FEEDBACK: Readers say it’s time to change rules for nurse practitioners

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Last week’s story by Lindsey Street on a state proposal to relax rules on nurse practitioners to improve health care access and reduce costs brought the most online comments ever – more than two dozen – to Statehouse Report.  Some folks, however, relied on the old-fashioned letter to the editor:

Bill would help to reduce health care costs

To the editor:

This new legislation S.C. Senate bill 345 would go a long way in reducing costs to the state of S.C., and keep patients out of the emergency room.

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 and asthma, among others.

— Helen Ngigi, FNP-C, Smyrna, S.C.

Doctors, nurse practioners work together

To the editor:

I have over 25 years of experience utilizing Certified Nurse Practitioners (CNPs) in my medical practice in Columbus, Ohio, until I retired in 2014. The law in Ohio allows prescribing, independent practice under supervision generally on site and although not specified they can practice remotely as long as a doc is available for consultation on phone or Skype.

One of my hospital rounding nurses went back and obtained her CNP license while working for us part-time.  As we had known her for over six years at the time, it was easy to trust her judgment.  The biggest medical hurdle would be that level of trust between doc and CNP.

This however doesn’t seem to be a problem at CVS Minute clinics. My daughter is a PA  (physician’s assistant) in Charlotte and worked there for a couple years.  They have protocols for what can and can’t be seen and management guidelines. I don’t think she ever met her supervising doc there but did discuss cases on the phone.  The CVS rules and guidelines are pretty clear. For a doc to recreate would be easy.

— Dr. John MacLaurin, Hilton Head Island, S.C.

Doctors and nurse practitioners needed in South Carolina

To the editor:

As an Family Nurse Practitioner (FNP) who has practiced now for 17 years, I am appalled at the S.C. Medical Association for its efforts  to block access to health care across this state.  The medical doctors (MDs) who want to limit Nurse Practitioner (NP) practice appear to be less interested in the health and well-being of the people of South Carolina, and more interested a turf war.

As a Primary Care Provider for the past 17 years, I collaborate primarily with two of my supervising physicians.  I currently work alone as the sole provider in a Summerville medical office, but enjoy a very healthy relationship with my medical director and MD colleagues.  These family practice MDs are very supportive and see the value in allowing me to practice alone.  My practice has very low overhead because I work with just two other employees who are Certified Medical Assistants.

Both MDs and Nurse Practitioners are needed to care for the people of South Carolina.  All of the current regulations limiting our practice limit access to health care by S.C .citizens.  I also want to add that the article erroneously states that the proposed bill will allow NPs to prescribe medication; we have been prescribing medications for many years now.  The proposed bill would simply allow NP’s to prescribe controlled substances when appropriate without having  the patient wait for an MD to authorize these medications.  The only losers in this turf war are the medically underserved people of our state.

— Alison MacLeod, FNP, Summerville, S.C.

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  1. josie esparza says:

    As a patient I should be allowed to choose whether I want to go to an NP or an MD, if this is in fact patient-centered care! This would drive down healthcare cost with competition. Economic studies have been done in TX, OH, WV, FL, CA, and NC overwhelmingly suggesting financial benefit to States who remove such barriers to NPs who practice within licensure. In fact 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)- As a US citizen, medical bills are the one cause of personal bankruptcy!

    Allowing Ms. Jackie to practice independently will not only benefit me but our rural community. We are not re-inventing the wheel but only following what other States have done with great success including our own VA. If the VA can count on NPs to improve access to care in SC with safe quality outcomes, than why are we holding back?

    Our Legislators now need to step up and be game changers.
    We need to save our tax-dollars and provide innovative solutions that work for the people and help reduce our growing health care bills! Competition is good in any industry, to drive the cost down. We really need this to improve our health care cost to save money!

    Let NPs practice independently!!

  2. Daniel K, Game' says:

    I have been practicing pulmonary medicine for the past 20 years [15 years in Charleston area. I can say that I have been privileged to have wide range of very good patient referrals from various providers. Most of these patients are seen the first time in their lives by nurse practitioners. These patients usually have complex medical conditions and are promptly referred to the subspecialist for appropriate and timely workup and care. I fully support any legislation which will facilitate independent practice for the nurse practitioners that are properly educated and licensed and indemnified. Having a nurse practitioner sister who independently practiced in Maryland, this worked very well in saving millions of dollars in health care expenses that can be used for other expenses. This will likely reduce the delay in screening high risk patients with potentially treatable conditions and ultimately translate in reducing malpractice rates for physicians.

