs or MDs-driving down healthcare cost with competition!There are hundreds upon hundreds of scientific studies showing that independent primary care nurse practitioners (NPs)provide quality of care equal in every aspect to that of primary care physicians (MDs)-
    Why should SC have outdated laws tethering NPs creating a unjust monopoly?
    #New Laws for the people

  23. Alondra Barbosa says:

    Why Is Access to Health Services Important?
    Access to health services means the timely use of personal health services to achieve the best health outcomes. It requires 3 distinct steps:
    • Gaining entry into the health care system.
    • Accessing a health care location where needed services are provided.
    • Finding a health care provider with whom the patient can communicate and trust.
    Access to health care impacts:
    • Overall physical, social, and mental health status
    • Prevention of disease and disability
    • Detection and treatment of health conditions
    • Quality of life
    • Preventable death
    • Life expectancy
    Disparities in access to health services affect individuals and society. Limited access to health care impacts people’s ability to reach their full potential, negatively affecting their quality of life. Barriers to services include:
    • Lack of availability
    • High cost
    • Lack of insurance coverage
    These barriers to accessing health services lead to:
    • Unmet health needs
    • Delays in receiving appropriate care
    • Inability to get preventive services
    • Hospitalizations that could have been prevented

    What does SC have to lose?

    NPs can provide a common-sense solution with independent practice while saving the State millions of dollars-
    #New Laws that work for the people!!

  24. Jacinto Diego says:

    Problems with Rural Health include:

    • Financial means to pay for services, such as health insurance coverage that is accepted by the provider.
    • Means to reach and use services, such as transportation to services which may be located at a distance, and the ability to take paid time off of work
    • Confidence in their ability to communicate with healthcare providers, particularly if the patient is not fluent in English or has poor health literacy.
    • Confidence in their ability to use services without compromising privacy.
    • Confidence in the quality of the care that they will receive.

    Common-sense Solutions: Conclusive evidence from the IOM; NCSBN; and the FTC show that NPs work

    Problem: SCMA will continue to resist in spite of good science

    NOW IT IS UP TO UP, our legislators to help be a voice for the people.
    #New Laws for the People!!

  25. Helen Ngigi says:

    This new legislation SC Senate bill 345 would go a long way in reducing costs to the state of SC, and keep patients out of the ER. This bill is very important in helping improve the health of all patients, especially those in rural areas. Nurse practitioners have a proven record of providing quality care to their patients with chronic diseases, such as diabetes, hypertension, asthma among others.

  26. Donna White says:

    NPs provide safe and efficacious care for patients like me living on Walmalaw Island,SC.
    The facts:
    1. Not enough MDs. to provide primary care in our community
    2. The SCMA has no evidence to dispute the competence of NPs. There is overwhelming conclusive evidence for IOM; FTC; and decades of data.
    3.National Council for the State Boards of Nursing recommends independent practice
    4. NPs should be monitored like MDs when they over-prescribe controlled medication like Opoids

    My common-sense solution: Use NPs in our rural community to fill the void left by MDs otherwise we will have no access to care.

    Personally, Ms. Jackie has been taking care of me for years and has kept me and my family out of the ERs. NOW our legislators need to support # New Laws that help our people!!

  27. It’s pretty simple. Relax the restrictions on NP’s and we can actually provide a much needed service in areas that are otherwise not served. Access to healthcare is a major issue in much of the country, but specially so in SC. It’s a blessing to have the Ms. Baer’s of this world.

  28. As an NP for over 20 years, it is time we move into this century with healthcare. SC medical association needs to take care of their own issues and stay out of our governing body which is the SC nursing association. The SCMA is only concerned about power and money and not about access to healthcare. Look at the healthcare statistics in SC, they are down right embarrassing! updating the regulations to this century’s standards would provide improved outcomes. Thank-you Senator Tom Davis for your support. The delay tactics in the senate and the house have been very frustrating and this has been going on for years. Can’t we just move on and improve healthcare. If NP’s are good enough for our veterans then why not for the rest of the state?

  29. Norma Strickland says:

    We need our NPs to provide care in our rural communities. We come all the way from Ravenel to see Ms. Jackie because do not like going to the Fetter Clinic- it takes too long to get in! We love her bedside manner and she keeps all my grand-kids vaccines up to date. She saves me time and money. She is a phone call away and we love the personal touch- she treats us like family..

    NPs will drive done the cost of care for everyone. Competition is good for any field, esp. healthcare since it has gotten so very expensive…As a senior, she provides safe and efficacious care! I trust her with my family and friends and she is quick to refer when needed. She has kept me out of the ERs and been a great blessing to our rural community. SC is so very rural that many other people would also benefit from the great care and compassion that we find with our NP. The VA is using NPs to improve access to care, why are we still so far behind?

    Our legislators need to not re-invent the wheel but use what is already helping other States.
    NPs provide a common-sense solution to the primary care service that our rural communities need.

