Overview of Scope of
Practice Initiatives
Sheila Abood
American Nurses Association
Scope of Practice Issue
Defines each health care providers lawful
sphere of activity
 Historical context
 Multiple stakeholders
 Frequent target of organized medicine
 Recurring complex issue
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Federation of State Medical Boards
“Assessing Scope of Practice in Health
Care Delivery: Critical Questions in
Assuring Public Access and Safety” (2005)
 Questions related to Scope Expansion
 Resource for Legislators and Regulators
 Medicine defining scope of health care
providers
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AMA Environment
What did the AMA members want?
 Involvement
 Advocacy
 Communication
AMA Priority Issues
Medicare Physician Fee Reform
 Pay for Performance
 Medical Liability Reform
 Medicare Reform
 Expanding Coverage for the Uninsured
 Disaster Preparedness

Scope of Practice Partnership
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What is it doing?
Provides financial or in kind support to federation
members facing significant scope of practice
issues.
Funds studies:
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To determine whether allied health professionals truly fill
health care voids in rural and other underserved areas.
To closely examine the education and training of allied
health professionals and provide this information as a
point of comparison for legislators.
Scope of Practice Partnership
Serves as an information and advocacy
clearing house for the Federation on scope
of practice issues
 AMA houses and staffs the partnership
and provides a basic level of support
 Additional support comes from state and
specialty medical societies.
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Scope of Practice Partnership
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Each initiative be it a state-specific concern or a
research study will be considered by the
partnership on a case by case basis.
An Executive Committee:
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Reviews the issues
Assists in prioritizing scope of practice concerns
Ensures adherence to anti-trust laws
Focuses on maintaining the highest level of cooperation,
coordination, and consensus between Federation
members.
Scope of Practice
Steering Committee Founding Members
 Six State Medical Associations

Massachusetts
• New Mexico
• Maine
• Texas
• Colorado
• California
Now at least 26 state medical associations
•
Scope of Practice Partnership

Six Medical Specialty Organizations
•
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•
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American
American
American
American
American
American
and Neck
Society of Anesthesiologists
Society of Plastic Surgeons
Psychiatric Association
Academy of Orthopedic Surgeons
Academy of Ophthalmology
Academy of Otolaryngology-Head
Surgery.
Scope of Practice Partnership

Targeted Groups
Everyone who threatens reimbursement.
Medicine Scope of Practice encompasses
everything.
Medical Specialty Organizations have their
own targets.
2005 Texas Resolution 814
Where did it come from?
 What problem is it trying to address?

2006 Texas Resolution 814
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Resolve to study the qualifications, education,
academic requirements, licensure, certification,
independent governance, ethical standards,
disciplinary processes, and peer review of limited
licensure health care providers and limited
independent practitioners
Fiscal note- $171,975
Progress report back by June 2006 AMA HOD
2006 American Association of
Anesthesiologists Resolution 902

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AMA policy that state medical boards shall have
full authority to regulate the practice of medicine
by all persons within a state not withstanding
claims to the contrary by boards of nursing, midlevel practitioners or other entities (New HOD
Policy);
AMA, through the Scope of Practice Partnership,
work jointly with state medical boards to assist
law enforcement authorities in the prosecution of
unlicensed medical practice by limited or midlevel practitioners (Directive to Take Action)
2006 American Association of
Anesthesiologists Resolution 902

AMA, through the Scope of Practice Partnership,
immediately embark on a campaign to identify
and have elected or appointed to state medical
boards physicians (MDs or DOs) who are
committed to asserting and exercising their full
authority to regulate the practice of medicine by
all persons within a state notwithstanding efforts
by boards of nursing or other entities that seek to
unilaterally redefine their scope of practice into
areas that are true medical practice. (Directive to
Take Action)
Scope of Practice Partnership

How this is playing out……in the states?
Patients First Campaign in Texas
 Bypassing the Legislature

AMA Scope of Practice Partnership: State
Legislation
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Legislation introduced in over 30 states
attacking SOP of more than 20 health
professions:
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Licensure/Certification/Credentialing
General prescriptive authority
Authority to prescribe controlled substances
Opposition to expanding Scope or Authority
Inclusion in health insurance panels
AMA Scope of Practice Partnership:
Federal Legislation
Healthcare Truth and Transparency Act
 seeks to outlaw any act, speech, or practice
conducted by a licensed health care provider who
is not a MD, DO, DDS, or DDM that leads
patients or the public to believe that the health
care practitioner has the same or equivalent
education, skills, or training as a physician or
dentist
 would bring these activities under the purview of
the Federal Trade Commission which would be
granted the ability to fine health care
practitioners up to $10,000 per violation
 Introduced in 109th Congress, what’s in store for
110th?
Coalition for Patients’ Rights
Organized by ANA in 2006
 Comprised of over 34 associations
representing more than 3 million licensed
health care providers
 Joint statement released June 2006 “The
erroneous assumption that physician
organizations should determine what is best
for other licensed healthcare professionals is
an outdated line of thinking that does not
serve today's patients.”
www.patientsrightscoalition.org

Coalition for Patients’ Rights
Coalition for Patients’ Rights
Development of a positive and consistent
message and strategy appropriately
framed for the targeted audience.
 One message or multiple messages?

Coalition for Patients’ Rights
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Potential Audiences
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Nurses
Consumers/Patients
All Media
Payers
Employers
Business Community
Physicians
Legislators/Regulators
Other Health Care Providers
Coalition for Patients’ Rights

To ensure that patients have access to
quality healthcare provided by the full
range of licensed health professionals of
their choice.
Provider Responsibilities
Know your scope of practice and personal
competence.
 Be aware of state regulations governing
practice.
 Stay informed about proposed changes to
scope of practice.
 Be knowledgeable about employer policy
and procedures- They may limit scope but
never exceed it.
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