SCOPE OF PRACTICE
KENTUCKY BOARD OF NURSING GUIDELINES FOR DETERMINATION OF APRN SCOPE OF PRACTICE
The APRN legal scope of practice includes prescribing treatment , drugs , devices , and ordering diagnostic tests . Prescribing of drugs is defined and limited by statute . The statute also states that the performance of the additional acts shall be consistent with the national certifying organization ’ s scopes and standards of practice , recognized by the Board . The Board recognizes the scope and standards of several national certifying organizations in 201 KAR 20 : 057 .
Source : https :// kbn . ky . gov / KBN % 20Documents / aprn-scopeof-practice-decision-making-model . pdf
80 %, or even down to 50 %, of the physician fee schedule . Now the social engineers are feeling good . By encouraging expansion of nurse practitioners and similar fields , the social engineers feel that they have improved access to care , lowered the costs at an individual CPT code level and maintained their assumptions that clinical outcomes will be equivalent at the population level .
But then comes “ creep ” in scope of practice . In Kentucky , nurse practitioners and similar fields are granted their practice authority by the Kentucky General Assembly ; and regulated by the Board of Nursing . The Kentucky General Assembly passed a bill on the “ Scope and standards of practice of advanced practice registered nurses .” ( 201 KAR 20:057 ). 5 This Bill defines “ Collaboration ” and “ Collaborative Agreements .” It does not really set clinical appropriateness for use of a scope of practice ; but refers to other definitions in the Board of Nursing . These include the Kentucky Board of Nursing : which includes the following statement on the scope of practice :
The vagueness of the statute from the Kentucky Board of Nursing is not too dissimilar to that of the Board of Medical Licensure . Over the years , especially during the COVID-19 pandemic , there has been an increase in the services that nurse practitioners have been providing . While there is a range of acceptable clinical practice for physicians , there has been concern over what services are ordered by some nurse practitioners . For example , Kentucky has one of the highest rates of ordering of Ozempic per capita , with a significant volume of prescriptions coming from nurse practitioners . 7 This drug , used for diabetes and for weight loss , costs around $ 1,200 a month . The nurse practitioners are regulated with a different licensing board than physicians , and yet the intention of the social engineers was for nurse practitioners to assume the roles equivalent to a physician .
Kentucky Medicaid allows billing for “ psychoeducation ” by anyone who holds a certification . The original intent of the code for this service was that it be limited to psychologists and psychiatrists . Kentucky has no limits on billing frequency so that this use of non-doctor certified professionals has now become a top tier behavioral health cost .
While there is certainly a need for nurse practitioners and other health care professionals , there is also a need to ensure that regulatory and licensure board oversight remains at a high level . Is it time for those engaged in social engineering to reassess the value proposition with the increasing complexity of services being provided by these health professionals ?
References :
1
AAMC , “ New AAMC Report Shows Continuing Projected Physician Shortage ” https :// www . aamc . org / news / press-releases / new-aamc-report-shows-continuing-projected-physician-shortage ( last accessed July 21 , 2024 )
2
Kentucky Board of Nursing , Initial - KBN https :// kbn . ky . gov / advanced-practice-registered-nurse / Pages / aprn-initial . aspx ( last accessed July 21 , 2024 )
3
Nurse . org , “ 15 Highest Paying Nursing Careers ” https :// nurse . org / articles / 15-highest-paying-nursing-careers / ( last accessed July 21 , 2024 )
4
Lohr RH , West CP , Beliveau M , Daniels PR , Nyman MA , Mundell WC , Schwenk NM , Mandrekar JN , Naessens JM , Beckman TJ . Comparison of the quality of patient referrals from physicians , physician assistants , and nurse practitioners . Mayo Clin Proc . 2013 Nov ; 88 ( 11 ): 1266-71 .
5
201 KAR 20:057 . Scope and standards of practice of advanced practice registered nurses . https :// apps . legislature . ky . gov / law / kar / titles / 201 / 020 / 057 /
6
Never Events . PSNet [ internet ]. Rockville ( MD ): Agency for Healthcare Research and Quality , US Department of Health and Human Services . 2019 . https :// psnet . ahrq . gov / primer / never-events
7
Prescriptions for Drugs Like Ozempic and Wegovy Are Highest in These States . Nancy Schimelpfening , MS . Healthline . January 31 , 2024 .
Dr . James is a part-time physician with Family Health Centers .
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