TMA remains steadfast in advocating for policies that improve and strengthen interprofessional relationships, not weaken them. We also aim to ensure Tennessee's physician oversight structure is working as intended. In pursuit of a more efficient collaborative care model, our organization has offered numerous proposals to modernize regulation of the professional working environment and better utilize all members of the health care team. Unfortunately, those groups advocating for non-physician practice have been unwilling to consider solutions to improve collaboration.
- AMA data shows that primary care physicians, APRNs and PAs tend to work in the same geographic areas in Tennessee and other states, regardless of the level of autonomy allowed by state policies. These providers are no more likely to open or maintain rural practices than primary care physicians for the same economic reasons.
- 2022 legislation permitting remote site visits (P.C. 949) via telehealth allows for more frequent and effective collaboration between physicians and the rest of the healthcare team despite geographic challenges.
- It has been suggested that APRNs and PAs can provide comparable care to primary care physicians at a fraction of a cost, but any cost savings realized are often offset by increased utilization of other healthcare services, including referrals to specialists, increased diagnostic imaging and increased opioid and antibiotic prescribing.
- Mid-level providers claim that they can fill a healthcare gap in Tennessee communities where hospitals have closed, but primary care offices staffed with PAs or APRNs are not equivalent to physician-led emergency and specialized care access via hospitals.
- Patients overwhelmingly prefer to have a physician involved in their care and deserve access to safe, high-quality care led by a physician no matter where they live.
- Severing the formal collaborative practice agreement will neither increase access to care nor lower health care costs.
COALITION FOR COLLABORATIVE CARE
In 2018, TMA organized a coalition of the state’s largest medical specialty societies to identify and promote best practices for physician-led, team-based healthcare delivery in Tennessee and develop a solution(s) to increase access across the state. The group meets regularly to discuss how the state might improve the regulatory environment to support more efficient primary care, particularly in rural, underserved areas of the state, as an alternative to mid-level independent practice.
In addition to the CCC, Tennessee physicians are working to address rural access through the Project Access initiative and the Tennessee Charitable Care Network (TCCN).
Project Access provides access to specialty medical care at no cost to the residents of several counties in Tennessee who lack health insurance and are unable to afford the medical care they need.
It functions as a clinic without walls that solicits and coordinates donated specialty care (physician, hospital, lab, and other resources) for uninsured individuals.
- Provides specialty care coordination for 117 health clinics and centers (Chattanooga – 14 health centers; Knoxville – 40 health center locations; Nashville – 42 health centers; AMPA – 21 health centers)
- Project Access programs have provided $740.5 million in donated health care services provided by 6,233 volunteer physicians and 34 hospital campuses, coordinating for patients are 117 health centers and clinics.
- In FY 2021, Project Access programs coordinated $53 million in donated health care services, a return on investment of $9 of care for every dollar of grant funding.
- By providing access to specialty care services, the Project Access care coordination strategy has been documented to increase the productivity and capacity of primary care centers.
TENNESSEE CHARITABLE CARE NETWORK
TCCN is Tennessee's network of nonprofit clinics and programs providing free or reduced cost health care services to those in need. Its mission is to support, educate, and represent nonprofit organizations that provide charitable healthcare services to low-income, uninsured, and underserved Tennesseans.
- The TCCN is comprised of 23 urban members and 25 rural.
- West – 5 members in 5 locations
- Middle – 22 members in 26 locations
- East – 22 members in 24 locations
- In FY 2021, the health care safety net provided quality health care services to 250,672 uninsured and underinsured patients, representing more than 587,434 care encounters.
TMA'S NOTABLE ACHIEVEMENTS
TMA entered session with scope of practice as its top legislative priority and, after unsuccessfully attempting to reach common ground with nurses and physician assistants prior to the start of session, filed a placeholder caption bill that gave legislators an alternative to APRN independent practice and a more reasonable solution for addressing healthcare access without compromising patient safety or quality of care.
The Tennessee Nurses Association wasted no time filing a bill for independent practice (SB 2110 / HB 2203).
TMA and the Coalition for Collaborative Care were united in opposing the bill, and our deep collaborative work with legislators and other partners killed the Nurses' association bill. This helped keep Tennessee physicians supervising patient care and prevent inappropriate scope of practice expansion by mid-level healthcare providers.
The nurse independent practice bill was one of several bills that would expand scope of practice for mid-level healthcare providers. Learn about the other bills in this brief video.