Scope of Practice Bill Sidelined by Sponsor
April 7, 2011—A bill that would create a more streamlined process for scope of practice changes is being tabled so legislators can focus their energy on more pressing healthcare transformation issues.
“I’m not motivated to work hard on [Senate Bill 225] this session,” said Sen. Laurie Monnes Anderson (D-Gresham), the bill’s sponsor, who's been encouraging professional mediation for medical provider groups struggling with scope of practice changes. “I feel that it’s a whirlwind right now.”
Moreover, added Monnes Anderson, the current mediation process in place, which has been utilized by dentists, naturopaths, psychiatrists, psychologists, and other healthcare professionals “is working well.”
The bill directs the legislature to ask the Oregon Health Authority to convene a scope of practice committee whenever changes to the clinical responsibilities of a healthcare provider were proposed. That committee would then make recommendations to the legislature about what changes to approve and deny, as well as whether the stakeholder groups should go through a professional mediation process to resolve their differences.
This approach takes its cue from the work of a scope of practice advisory group commissioned during the 2007 session, which engaged all healthcare provider associations in discussions and online surveys and also developed 37 criteria by which the legislature should evaluate proposed changes to scope of practice rules. Criteria included evidence of the proposed changes’ benefit to public health and the availability of educational testing and regulation.
“We found this process to be very helpful,” said Phil Donovan of the Oregon Association of Naturopathic Physicians, who went through an informal mediation process at Monnes Anderson’s suggestion. “[The legislature] made us do our homework, and present a lot of information in a way that’s easy for legislators to understand.”
Bill Cross, who represents the Oregon Optometric Physicians Organization and was a member of the 2007 scope of practice workgroup, also supported the bill.
“If there were some mechanism that would require parties to have neutral bodies to vet technical and scientific information and look at training and access issues, that would help the legislature understand issues better” and help them make informed decisions about scope of practice changes,,” he said.
But the Oregon Health Authority did not support the bill.
“Scope of practice would be a new area of work for the Health Authority,” said Jeremy Vandehy, the agency’s outreach director. “The bill includes that the authority should require that persons with an interest in scope cover the costs of arbitration, but it’s unclear as to how that would happen.”
Additionally, said Vandehy, “It’s presumed that costs would be covered through fees, but the bill doesn’t include authority for the authority to collect fees,” or any direction on how to prioritize scope change requests if multiple requests came in simultaneously.
“We’re in support of the concept,” said Courtney Dresser, a lobbyist with the Oregon Medical Association, “but we’d like to see issues addressed for criteria for what does get reviewed and what does not.”
Both Vandehy and Dresser acknowledged the importance of scope of practice issues in the context of Oregon’s healthcare transformation initiatives. “As we talk more about integrated healthcare homes and using different types of providers, scope of practice is a bigger issue,” said Dresser.
“[The Health Authority] appreciates the importance of ensuring that scopes of practice don’t create barriers to more efficient models of care,” Vandehy added.
Sen. Frank Morse (R-Albany) expressed frustration with the scope of practice challenge, but underscored his support for Monnes Anderson’s work on the issue.
“We’re laypeople, and the ability to distinguish between what’s economic and what’s clinical is very difficult,” said Morse. “How do we develop a process that gives us the information that we need, rather than a superficial lobby?”
He said that even though “I really don’t like this issue,” he wanted Monnes Anderson to “keep at it.” She definitely intends to follow his advice – just not before July.
TO LEARN MORE
Read The Lund Report’s past coverage of scope of practice issues here.