Restrictive Collaboration : One States Story
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1) The document discusses restrictive collaboration laws for nurse practitioners (NPs) in Alabama, including requirements that NPs have 10% on-site supervision by a physician and a 1:3 ratio for physician to NP collaboration. 2) Statistics on NPs in Alabama show there are far fewer NPs per capita in Alabama compared to the US overall, and many rural areas are underserved. 3) The document outlines strategies for Alabama NPs to advocate for less restrictive collaboration laws, including educating the public and legislators, building coalitions, and participating in the political process.
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Restrictive Collaboration : One States Story
- 1. Dr. Lori Lioce, CRNP, FNP-BC AANP 26 th Annual Conference Presentation Las Vegas, Nevada June 25, 2011 Restrictive Collaboration One States Story
- 4. America’s Healthcare Rankings 2010 ALABAMA OUTCOMES 49th
- 15. ADVOCACY MUST CONTINUE FOR CHANGE TO PREVAIL
Editor's Notes
- kets. Fundamentalist Christian values also play an important political and cultural role in the state. As in most of the South, Republicans have made very dramatic gains (especially for higher office) in a state that was pre- viously solidly Democratic. Governor Forrest “Fob” James is a Republican, but the legislature remains heavily Democratic.Structurally, Alabama state gov- ernment is characterized by a strong governor and a weak legislature and minimal delegation to counties of control over public programs. Part- time legislators meet for only 30 working days within a 105-calendar- day session each year and have very small staffs. Legislators have a strong local focus, reflecting an unusual aspect of Alabama’s constitution that greatly restricts the power of county government. As a result, matters of local interest are often taken up by the state legislature. The short length of the legislative session, the lack of leg- islative staff, and the emphasis on matters of local interest often mean that little time is available to address issues of statewide importance other than the budget.Alabama—along with Missis- sippi—is inextricably associated with the civil rights revolution of the 1950s and 1960s. Overt racism by public officials has disappeared, but many observers, especially black persons, believe that race is still an extremely important determinant of state and local policy.The budgetary environment of the state is determined by two related fac- tors. First, there is very strong anti-tax sentiment in Alabama. Although there is a modest state income tax and a rel- atively high sales tax, property taxes are among the lowest in the country. Overall, state and local taxes per capi- ta are very low. Second, the vast majority of Alabama taxes are ear- marked for one of two funds—the gen- eral fund and the Alabama Special Educational Trust Fund. Sales and income taxes, which account for the bulk of revenues, are earmarked for education purposes, while a wide vari- ety of miscellaneous revenue sources fund the rest of state government, including Medicaid, public health, welfare, and public safety. The netPopulation (1994–95) (in thousands)4,314260,202 Percent under 18 (1994–95)27.4%26.8% Percent 65+ (1994–95)13.6%12.1% Percent Hispanic (1994–95)0.8%10.7% Percent Non-Hispanic Black (1994–95)28.9%12.5% Percent Non-Hispanic White (1994–95)69.6%72.6% Percent Non-Hispanic Other (1994–95)0.7%4.2% Percent Noncitizen Immigrant (1996)*0.9%6.4% Percent Nonmetropolitan (1994–95)36.8%21.8%Population Growth (1990–95)5.3%5.6% EconomicPer Capita Income (1995)$19,181$23,208 Percent Change in Per Capita Personal Income (1990–95)26.0%21.2% Unemployment Rate (1996)5.1%5.4% Percent below Poverty (1994)17.6%14.3% Percent Children below Poverty (1994)23.8%21.7%HealthPercent Uninsured—Nonelderly (1994–95)16.9%15.5% Percent Medicaid—Nonelderly (1994–95)10.4%12.2% Percent Employer-Sponsored—Nonelderly (1994–95)66.3%66.1% Percent Other Health Insurance—Nonelderly (1994–95)6.4%6.2% Smokers among Adult Population (1993)18.5%22.5% Low Birth-Weight Births (<2,500 g) (1994)9.0%7.3% Infant Mortality Rate (Deaths per 1,000 Live Births) (1995)10.27.6 Premature Death Rate (Years Lost per 1,000) (1993)67.154.4 Violent Crimes per 100,000 (1995)632.4684.6AIDS Cases Reported per 100,000 (1995)15.127.8 Source: Complete list of sources is available in Health Policy for Low-Income People in Alabama (The Urban Institute, 1997). * Three-year average of the Current Population Survey (CPS) (March 1996–March 1998, where 1996 is the center year) edited by the Urban Institute to correct misre- porting of citizenship. Please note that these numbers have been corrected since the original printing of this report.Political and Fiscal LandscapeConservatism mixed with pop- ulism characterizes Alabama politics among Democrats and Republicans alike. According to some observers the state’s conservatism is rooted in maintenance of the status quo, rather than in a philosophical commitment to the superiority of competitive mar- effect of these two related factors, in conjunction with the relatively low average income of the population, is that financial resources for health and welfare are unusually constrained. Programs often rely extensively on federal funds, and the state operates few, if any, programs of fiscal signifi- cance that do not qualify for federal support. It should be noted that politi-cal and, thus, budgetary support for Medicaid is higher than for cash welfare assistance, in part because well-financed provider groups that are financially dependent on Medicaid, particularly the for- profit nursing home industry, lobby to protect the program.
