Proposed telehealth rule for nonphysicians draws fire

In Georgia, a proposed new telemedicine rule would prohibit nurse practitioners and physician assistants from treating patients unless those patients are first examined by a physician.

The proposal has created an outcry, with opponents saying it will hurt access to care--and pointing out that a physician exam is not required for them to treat patients by any other means, reports The Atlanta Journal Constitution. The Georgia Composite Medical Board is scheduled to vote on the plan today.

Dr. Jean Rawlings Sumner, the board's medical director, told the newspaper that the rule is designed to make sure these mid-level practitioners are working with a physician who is familiar with telemedicine technology. She said the board is listening to the opposition and keeping an open mind.

The article says Georgia will face a 5,000 physician shortfall by 2030, while the number of PAs and nurse practitioners has grown by close to 40 percent over the past five years.

Bill Rencher, health access program director for consumer advocacy group Georgia Watch, said the proposal goes beyond the scope of the Georgia Telemedicine Act, which was designed to increase access to care in underserved areas. He said PAs and nurse practitioners already must work within a written agreement with a physician and physicians are in the best position to judge what they can and cannot do.

The debate over whether PAs and nurse practitioners should be able to provide primary care independently has been heated. Many states credential nurse practitioners as primary care providers, a trend some expect to continue.

One recent study in Annals of Family Medicine estimated that 77 percent of preventive care could be delegated, leaving the most serious and acute cases to physicians. In Michigan, nurse practitioners have thrown their weight behind a state bill that would allow them to practice independently.

The role of physician assistants also is expected to expand under value-based purchasing. 

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