This past week, Hartley Medical issued its May-June 2012 issue of The Hartley Standard ““ our bi-monthly newsletter. Our intent of these newsletters is to provide information that is relevant to the world of pain management. Rarely do we take a stance on a topic; but if we do, that stance has been, and will continue to be, taken in an article written by one of our staff members; not an article that was recycled directly from a source.
This being said, one of the articles posted in our In the News section sparked some controversy. This article, entitled “Reject Costly Pain Management Bill,” discusses a bill proposed in Tennessee legislature that would prevent individuals in Tennessee from receiving pain management services provided by certain health-care professionals; primarily certified registered nurse anesthetists (CRNAs). One doctor in particular expressed:
“[“¦] There is a significant gulf separating nurses from physicians in terms of education, training and experience. I have had the responsibility of working with a number of Advanced Practice Nurses (APNs) in my career and have noted, more frequently than not, the information that they do NOT possess and the professional judgment that is lacking. This, of course, is a result of not receiving the astonishing quantity of information imparted during Medical School and Residency and of not being trained to practice Medicine independently as we are.”
We, at Hartley Medical, assured this doctor that we were neither advocating for nor against this topic of discussion, but rather providing an article that is currently at the forefront of the pain world today. We believe that some of the strongest conversations develop through opposing viewpoints on controversial topics.
Hartley Medical services a wide range of clients, which includes practices run by nurse practitioners. Information that may be relevant to those practices may not be relevant to others; some may even be contrary to the personal philosophies and practices of other practitioners. We trust, however, that no matter your stance, you’ll agree with the necessity of bringing topics such as these to light, if only for the sake of education and awareness.
We assure you that our purpose of the “In the News” portion of our newsletter is not to endorse or promote one particular practice or idea over another; we simply hope to inform our readers of the ever-changing world of medicine. Whether this change is for the better is for the reader to decide.
This being said, we are interested to hear your opinions regarding this topic. To read the full article, click here. To view the May-June 2012 issue of The Hartley Standard, click here.
For more information, visit Hartley Medical’s Knowledge Center by clicking here.
I read the article you posted in your newsletter. I think you received the concerns you did from physicians was because of the title “Reject Costly Pain Management Bill.” I am a Pain Management Physician from Tennessee where this article was published and unfortunately you just linked to an editorial and not a unbiased news report on the Bill. As a result it looks like, on the surface, that you were supporting the case CRNAs were making regarding this Bill. This Bill has now passed the House and Senate in TN and is off to the Governor’s desk for signature. This bill has gone through 3 legislative sessions just to get to a full vote on the floor of the House and Senate. It passed easily despite many attempts to add amendments. It was amazing how well it did on the full vote since it took so long to get out of committee. The Bill does not limit the scope of practice of any CRNA or Midlevel provider. It only requires that these providers receive supervision of Physicians who actually are proficient in these procedures themselves and are credentialed to perform these procedures in a Hospital or ASC setting. The problem we have in TN is that there are many Midlevel providers doing spine injections on their own and without direct physician oversight. The physician supervisors were mostly primary care physicians who did not even perform these procedures as a part of their normal practice. The opposers of the Bill focused on the reduction of access to care and that the these procedures can be safely done by Midlevels. Physician groups in TN as well as ASIPP showed that there is not an access to care issue. There is a Board Certified Interventional Pain Physician within 60 miles of every town in TN. This is also not a pain management issue but specifically “Interventional Pain Management” issue. This Bill does not limit access to pain management with medications or treatments outside that of spinal injections. The damning evidence against Midlevels regarding the use of these procedures came from Medicare data. For facet injections, TN mid-levels billed Medicare for 58% of all facet injections billed by mid-levels nationwide in the three-year period 2008-10. By comparison, TN physicians billed Medicare for only 2.9% of all facet injections billed by physicians nationwide in the same period. Tennessee only comprises 2.5% of all Medicare enrollees. These procedures are often over-utilized and unnecessary. This comes back to proper patient selection and diagnosis. Personally, I think this is the practice of Medicine, but we chose not to go down that path with the Bill. In TN Nurse Practitioners and CRNAs fall under the Board of Nursing. What we saw in testimony, were Nursing leaders stating that performing these procedures were within their scope of practice since it was in their by-laws. That is why we had to go as far as passing a Bill to help regulate these practices. The Board of Medicine and Board of Nursing could not fix the issue together. There is nothing to stop nursing boards from writing anything into their by-laws. They can state that colonoscopy, arthroscopy, brian biopsy, etc are within their scope of practice. Virtually any procedure that can be performed in the office is fair game. There is no credentialing required. By requiring the supervising physicians have credentials to perform spine injections in a Hospital or ASC adds a higher level of competency. All Physician will make the argument that if you want to practice medicine then go to medical school. There is a reason why people to to nursing school and become PAs or even Chiropractors. They can always go to medical school if they want to do more. I had many of these individuals in my medical school class. They made that choice for a reason despite taking on more debt. I hope this helps to educate readers about this Bill and what we are dealing with here in TN.