Discussion: United Behavioral Healthcare
In 2001, United Behavioral Healthcare conducted a national survey to better understand barriers to prescriptive privileges and availability of APRN-PMHNPs (as cited in Feldman et al., 2003). United Behavioral Healthcare surveyed the availability of a group of nurses and psychiatrists and the ability to receive patient referrals. Fifty-eight percent of the nurses had prescriptive authority but did not work in private practices. Of the 58% of nurses, only 16% had a strong desire to have a private practice regardless of the prescriptive authority. The most significant barriers to establishing a private practice included; billing and administrative burdens, the cost of malpractice insurance, the demands of current jobs, and difficulty obtaining referrals (Feldman et al., 2003).
The quality of the collaborative relationship between the nurse and physician was cited as another potential barrier to practice patterns. NPs cited concerns around the prescriptive practice agreement with physicians. Three cited barriers were; physician concerns about liability (24%), physicians’ choices of different drugs rather than supporting those selected by the NP (20%), and physician reluctance to prescribe medications selected by the NPs (20%) (Kaplan b Brown, 2004).
New York State legislation i In New York State, Assemblyman Gottfried and Senator Vbung have
sponsored legislation known as the NP Modernization Act (201 I) to amend the education law to allow NPs the right to practice without the statutory collaboration agreement. This bill would also provide direct and equitable insurance reimbursement to the NP for the same services performed by the physician. If approved, the NP Modernization Act will also establish an NP advisory panel, recommended by the State Board of Regents. The fiscal implications of this bill are to reduce the administrative costs for NYSED. This bill will also cut costs for institutions, since the institutions are currently charged with paying
the cost of the supervision for the statutory collaborative agreement (T. Nicotera, personal communication. May 5, 2011). However, it is unclear who will fund the administrative costs of the advisory board that is to be recommended by the State Board of Regents.
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