Managed Care Organizations

Managed Care Organizations


Managed Care Organizations

The collaborating psychiatrist would not allow the NP to work with adolescents younger than 14 years old, and they had to be of adult height and weight. The clause in the education law states that if there is a disagreement between the NP and the physician, the physician’s preference takes precedence in spite of the NP’s educational level or years of experience (NPANyS, 2009a). Twenty years ago, statutory collaboration was developed as a political compromise. The statutory collaborative agreement serves no public purpose, nor is it a substitute for professional judgment. Healthcare professionals are responsible for knowing their respective scope of practice and safely practicing within that parameter. Professional judgment is a requirement of NP practice and an expectation of the public (NPANyS, 2009a).

Managed care organ iza t ions have dominated healthcare delivery over the past two decades. These companies have become multi-state corporations that establish their own set of rules. These rules exclude NPs as providers on the insurance company panels and impose addit ional practice restrictions, such as mandating a statutory collaboration agreement with an empanelled physician. In addition to insurance company restriction, organized medicine has launched an aggressive campaign to further restrict scope of practice of APRNs through federal

Journal of the New York State Nurses Association, Volunne 42, Numbers 1 & 2 11
Barriers to Practice and Impact on Care si;- [, ‘j”’ii-/¡ “,;,.

Psychiatric NPs are the logicai aiternafive to continue to aiiow open access { • to higii quaiity mentai tieaitti care.

and state legislation that would give physicians more power and control

over nursing practice (American Nurses Association, 2009).

There are few studies in the literature addressing the statutory collaboration, reimbursement, and access to treatment as barriers to treatment (Elsom et al., 2005; Feldman et al., 2003; Staten et al., 2005; Pearson, 2009; Weiland, 2008; Lugo et al., 2007). An extensive literature review by United Behavioral Healthcare, as cited in Feldman and colleagues (2003), was conducted from 1997 to 2001. This review accounted for identified barriers to providing treatment, such as prescriptive authority, including lack of interest in the addition of prescriptive authority, work-setting limitations, personal comfort with prescribing, ability to develop a collaboration agreement with a physician, fees, legislative and statutory obstacles, and obtaining a Drug Enforcement Agency number (Feldman et al., 2003).

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