Executive Committee Minutes Conference Call of 7 / 22 / 2020
The AMS Executive Committee met via conference call on Wednesday , July 22 beginning at 6:05 pm . Present : Drs . Danny Wilkerson ( chair ), Chad Rodgers , Seth Barnes , George Conner , Bradley Bibb , and Dennis Yelvington . David Wroten and Mike Mitchell also attended .
1 . Chair Dr . Wilkerson called the meeting to order at 6:05 pm .
2 . The Committee approved Direct Membership status for 50 new AMS members and one current member eligible for Emeritus status .
3 . The Committee discussed issues referred by the Board of Trustees . Staff provided research on each of the issues .
Issue 1 . The Biometric / Wellness Screening program utilized by the Arkansas State and Public-School Life and Health Insurance Plan . This program is administered through a contract with Catapult Health . The state program is self-funded and administered by ABCBS .
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Texas physician supervising APRNs in Arkansas – The physician is the corporate supervisor of the APRNs rather than being a collaborative practice physician . The APRNs are not prescribing , so no collaborative practice agreement is required by Arkansas law . There is no requirement that this physician have an Arkansas license .
Compliance with Arkansas Telemedicine Act – The interaction between employees and Catapult APRNs is done either in person or using real-time audio video with a nurse at the originating ( job ) site and the APRN at the distant site . This complies with Arkansas law .
Compliance with ABCBS Provider Manual – While some of these services could not be provided by APRNs under ABCBS ’ s provider manual , this is a self-funded plan and the plan has the authority to allow this .
Involvement of the employee ’ s physician – These screens can be performed by the patient ’ s primary care physician . Last year , 72,000 screens were performed ; 26,000 of those were performed by a physician . During the screens , employees are asked if they have a primary care physician . If they do , Catapult provides the results of the screens to the physician for any diagnosis and / or follow-up . If not , Catapult staff will assist the employee in finding someone within a reasonable distance from their home / work that is taking new patients .
Issue 2 . Utilization of APRNs and PAs by specialists – The Nurse Practice Act requires APRNs “ with prescriptive authority ” to have a collaborative practice agreement with a physician who has “ training in scope , specialty , or expertise ” in the same area as the APRN . APRNs are required to have certification in one of several areas in order to be licensed . The Arkansas State Board of Nursing has a history of firmness in their regulation of this requirement . AMS is aware of several instances where the Board refused to allow an APRN to practice in an area that was not within their certification area . For example , an APRN with certification in “ Adult Nurse Practitioner ” would not be allowed to practice in a pediatric clinic . However , their certifications do not mirror physician board certifications and the nomenclature is significantly different . This does create confusion . It is important to note that the statute does not require the physician and APRN to have the same “ specialty ” certification . Furthermore , APRNs without prescriptive authority are not required to have a collaborative practice agreement at all .
Issue 3 . The Corporate Practice of Medicine – The “ corporate practice of medicine ” statute requires all shareholders of a medical corporation to be physicians . This would seem to prohibit hospital employment of physicians . However , this has become common practice and most hospitals have either found a way to comply or they assume no one will challenge the practice . More concerning is the potential for corporate entities to begin opening medical clinics . The primary concern and the reason for the corporate practice of medicine doctrine is to ensure that a physician ’ s fiduciary duty continues to be directly linked to their patients rather than the corporation whose primary fiduciary duty is to the shareholder .
Executive Committee Recommendations
1 . The Committee recommends that a letter be sent to the Arkansas State and Public-School Life and Health Insurance Board recommending that it add practicing physicians to its decision-making bodies .
2 . The Committee recommends that AMS legal counsel confer with the legal counsel of the Arkansas Hospital Association to investigate ways to strengthen the corporate practice act to ensure that patient care always takes precedence over corporate profits .
3 . The Committee discussed the idea of having an AMS policy supporting efforts to eliminate racial injustice and other discriminatory practices . AMS president , Chad Rodgers , MD , agreed to head an ad hoc committee to consider this issue .
4 . The Committee reviewed a recent statement from the Arkansas Chapter of the American Academy of Pediatrics stating their position that Arkansas schools should not be required to re-open to in-person learning until the CDC recommendations for downward trends are met .
5 . The meeting was adjourned .
254 • The Journal of the Arkansas Medical Society www . ArkMed . org