  30. cresta presnell says:

    We need to change the law so that our families can continue to come to this clinic that has been taking care of us for over 15 plus years. When doctors have come and gone after paying off their medical school debt, Ms. Jackie continues to be here. We get safe and reliable care that we can count one. She is convenient and keeps us out of the ERs and emergency care centers.

    She also promotes good health habits by insisting that we quit smoking and lose weight and improve our diet. Her persistence has made me healthier and because she knows us well our visits are short and easy.

    Like Ms. Jackie said, we need a game-changer!! Allowing NPs to fill the gap in healthcare can only help us do better. We need our legislators to step up and change the law for the people and improve our health with NPs and also save our tax-dollars.

  31. The American College of Nurse Midwives and the American Congress of Obstetrics and Gynecology have agreed supervision should be removed from nurse midwife regulations in all states to help bring access to women’s health and prenatal care providers. Our country is facing a maternity care crisis. Areas of SC have mothers and babies that die at rates higher than many third world countries. 13 counties in SC have NO obstetricians or nurse midwives. Our maternal mortality rates and preterm birth rates are rising. Our country spends seven times more health care dollars than other developed countries and our outcomes are shameful. SC tax payers are footing the bill for half of all births. Our state is the 3rd most restrictive state for advanced practice nurses and we have a health grade of F. Hundreds of studies have shown that removing supervision for advanced practice nurses improves outcomes, improves access, reduces costs without negative effects to the physician practices. Why is this even a debate. Lets move SC forward!

  32. Ophelia CM Game` says:

    FNP Jackie Baer is an integral part of John’s and the Sea Islands community for almost 20 years. She provides primary care services especially to the rural population who are medically underserved. She has been helping reduce health disparities agressively and compassionately saving major tax dollars whilst improving population health outcomes. Mrs Baer’s accessibilty to these communities and the trust she had established to her patients keep them from inundating Emergency Rooms and hospitals. Urgent situations are immediately referred appropriately because of her quick evaluation, diagnoses and management. I am an Registered Nurse in SC who had been working closely with a pulmonologist for over 15 years. Our office, Pulmonary Diseases Care, P. A., is quite familiar of Mrs Baer’s ability to collaborate with several offices enabling patient care safety, efficacy, thus improving quality of life. Essentially, having Nurse Practitioners independently practice without supervision by other licensed professionals like MD’s, bridges a major gap in SC heath care system. State Laws need to be revised to reflect a more interdisciplinary collaboration that will provide a more autonomous professional partnership for improved patient-centered outcomes.

  33. Nurse Meredith says:

    While treating patients, we abide by clinically-appropriate evidence-based and cost-efficient care. I also exercise this same respect while reviewing and supporting legislative efforts. As a nurse practitioner, I give the same respect to my congressmen. I would like to assume other health care professionals do the same. I can provide my congressmen a mountain of evidence-based research articles about the safe care nurse practitioners provide. I am still on the search for finding evidence-based research articles showing the contrary. I urge our congressmen and congresswomen to demand the same respect to information that we provide to our patients.

  34. Tracy Brown says:

    We need to keep clinics like Ms. Baer open instead of going to the ER, spending hours there and costing a lot of money when it is closer to come here on the Island. As a single parent, with a small child it would take hours to been in the ER and I don’t have the time because I have to work. Laws need to be changed to allow for NPs like Ms. Baer to bring down the cost of healthcare. Medical bills are the #1 reason for personal bankruptcy and I believe that coming to the clinic allows me to get the same treatment at a lower cost- this is called value based health care!
    As a patient I should be able to chose who I want to care for me, whether it is a MDs or an NPs. This is also called patient centered care.

    I don’t understand why other States are doing this and our own VA and we are not. We need to start saving taxpayer money and not re-invent the wheel but do something that saves us time and money so that we can use it more wisely for other projects, like public transportation, sidewalks, safe play-zones for our kids, and after-school activities to name a few..

    Legislators should help us by being game-changes. We need a better strategy to help patients and families like me to save time and money with providing access to healthcare in our community versus driving and waiting for costly care elsewhere.

    Ms. Jackie provide a great alternative that has been successful in other States including our VA so we need to use common-sense are use what works instead of be arrogant, greedy!
    Money is the root of all evil.

    Legislators need to change the laws since they are not working for the people and do what is right for the communities that they serve.

  35. Lindsay J says:

    Mrs. Baer’s clinic is an integral part of the community on Johns & Wadmalaw Islands. We need access such as this for our diverse community. Please help ease the restrictions

  36. Colleen Boyd FNP says:

    Another factor to consider- lots of NPs, like myself, are from other states and not only trained but EXPERIENCED in doing a lot more. Not only would this bill improve my ability to deliver care, but it improves women in South Carolina’s ability to *grow business*!

  37. Paula Brooks, DNP, FNP-BC, MBA says:

    As the number of Advanced prepared APRN practitioners continue to grow, their roles continue to evolve. Overly restrictive Scope of Practice, prescriptive authority, and collaborative practice requirements for Advanced Practice Nurses place barriers to practice and contribute to the poor health rankings of the population.

