Louisville Medicine Volume 62, Issue 4 | Page 33

ications that have complex interactions and potential side effects that are less predictable than controlled substances, despite claims to the contrary. Physicians finally presented how physician-led team-based care, along with efficient applications of technology, can dramatically reduce the impact of physician shortages. In hopes of improving collaborative agreements in Kentucky, KMA and KAFP offered to develop a clearinghouse of physicians who would be willing to work with nurses who lose their collaborating physicians through no fault of their own, and the organizations recommended building on legislation proposed in the Senate for the previous two years regarding improving the collaborative agreement in a way that would allow for better transparency and for efficient and fair resolution of grievances, including complaints of excessive fees. After further discussions revealed that the KCNPNMW was committed to eliminating rather than improving the collaborative agreement, and proposals to develop a Joint Medical/Nursing Board while holding independently prescribing APRNs and physicians to the same professional liability standards were deemed non-starters for further discussion, physicians proposed the following: (a) form a Joint Advisory Committee made up of equal parts Kentucky Board of Nursing and Kentucky Board of Medical Licensure, and charge it with monitoring APRN-written prescriptions, developing a standardized collaborative agreement form, and advising each Board on the issue; (b) develop a process for APRNs who wish to practice and prescribe independently that includes a requirement to complete several years of meaningful collaborative practice with a physician who specializes in the APRNs area of focus; (c) incentivize APRNs to serve in one of Kentucky’s approximately 80 medically underserved areas by establishing a rural/underserved area carve out for nurses who opt to prescribe without a collaborative agreement; and (d) allow APRN’s to maintain the protection of their existing collaborative agreements as the default. The final agreement that is now law was made within the confines of a smaller group that Dr. Waldridge and I were not a part of. In essence, it establishes a requirement for a newly graduated APRN to maintain a collaborative agreement for four years, after which time the APRN may opt to prescribe independently in any part of the state with no stipulation about his or her area of practice. Meaningful collaboration is not required during any part of the process. The Joint Advisory Committee will be established with no definitive authority to make recommendations regarding collaborative agreements or prescribing, and it will not monitor prescriptions written by APRNs who have opted out of the collaborative agreement requirement. It may, however, develop a standardized collaborative agreement form, and hopefully it will opt to do that in a manner that provides transparency and guidance without being unnecessarily restrictive. (See 2014 Senate Bill 7.) The combination of focused physician engagement, enhanced professional lobbying, and dedicated legislative champions allowed for compromise with physician input on the APRN collaborative agreement issue. Ultimately, however, KCNPNMW, the group that had been the most active -- both in Frankfort where policy is made and in