HB2451/SB1257, HB2437, SB1210, HB2457/SB1266, HB2443, HB578/SB549, HB2446, SB1261
Professional Licensure & Scope of Practice

The Massachusetts Health & Hospital Association (MHA), on behalf of its member hospitals, health systems, physician organizations and allied healthcare providers, appreciates this opportunity to offer comments on bills relative to professional licensure and clinician scope of practice.

HB2451/SB1257, HB2437 and SB1210 address issues surrounding the expansion of scope of practice for advanced practice registered nurses. MHA supports the expansion of scope of practice for all Advanced Practice Registered Nurses (APRNs) – including nurse practitioners, certified registered nurse anesthetists, and psychiatric clinical nurse specialists. MHA backs the ability of APRNs to have pathways to independent practice authority. MHA also recommends that the expansion of scope should include additional post-graduate training prior to full practice authority or independent practice for APRNs, including orientation, mentorship, or preceptorship. APRNs should also be granted the ability to supervise the process of their fellow nurses toward independent practice authority.

In concert with expanded scope, APRNs should also be held to the same standards of transparency, accountability, and professional responsibility under which physicians practice. This includes Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE), public reporting to the Department of Public Health or Board of Registration in Nursing, quality reporting tied to the practitioner, public reporting of medical malpractice awards or settlements, mandated medical malpractice liability policy limits, public reporting of any arrangements between practitioner and the pharmaceutical industry, continuing education requirements, and peer review. And like physicians, APRNs must carry professional liability insurance in order to practice.

APRNs are guided by specialty-related national and local standards of care, their education and training, and specific regulations governing their scope of practice. Consistent with recommendations from The Joint Commission, OPPE is appropriate for all clinicians, including APRNs. There may be gaps in organizational structures supporting OPPE and, where there is appropriate movement towards full practice authority, steps should be taken to ensure that structure and accountability is the same for all licensed independent providers. At the institutional level, scope of practice should be determined by education, training and experience for APRNs as it is for physicians. It should be expected and verified that an individual’s practice is within his/her education, training, and experience, and that he/she functions within professional boundaries with ongoing professional evaluations.

While MHA supports the intent of HB2457/SB1266, we urge the committee to consider the addition of further protections to this proposal. HB2457/SB1266 provides important liability protections to registered nurses who volunteer services in a disaster or emergency without compensation or expectation of payment. Additionally, it provides a means of financial coverage to a volunteer in cases of injuries, disabilities, or death. While this is a very important coverage item, it should also include protections for all members of the healthcare team that provide these services to patients. We strongly encourage the committee to expand the bill to specifically apply to a “healthcare provider” as that term is defined in Section 1 of Chapter 111 of the General Laws. All healthcare providers should be afforded these protections when volunteering services during public health emergencies.

MHA also supports the intent of the provisions in sections 2 & 3 of HB2443 that will align Massachusetts rules with federal standards that currently allow appropriate clinicians to provide telemedicine services within their licensure and scope of practice standards. Currently, healthcare providers (physicians and other allied health professionals) must follow specific scope of practice criteria to be licensed to provide healthcare services. Yet Massachusetts still requires providers seeking to offer telemedicine services to go through an extensive and duplicative licensure and credentialing process at each site of care (which requires detailed documentation of Primary Source Verification of each clinician’s education, skills, trainings, and more). This unnecessary process adds to the increased costs and time delays for each facility, while offering no benefit to quality or safety. Sections 2 & 3 of HB2443 direct the respective boards of registration for various healthcare providers to promulgate regulations allow licensees to obtain proxy credentialing and privileging for telemedicine services with other healthcare providers or facilities in a manner consistent with existing federal Medicare Conditions of Participation telemedicine standards. While MHA is supportive of the intent of sections 2 & 3 in HB2443, MHA, along with the Massachusetts Telemedicine Coalition (tMED), instead recommends the approach outlined in HB578/SB549 which comprehensively seeks to address telemedicine coverage parity, proxy credentialing for telemedicine and includes an updated flexible definition of telemedicine to encourage the widespread adopt ion of telemedicine here in Massachusetts.

MHA is opposed to HB2446 as it prohibits hospitals from requiring maintenance of certification or recertification for privileging in hospitals. While the current maintenance of certification process is problematic, improvements to the current program are under consideration. HB2446 recommends a dramatic departure from current practice, as hospitals have recognized medical specialty certification as independent confirmation that a physician is maintaining the knowledge and skills necessary to provide safe, high quality specialty care. While hospitals should be able to consider board certification and maintenance of certification during credentialing and privileging deliberations, it should be considered as one of many factors in determining medical staff eligibility, not the sole factor. Board certified physicians practice safe, high quality medicine and tend to incur fewer disciplinary actions by state medical licensing boards. They complete practice-relevant continuing medical education, take periodic knowledge and skill assessments and participate in important activities that improve the quality of their practices. Board certification and maintenance of certification signify to the public, including hospitals, that a physician is up to date with emerging medical advances and has a working knowledge of the rapidly changing medical treatment therapies and techniques in his/her medical specialty.

MHA opposes SB1261. While MHA supports efforts to ensure patient safety and the competency of all members of the healthcare team, we are concerned the restrictive nature of this bill would offer an unsound, random, and arbitrary approach to the identification of physicians, and would eliminate the ability of BORM to determine appropriate consequences for a physician convicted of medical malpractice. Medical malpractice cases are each extremely different in nature, and a jury verdict of negligence is not always based on science. A physician who is sued three or more times and found by a jury to be “not negligent” may be less safe than one who is found to be negligent. Under current law, BORM collects data from licensees on malpractice claims and their outcomes, with the objective of evaluating trends and ensuring proper conduct by physicians. MHA believes that the collective experience of BORM is the correct forum in which to determine whether a license should be revoked or limited based on the nuances of each particular case. The current process to determine revocation of medical licenses in Massachusetts is adequate and the rigid proscription proposed by SB1261 is inappropriate in light of the realities of the medical malpractice arena. MHA respectfully urges the committee to reject SB1261.

Thank you for the opportunity to offer testimony on these important matters. If you have any questions, or require further information, please contact Michael Sroczynski, MHA’s Vice President of Government Advocacy, at (781) 262-6055 or msroczynski@mhalink.org.