Latest news with #HouseBill1116
Indianapolis Star
06-08-2025
- Health
- Indianapolis Star
Rural hospitals are closing. Nurses could help, if Indiana would let them.
Rural hospitals across Indiana expect to face severe financial difficulties after state and federal Medicaid cuts. That's, in part, because it is harder to retain physicians in rural areas, where the population is more dependent on government assistance, suffers from worse health and faces greater barriers to care. State Rep. Cindy Ledbetter, R-Newburgh, has floated an idea to address this problem every year since she joined the Indiana General Assembly. Her latest effort, House Bill 1116, would have allowed advanced practice nurse practitioners like herself to write prescriptions without needing a collaborative practice agreement with a physician. The problem with collaborative practice agreements, Ledbetter told me, is that they require physicians to review at least 5% of the patient care they provide. 'It creates unnecessary barriers for APRNs to care for patients, limits access and increases costs, (because) some physicians charge $500 an hour or more to review these charts and the hospital administrative fees for writing these agreements are very burdensome,' Ledbetter said. 'So if an APRN wanted to open a medical practice in a rural community, and they had the state average of 2,400 patients, that would be a minimum cost of $15,000 a year.' Nurse practitioners often have just as many years of medical training and education as a physician. Nonetheless, Ledbetter's proposal has never received a hearing. Studies show nurse practitioners tend to move into rural and high-need areas when requirements for collaborative practice agreements are removed. This is important. More than 65% of Indiana counties are considered a primary care professional shortage area or contain a shortage population, while all but 10 of Indiana's 92 counties are considered a mental health professional shortage area. More: Trump's tax bill will crush the rural voters who chose him Modifying medical scope of practice is nearly always a controversial topic with lobbyists, even in fields as seemingly mundane as horse dentistry. Gov. Mike Braun, however, has signaled his approval for eliminating unnecessary professional licensing requirements and regulations. The legislature should take this into account and finally acknowledge this very small-government way to address the state's physician shortage. Lobbyists argue that medical professionals with a slightly different type or length of education will perform a health service significantly worse. The underlying motivation to their opposition, however, seems to be job security. 'During a meeting with the members of the Indiana State Medical Association, it was shared that there is concern that if the collaborative agreement is terminated, hospitals may lay off physicians and replace them with advanced practice nurses, and this is not something that's going to occur,' Ledbetter told me. But, she added, "when you interview these individuals about the legislation, they will tell you that they are concerned about policy and safety and that the APRNs do not have as much education as the physicians.' Opinion: Give medical decisions back to patients, doctors There is a great deal of evidence that granting full scope of practice to nurse practitioners does not lower health outcomes. If nurse practitioners can provide similar health care outcomes at a lower cost, there is no reason to overburden them with regulations. Midwives are another type of health care provider required to work under a physician under Indiana law, despite Indiana's relatively high maternal and infant mortality and lack of obstetric care in rural areas. These professionals are generally utilized during home births. Studies have also shown that they have similar health outcomes to hospital births and can increase the accessibility of care in rural areas. These two examples show Indiana has a broader problem of overburdening health care providers that don't have a doctor of medicine degree with costly regulations — possibly because both the House and Senate committees in charge of the state's health care are run by physicians. "Practitioners' scope of practice is just one of several policy tools to improve access," state Rep. Brad Barrett, R-Richmond, chair of the House Public Health Committee, said in a statement. "However, recent studies from the American Medical Association and the Journal of Rural Health show advanced practice registered nurses tend to follow the same geographic distribution patterns as physicians regardless of scope of practice laws, raising doubts about whether changing those laws would actually improve access." Their preferred strategy has long focused on making health care more competitive and transparent in an attempt to make it more affordable, but those reforms also tend to arbitrarily exclude health care providers without an M.D. 'Giving a one-time tax credit to a physician to open a medical practice is not going to provide much change,' Ledbetter said. 'The reason being is that physicians cannot sustain private practices (in rural areas) due to low Medicaid reimbursement rates, rising processing costs and administrative burdens. … Another thing that's frustrating as an APRN is that bill only allowed for the physicians to have those tax credits.' Other reforms seem to directly work against rural providers. 'I think the financial pressures that recent legislation has passed on hospitals are actually causing increased consolidation," Ledbetter added. Perhaps if there were more representation from other types of health care providers in the legislature, there would be greater support for simply eliminating unnecessary regulations to help all medical professionals meet people where they are. Even in places without the difficulties faced by rural communities, physicians are overworked and often forced to spend most of their time on administrative tasks. Nurse practitioners can be vital partners in their efforts to deliver affordable health care, especially in Indiana's rural communities, if the state would just remove the regulations that keep them from efficiently doing their job.
Yahoo
08-04-2025
- Health
- Yahoo
Rep. Pugh introduces bill to study 'forever chemical' effects
Apr. 7—HARRISBURG — Rep. Brenda Pugh on Monday said an analysis of data from the National Center for Health Statistics (NCHS) estimates that at least 95% of Americans have PFAS chemicals in their bodies. Pugh, R-Dallas Township, introduced legislation that would direct the Pennsylvania Department of Environmental Protection (DEP) to conduct a study to better understand the potential risks that certain land-applied biosolid chemicals pose to the environment, food and water supply, and potential mitigation measures to reduce these chemical levels. Pugh said the chemicals are known as PFAS — per- and polyfluoroalkyl substances — and are a large group of nearly 15,000 synthetic chemicals that have seen wide use in consumer products since the 1940s. Pugh said PFAS are generally highly durable and water-resistant, and as a result are referred to as "forever chemicals" that can persist in the environment, water, air, soil and even the human body for long periods of time. "Because of the many kinds of PFAS, and their wide range of uses, they are difficult to study," Pugh said. "However, many studies have found that exposure to certain types of PFAS can have serious impacts on human health, including decreased fertility, developmental delays in children, increased risk of certain cancers, hormone disruption, inhibited immune system responses and more. Pugh added that while federal and state agencies have taken effective steps that already have or are estimated to reduce the levels of PFAS exposure of Americans, there are still many sources of exposure that are not well understood. "Ingesting contaminated food and water is one of the most common avenues of human exposure, which makes it critical that we fully understand how these chemicals enter our food and water supplies," Pugh said. House Bill 1116 has been referred to the Environmental and Natural Resources Protection Committee. Pugh said all residents are encouraged to contact their legislators and encourage their support of this bill. Reach Bill O'Boyle at 570-991-6118 or on Twitter @TLBillOBoyle.
