LEGISLATIVE UPDATE LOUISIANA LEGISLATURE ADJOURNS SINE DIE Maria Bowen, LSMS - Vice President Governmental Affairs
PRESIDENT’S MESSAGE Independent Practice for Nurse Practitioners and Physician Assistants is Bad Medicine for Louisiana.
Louisiana’s 2021 regularly-scheduled, fiscal-only session of the Legislature adjourned sine die on Thursday, June 10, at 6 p.m. For LSMS andourmembership, thesessionwasdominatedbynon-fiscal legislation, but we would be remiss in not sharing the passage of five bills pushed by legislative leaders with the backing of the business community.
For physicians, the 2021 session focused on two controversial issueareas: scopeof practiceandnoncompete clauses. Incredibly, LSMS members delivered more than 75,000 messages through email and text to legislators on the following bills. We thank you for your advocacy on behalf of your profession!
The first four bills are a package including a constitutional amendment that must pass a vote of the people prior to any taking effect: • SB 159 (Act 134) by Sen. Bret Allain (R-Franklin) is a Constitutional Amendment which would remove the requirement of a federal income tax deduction and would cap the maximum individual income tax rate at 4.75 percent. It will appear on the October 9 ballot. • SB 161 (Act 389) , also by Sen. Allain, eliminates the federal income tax deduction and phases in lower franchise tax rates gradually as certain positive economic and tax revenue triggers are met. • HB 278 (Act 395) by Rep. Stuart Bishop (R-Lafayette) eliminates the federal income tax deduction and lowers individual income tax rates with similar tax revenue triggers. • HB 292 (Act 396) by Rep. Neil Riser (R-Columbia) reduces the number of tax brackets for corporate income taxes, lowers rates and eliminates the federal income tax deduction. • HB 199 (Act 131) by Speaker Clay Schexnayder (R-Gonzales) creating the State and Local Streamlined Sales andUseTaxCommissionwill alsobeon theOctober 9 ballot. If approved by the voters, this commission will be tasked with the promulgation of rules aimed at simplifying electronic filing and remittance of local sales taxes. It will also serve as the entity to perform audit functions for out-of-state businesses and develop rules to streamline the audit process for companies with a physical presence in Louisiana.
Medicare beneficiaries from 2003 to 2015, found ordering increased substantially—more than 400% by NPs and PAs during this time frame. They further found greater coordination in health care teams may produce better outcomes than merely expanding scope of practice. A 2020 study published in the Journal of Internal Medicine found, that in states that allow independent prescribing, NPs were 20 times more likely to overprescribe opioids than those in prescription-restricted states. Furthermore, while the number of NPs doubled between 2010-2017, there has been no noticeable increase of nurse practitioners within rural, underserved areas. A recent CMS study confirmed few nurse practitioners choose to work in rural areas following graduation. It’s clear: scope of practice changes do not benefit patients, they benefit for-profit entities and non- physicians. Legislators must see past the false promises and oppose continued legislative efforts to increase scope of practice for non-physician practitioners. ■
On scope of practice, we had four pieces of legislation that we focused on:
Allowing non-physicians to provide physician-level care would be a step in the wrong direction. We must continue to educate legislators and encourage their oppostion to bills like HB 495 and HB 442, which risk patient safety, increase costs, and do not improve access to care. The best way to ensure patient safety is to keep physicians at the helm of the health care team. Patients deserve the most qualified health care provider, and that is a physician, who has unmatched training, education, and experience. Scope of practice changes do not decrease costs, nor do they increase access to care. Studies from the Mayo Clinic and JAMA found nurse practitioners (NPs) and physician assistants (PAs) are more likely to make unnecessary referrals and imaging orders, resulting in higher costs for patients. A study in the Journal of the American College of Radiology, which analyzed skeletal x-ray utilization for
• HB 495 by Rep. Barry Ivey (R-Baton Rouge) would have granted full practice authority to advanced practice registered nurses. This legislation was the most contentious bill of the entire session and finally died on the calendar when the legislature adjourned. LSMS and other physician groups fought hard to educate legislators as to the dangers associated with the bill. As the legislature adjourned, the Louisiana Association of Nurse Practitioners has already challenged its membership to continue advocating and promised to return next year. It is incredibly important for our membership to remain engaged and work to educate your legislators on our concerns. • HB 442 by Rep. Larry Bagley (R-Stonewall) would have changed how all physician assistants practice by removing physician involvement from any requirement of oversight. This bill died on the house floor with a 39 to 39 tie vote. • HB 181 by Rep. Dustin Miller (D-Opelousas) was intended to provide mental health nurse practitioners the ability to admit patients to inpatient mental health hospitals among other items. The bill was amended to only allow these items to occur if authorized by a
President Louisiana State Medical Society
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J LA MED SOC | VOL 173 | SUMMER 2021
J LA MED SOC | VOL 173 | SUMMER 2021
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