- In FY 2003 the Board voted to establish a Center for Nursing within the organizational structure of the Board to collect, analyze, and disseminate nursing workforce data. In May the operational plan for the Center for Nursing was approved. The Board is now in the process of identifying a qualified director for the Center. Implementation of the Center is expected in FY 2004. No CRNP CNM data reported in 2003---
- Steadily fallen
- Health_ExpEstimate of dollars spent per person on public health. PH_SpendingState funding dedicated to public health as well as federal funding directed to states by the Centers for Disease Control and Prevention and the Health Resources and Services Administration, expressed on a per capita basis. This represents the annual investment being made in public health programs to monitor and improve population health. See &quot;Measures & Changes&quot; (http://www.americashealthrankings.org/2010/component/details. aspx) for more information on individual measures.
- HealthInsurancePercentage of the population that does not have health insurance privately, through their employer or the government. This is an indicator of the ability to access care as needed, especially preventive care. HealthInsurance Two-year average of the percentage of the population that does not have health insurance privately, through their employer or the government. This is an indicator of the ability to access care as needed, especially preventive care. See &quot;Measures & Changes&quot; (http://www.americashealthrankings.org/2010/component/details. aspx) for more information on individual measures.
- Special Sessions may be called at any time, by the Governor, for emergency or extraordinary reasons. Special Sessions can consist of no more than 12 Legislative (meeting) days, within a 30 Calendar day period. In his/her Proclamation, calling the Legislature into such session, the Governor will state the date and time for convening of such session.
- Statewide Health Coordinating Council (SHCC) --. A council, appointed by the Governor, established pursuant to Sections 22-4-7 and 22-4-8 to advise the State Health Planning and Development Agency on matters relating to health planning and resource development and to perform other functions as may be delegated to it, to include an annual review of the State Health Plan. Appointed by the governor, the Council makes recommendations for development of state health policy. All members are medical doctors. The council shall have not less than 16 members appointed by the Governor from a list of not less than five nominees submitted by each health systems agency which falls, in whole or in part, within the state. Each health systems agency shall be entitled to not less than two members of the council, and each shall have the same number of members. Of the representatives of a health systems agency, not less than one half shall be individuals who are consumers of care and who are not providers of care. In addition, the Governor may appoint such persons, including state officials, public elected officials and other representatives of governmental authorities within the state, to serve on the council as he deems appropriate; provided, however, that the number of such persons appointed to the council shall not exceed 40 percent of the total membership of the council, and a majority of such appointees of the Governor shall be consumers of health care who are not also providers of health care. Alabama Department of Public Health – The Department of Public Health is mandated to provide services for the improvement and protection of the public’s health. Much of its work is in the areas of Prevention and Education. The State Board of Health serves as an advisory board in all medical matters. Dr. Don Williamson is the state health officer. Funding for the Department is passed each year by the Legislature and comes from the General Fund. When the fund runs short, services have to be cut. Governor’s Office -- Influences health decisions through budget and policy recommendations to the Legislature as well as nomination of department heads and other positions such as SHCC. Legislature -- Provides funding and oversight for state programs. U.S. Government -- Sets mandates for many state programs and impacts state budgets and programs through matching fund requirements. Certificate of Need Review Board (CON) -- Requires hospitals, nursing homes, ambulatory surgery centers and diagnostic imaging facilities to have explicit approval before they can operate. The Birmingham News (Oct. 14, 2007) printed an article suggesting that CON provides less choice and less innovation and likely never controlled costs and should be discontinued. This is a very debatable subject.
- R=RULES
- & to Utimately to improve health