Few issues garnered as much attention and heated debated this legislative session as a bill passed by the House last week that expands the independence of nurse practitioners.
The measure, which has the support of Gov. Dannel P. Malloy, allows advanced practice registered nurses, or APRNS, to practice on their own after working in collaboration with a physician for their first three years.
Currently APRNs, which are legally allowed to diagnose patient illnesses and prescribe drugs, are required to work in a collaborative arrangement with doctors at all times.
Now they’ll gain more freedom to operate on their own. The bill makes sense, particularly at a time when access to primary care needs to be expanded as more Connecticut residents gain insurance through federal healthcare reform. Doctors have already warned about a potential physician shortage. Allowing APRNs to handle primary care duties with greater freedom seems to be a cost effective answer.
The Connecticut State Medical Society, however, has raised serious concerns about the bill, warning it could negatively impact patient safety and healthcare transparency. The doctor’s group is particularly upset that the bill passed by both the House and Senate, unlike similar laws in other states, didn’t provide details about the structure of the three-year collaborations, educational requirements or oversight in establishing independent APRN practices.
Those are legitimate concerns and lawmakers should have fleshed out more of the details. All too often legislation is passed without important regulatory guidelines, opening the window for interpretations of the law that don’t necessarily reflect original intent. Before this new law goes into effect, lawmakers or state regulators must clarify the rules APRNs must follow.
But let’s not kid ourselves, turf wars are also clearly at play. Primary care doctors have more training than APRNs; physicians must complete four years of medical school and three years of residency, while APRNs need a graduate degree and certification from a national association. APRNs that open their own practice will create added competition for primary care doctors.
You can understand the angst of a more highly trained physician potentially losing patients to an APRN practice.
Still, it would seem there is and will be a large enough patient base to meet any new supply of primary care providers.
CT’s fiscal house not in order
Connecticut’s fiscal house of cards appears to be collapsing.
Just months after Gov. Dannel P. Malloy proclaimed that his fiscal stewardship would generate a $500 million surplus this fiscal year, projected excess revenues have dwindled to $43 million. That has forced Malloy to scrap his plan to offer individual taxpayers $55 rebates. It also threatens his ability to replenish the rainy day fund and payoff long-term debt.
Even worse, next year’s projected deficit has swelled to nearly $300 million, while Connecticut taxpayers face a daunting $1.4 billion deficit in fiscal 2016.
The bleak budget projections, released last week by the legislature’s nonpartisan Office of Fiscal Analysis, are a result of plummeting tax receipts, particularly income tax revenues.
The numbers indicate Connecticut’s financial house is not in order, even after Malloy pushed through the largest tax increase in Connecticut’s history in 2011. In fact, our state budget appears to be broken. One time revenues are keeping the current budget afloat. When those expire, the state faces another billion-dollar deficit.
How lawmakers handle this fiscal mess will determine the state’s economic competitiveness for years, maybe even decades to come. We can no longer tax our way out of red ink. A new approach to state government, one that leans out bureaucracy and reinvents the way services are delivered must be considered.
