Role of physician extenders: more regulation is necessary before full integration into practice.

PURPOSE OF REVIEW: To discuss the drawbacks and propose recommendations for integrating physician extenders in ophthalmologic practice. RECENT FINDINGS: In this article, the role of utilizing physician extenders in ophthalmology is discussed. A role for physician extenders has been suggested as more and more patients will require ophthalmologic care. SUMMARY: Guidance is needed on how to best integrate physician extenders into eye care. However, quality of care is of the highest importance, and unless there is reliable and consistent training of extenders, using physician extenders to administer invasive procedures (e.g., intravitreal injection) should be avoided due to safety concerns.

Opioid use disorder and COVID-19: Implications for policy and practice.

ABSTRACT: Preliminary data suggest that opioid-related overdose deaths have increased subsequent to COVID-19. Despite national support for expanding the role of physician assistants (PAs) and NPs in serving patients with opioid use disorder, these clinicians are held to complex and stringent regulatory barriers. COVID-19 triggered significant changes from regulatory and federal agencies, yet disparate policies and regulations persist between physicians and PAs and NPs. The dual epidemics of COVID-19 and opioid use disorder highlight the inadequate infrastructure required to support patients, communities, and clinicians, and may serve as the catalyst for eliminating barriers to care.

Seventeen states enacted executive orders expanding advanced practice nurses' scopes of practice during the first 21 days of the COVID-19 pandemic.

CONTEXT: Rural hospitals in the USA are often served by advanced practice nurses, due to the difficulty for such facilities to recruit physicians. In order to facilitate a full range of services for patients, some states permit advanced practice nurses to practice with full independence. However, many states limit their scopes of practice, resulting in the potential for limited healthcare access in underserved areas. The COVID-19 pandemic temporarily upended these arrangements for several states, as 17 governors quickly passed waivers and suspensions of physician oversight restrictions. ISSUES: Physician resistance is a primary hurdle for states that limit advanced practice nurse scopes of practice. Longstanding restrictions were removed, however, in a short period of time. The pandemic demonstrated that even governors with strong political disagreements agreed on one way that healthcare access could potentially be improved. LESSONS LEARNED: Despite longstanding concerns over patient safety when advanced practice nurses practice with full autonomy, governors quickly removed practice restrictions when faced with a crisis situation. Implied in such behavior are that policymakers were aware of advanced practice nurses' capabilities prior to the pandemic, but chose not to implement full practice authority, and that governors appeared to disagree as to whether to temporarily waive specific restrictions or suspend restrictions entirely, consistent with their political affiliation. We propose more research into understanding whether or not such changes should become permanent.

NP and PA Privileging in Acute Care Settings: Do Scope of Practice Laws Matter?

As hospitals' interest in nurse practitioners (NPs) and physician assistants (PAs) grows, their leadership is eager to know how their medical staffing privileging policies for these professionals compare to peer hospitals. This study assesses the extent of variation of these policies in four clinical areas and examines whether the differences are associated with state scope of practice laws for NPs and PAs. We also examine the relationship of NP and PA privileging policies to each other. Our analysis finds no evidence that hospital privileging is associated with state scope of practice, and indeed within-state variation is more significant than cross-state variation. We also find a strong correlation between NP and PA privileging in all four clinical areas. These results suggest the need for additional research to understand the institutional-level variables and human dynamics at the level of medical staffing committees that may explain the dramatic variation in privileging policies and, ultimately, the effects of different privileging levels on costs and quality.

Using buprenorphine to treat patients with opioid use disorder.

The US opioid epidemic is a complex problem that has resulted in legislative actions to make treatment more accessible to patients. Physician assistants (PAs) have taken an active role in expanding their scope of practice to keep up with treatment needs. This article describes opioid use disorder in the United States, treatment gaps, safe treatment with buprenorphine, and PA prescriptive authority.

Rules and Regulations Relating to Roles of Nonphysician Providers in Radiology Practices.

Nonphysician providers (NPPs) in radiology practices include nurse practitioners, physician assistants, and radiologist assistants. The number of NPPs has been increasing both within and outside of radiology departments. In order for leaders in radiology departments to incorporate NPPs effectively into their practice, they require nuanced knowledge of appropriate coding and billing for services these professionals render. Furthermore, the existing body of literature suggests that with a defined and appropriate scope of practice and proper supervision, NPPs can provide care that is at least equivalent to that provided by attending physicians for narrowly defined tasks. A broader understanding of the rapidly evolving NPP workforce both within radiology practices and throughout other health care specialties will inform practice leaders who are adapting to a health care system that is moving rapidly toward value-based incentive payment models. ©RSNA, 2018.