    The current laws in South Carolina are some of the least progressive in the country and are simply outdated. With the exception of minor revisions in 2008 regarding application fees, background checks, name badges, and the election of district members to the Board of Nursing, the last significant amendment to the South Carolina Nurse Practice Act was in 2006, over 11 years ago. This restricted practice requires a physician to oversee all care provided by the NP and many studies suggest that this considerable variation of restrictions from state-to-state in scope-of-practice contributes to NPs’ relocating from highly restrictive to less restrictive states and contributes to the reduction of patient access in many of the under served areas.

    According to the IOM report (2011, pg. 96) “overly restrictive scope-of-practice is recognized as being one of the most serious barriers to receive accessible care for patients”. These barriers to Nurse Practitioners practice contribute to the poor health rankings of the residents in the State of South Carolina. In 2016, The United Health Foundations report ranked South Carolina in the 42nd place when compared to other states in the US. Another study described by Bernardo (2016) compared the 50 states and the District of Columbia between three key factors, including health care costs, health care access and outcomes. They evaluated 29 relevant metrics which were graded on a 100-point scale, with 100 representing the best health care (Bernardo, 2016). South Carolina ranked slightly better than the United Health Foundations report, resulting in an overall ranking of 43rd in the nation. It ranked 31st in access to health care and 41st in health outcomes. Reasons, such as poor rural health and high uninsured rates, are recognized as contributing factors to why South Carolina and other Southern states rank near the bottom of the list.

    In addition, by preventing Nurse Practitioners from practicing to their full capacity, patients and their insurers incur unnecessary delays and increased costs. Patients often wait needlessly for prescriptions they need, get their test results—and thus their follow-up care—later than necessary, and many do not learn the best ways to avoid and manage their diseases.

    Nurse Practitioners have a long and recognized record of providing cost-effective, quality health care services to those in greatest need and evidence support that Nurse Practitioners provide quality patient care and can help improve the health of the community. Advanced Practice Nurses would be able to better serve their patients and potentially lower healthcare costs if they were given the authority to practice to the full extent of their education and training which includes Schedule II prescriptive authority in the State of South Carolina. Outdated and restrictive APRN practice regulations do not align with national trends and prevent the state from meeting the needs of its growing patient population. The state needs to remove all references to a ratio of APRNs to physician and remove all references to a mileage requirement for APRNs practicing at a distance from physicians in South Carolina. These factor limit the ability for APRN’s to practice to their fullest extent and provide cost effective, safe and quality healthcare at their maximum potential and this, in turn, will help to improve the overall health rankings of the residents in the State of South Carolina. It would allow APRNs to fully utilize their education and experience to serve the needs of South Carolina health care consumers. 

    Bernardo, R (2016). 2016’s States with the Best & Worst Health Care. Access at https://wallethub.com/edu/states-with-best-health-care/23457/#ask-the-experts

    Institute of Medicine (IOM). (2011). The future of nursing: Leading the change, advancing health. Washington, D.C.: The National Academies Press Retrieved from http://books.nap.edu/openbook.php?record_id=12956&page=R1

  38. Dr. Valarie Petersen, DNP, FNP-BC, GCNS-BC says:

    Nurse practitioners in the state of South Carolina are merely asking to practice to the full scope of the education and knowledge that they already have. We are NOT asking to practice unsafely or in any manner other than how we currently practice. My woodworker husband stated that the way the law currently stands, nurse practitioners are functioning as indentured servants–apparently right where many physicians and legislators desire for us to remain. Give us our scope of practice. And many thanks to those legislators and physicians who have the guts to admit that the research shows that we can do a great job, if given the opportunity.

  39. Janiece Binns says:

    If legislators and physicians were truly concerned about increasing access to healthcare for thousands of people in the United States, they would not be fighting this bill.

    Nurse practitioners provide safe, high quality, holistic care to their patients. They have the clinical experience necessary to provide this care. There is plenty of evidence to show that quality of care and patient satisfaction with nurse practitioners is equal to that of physicians. Nurses gain 2-3 years of clinical experience with a bachelor’s degree + years of experience as an RN + hundreds of hours in their master’s degree program (even more if they choose to complete a Doctorate of Nursing Practice, which is being pushed more and more by national nursing associations, universities, and hospitals).

    Unlike PA’s (physician assistants — who could major in underwater basketweaving, pass the MCAT, and take 2 years of grad school), nurse practitioners actually have the clinical experience, critical thinking skills, and judgment for independent practice. (Please note, that I have met some fantastic PA’s, but this has been rare in my experience). Passing the MCAT does not necessarily a good clinician make.

    With their advanced clinical experience and education, nurse practitioners should be treated differently than PA’s, and allowed to practice to a fuller extent than PA’s.

    As a future nurse practitioner, I hope that SC legislators will support NPs practicing to the fullest extent of their training, thereby increasing access to care for thousands of SC residents.