  3. Thanks to my mom I found out about this clinic, and since this is Sundays my regular office with my MD was closed. Ms. Jackie is open on weekends and the evenings saving me time. We need her to keep the office open to continue helping the community with primary care services when no one else is available.

  4. Ms Chill A Lot says:

    To whom this may concern, I Carolyn Daniels would like to say that Jakie Baer has been taking care of my entire family for three generation. She is the most loving, patient, kind person and mother that I have come across. After seeing lots of other providers NP Jackie has been the best. Please change the law so that Jackie will continue to stay on Johns Island as well as help to recruit other Nurse Practitioners from other states that love to work in rural communities without unnecessary costly physician oversight. These Nurse Practitioners that work in other states without Physician oversight have saved their States million of dollars, tax payer time and monies!

    NP provide cost effective care for those most in need. We have a major shortage of primary care doctors in SC. This Law is obstructive and is destructive in recruiting the best and brightest of Nurse Practitioners to care for our community. Patients love and trust Jackie. Jackie is so close to rural housing and sees 80 to 100 Patients that are disabled and elderly and cannot go elsewhere. Her location is very much convenient and all residents are in walking distance.

    She saves time from going to the ER. Let me explain, at the ER I am exposing myself to everyone else’s germs, and sickness while already suffering with my own life-threatening illness. Upon arrival I wait 4-6 hours before I can be seen and on top of that I am getting sicker! The EMS cost $500 per trip because I have no transportation in the rural area. On return since you can’t get the EMS to bring me home, I have to wait another 3-5 hours for the Medicaid Van again, costing tax-payers and more importantly the State MONEY. I am exposing myself to more germs and the State is spending more money!!

    So to take a strain off of the ER’s Ms. Jackie provides primary care with NO wait time because so knows me and my family and friends so well. In addition the pharmacy is directly across the street from her office, and the patients are able to stay complyent and healthy with their multiple medication. She is always getting after our weight and getting us to quit smoking so we can be healthy.

    Best of all is that Ms. Jackie has immunizations so DSS doesn’t go after the families and the children can stay in school and learn. This is how the parents like myself are able to work.
    Thanks to Ms. Jackie, our communities are healthier.

    So to avoid all of this we could use common-sense solutions. As a patient I want to be able to chose whether I see a MD or a NP. This is called patient centered care. Having competition with independent practice will drive down the cost of healthcare. Jackie saves time and monies for the State, and this is called value based healthcare.

  5. Milagros Hernandez says:

    It’s all about the MONEY!! MONEY!!! MONEY!!
    Why would MDs do this when overwhelming evidence shows that MD supervision has no measurable effect on the outcomes of NP care?

    Primary care doctors make a huge amount of money on NPs. A MD can make $50,000 or more profit per NP. Under the current law each MD is allowed to supervise three NPs, plus they can also have physician’s assistants (PA). With six NPs and a few physician assistants a primary care physician can make hundreds of thousands of dollars of profit a year.

    As a patient with 3 small kids I have a right to choose who I want to see: an MD or an NP. NPs provide access, cost-effective care that is backed up by solid evidence. 95% of our State is medically under-served.

    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.

    I believe our legislators need to step up and allow patient to chose their providers and save tax dollars in the process. These monies could be used to improve our schools and communities. NPs provide safe, efficacious care for my family, friends, and our rural communities with conclusive evidence.

    Our legislators need to modernize laws and be the game-changers!!
    Competition will reduce the cost of care and help to better serve the people like it does for other industries.

    SC what do we have to lose??

  6. We need to support our NPs like Ms Jackie!!
    When, contrary to forty years of intense study and independent research, the SCMA physicians say that supervision is necessary or has any effect on the outcome of care by nurse practitioners, they abuse the trust and confidence that we have historically placed in doctors. They are misrepresenting the evidence to further their own financial interests at the expense of 95% of this state that lacks decent access to health care. They should be ashamed and the public should be outraged.

  7. Trevor Mitchell says:

    NPs need have their own practice. Jackie has been taking care of me and my family and friends for 15 years!! Even after a fatal car accident, when I was left at the side of the road Ms. Jackie kept me going in spite of being with insurance. She encouraged me not to give up during this painful time of all my broken bones and a new prosthetic leg. She told me I needed to get back on my feet and put a smile on my face and start working so that I would not be sad and depressed. With her encouragement I am back on my feet and have started my own towing business: Mitchell’s Towing and Auto Repair, LLC @843-813-6335.
    Please call me if you need my help- not only has Ms. Jackie been there in sickness and in health but is always helping to improve our community. Thanks to Ms. Jackie and many like her- Blessings!! Be Brave and change our outdated laws to help our people!!

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