Committee reviews S.163 to recognize APRNs as attending clinicians in hospitals

A legislative committee on March 18 held a walk-through of S.163, a bill that would add advanced practice registered nurses (APRNs) to the hospital patients’ bill of rights and to hospital licensure language so that APRNs may be recorded as the attending clinician responsible for coordinating a patient’s care.

Jen Carbic of the Office of Legislative Counsel told the committee the bill ‘‘updates the statutes to reflect roles that they are permitted under their existing scope of authority’’ and does not expand APRN scope. Carbic said the draft inserts APRNs throughout the patient bill of rights and clarifies that ‘‘physician’’ references include both MDs (Board of Medical Practice) and DOs (regulated by the Office of Professional Regulation), and that where a statute refers to an individual it means a person rather than a corporate entity.

Jennifer Cohen, director of the Office of Professional Regulation, told the committee the OPR supports S.163 and described APRNs’ authority under Vermont law. ‘‘APRN scope of practice in Vermont is a full practice authority as a medical provider,’’ Cohen said, adding that APRNs can ‘‘diagnose, treat patients, order and interpret diagnostics, prescribe medications, [and] manage care’’ without supervision once initial licensure requirements are satisfied.

Representatives of Vermont’s hospitals said the bill generally reflects care delivered on the ground but raised operational questions. Devon Green of the Vermont Association of Hospitals and Health Systems said he reached out to chief nursing officers and medical directors and that ‘‘the majority of folks were in support of this bill.’’ He cautioned, however, that Medicare regulations requiring a physician signature for certain admitting and payment rules could require hospitals to adopt workflow changes.

The Vermont Medical Society took a neutral position. Jessa Barnard, who represents physicians and physician assistants for the society, said the board ‘‘took a neutral position’’ after extended review. Barnard said S.163 does not change professional scope on paper but could change how hospitals document the ‘‘attending of record’’ and urged caution about patient-safety oversight. She also said that if APRNs are added, the society’s members thought physician assistants should be considered for similar treatment because day-to-day hospital care can look similar between APRNs and PAs.

Frontline clinicians described the practical effects at critical access hospitals. Michelle Wade, a nurse practitioner and president of the Vermont Nurse Practitioners Association, said in many rural hospitals APRNs ‘‘independently evaluate our patients, diagnose their conditions, develop and manage the treatment plans’’ and that codifying admitting/attending recognition would reduce administrative burden and support recruitment and retention. Certified nurse midwife Jade Kaplan told the committee her admitting name appears on a laboring patient’s bracelet and said inconsistent admitting records obscure who is providing care: ‘‘That data then gets lost,’’ Kaplan said, arguing clearer statutory language would improve reporting and planning.

Committee members pressed witnesses about Medicare-specific payment rules. Witnesses and members agreed Vermont cannot change federal Medicare requirements; hospitals could decide to maintain physician sign-off for Medicare patients while allowing APRNs to serve as attending clinicians for other payers, or develop workflows that accommodate both federal and state rules.

The committee did not take a vote. The chair announced a recess and that three amendments to S.163 would be offered when the panel reconvenes.

The committee’s next procedural step is to consider the proposed amendments and any additional testimony; no final action on S.163 was recorded at this meeting.