Physician Voices for Patient Safety
On this page:
About the bill
Impact on patients in DC
Impact of physicians in DC
What can you do?
Resources
About the bill
In November 2023, DC Health introduced B25-545, the Health Occupations Revisions General Amendment Act of 2023. This bill is a comprehensive rewrite of the law overseeing medical licensing and regulation in Washington, DC.
Unfortunately, the bill as written would overhaul scope of practice, place allied health professionals in oversight positions of medical licensing, and remove the physician from the center of the care team.
MSDC has long advocated that a physician is the most qualified professional at the head of a care team. Physicians have the most health education and pre-practice experience of any health professional, and thus must be involved in all but the most mundane health care decisions. Allied health professionals are a valuable part of the care team, but their medical education and experience limits their role.
The Medical Society of the District of Columbia (MSDC) is the leading voice for physicians in Washington, DC, committed to uniting physicians to advocate for physician-led health care in Washington, DC that protects patients from harm and increases access to quality care. MSDC is leading a coalition of Washington, DC specialty medical societies to advocate against the Health Occupations Revisions General Amendment Act of 2023.
Impact on patients
As currently written, the bill would weaken patient care by expanding the ability of non-physician professionals to practice medicine beyond their training. DC residents deserve access to proper medical care from professionals with the right knowledge and experience to ensure appropriate diagnosis and treatment.
Impact on physicians
Below is a breakdown of some of the major changes the bill would introduce, click on the title to expand how the bill would change that item.
Currently the Board of Medicine is composed of 10 physicians and 4 members of the public. The bill as amended would reduce the number of physicians to 9 and adds 2 physician assistants but keep the four members of the public health.
The concern: The bill would codify that APRNs could independently diagnose, prescribe, and administer medicine.
The details: See the analysis from G2L Law Firm on the APRN provisions
The solutions: Independent Advanced Certified Nurse Practitioners should have a defined scope of practice limited to the following functions:
- Practice only in the field of certification;
- Comprehensive physical assessment of patients;
- Certify to the clerk of the court that an adult has given birth;
- Certify to the Transportation authority that an individual has special needs for certain health reasons;
- Complete date of birth and medical information on a birth certificate;
- Complete a death certificate if medical examiner does not take charge and deceased was under the care of the PN;
- Establish medical diagnosis of common short-term and chronic stable health problems;
- File a replacement death certificate;
- Issue a “do not resuscitate order” in medical emergencies;
- Order, perform, and interpret laboratory and diagnostic tests;Prescribe drugs and devices under DC controlled substance Schedules II-V with a valid DEA license, and medical marijuana under DC laws;
- Provide emergency care within the scope of their skills;
- Refer patients to appropriate licensed physicians or other health care providers;
- Certify to utility company that a client has a serious illness or the need for life-support equipment;
- Witness an advanced directive;
- Sign off on home health/care orders.
The concern: As seen below, additional allied health professions are permitted to apply anesthesia. Most concerning is the scope expansion that could permit nurse anesthetists to practice without physician collaboration.
The solution: This bill asks to repeal Section 603 of DC official code ₰3-1206.03, and this action will allow nurse anesthetists to administer anesthesia without an anesthesiologist or other physician's direct collaboration. Language seeking repeal of Section 603 of DC official code ₰3-1206.03 should not be included.
This bill adds Sec. 605a, which contains language that a CRNA may plan and deliver anesthesia, pain management, and related care to patients or clients of all health complexities across the lifespan. Language adding Sec. 605a should be removed from this bill.
The expands audiologists' scope to include "cerumen management" and "interoperative neurophysiologic monitoring" and permits audiologists to screen for cognitive, depression and vision.
The bill completely rewrites the definition of the practice of "chiropractic". Chiropractors could:
- Diagnose and treat biomechanical or physiological conditions that compromise neural integrity or organ system function
- Refer patients for further medical treatment or diagnostic testing
The bill would not longer have physicians overseeing their work but instead a clinical laboratory director
The bill would expand pharmacists' scope to include:
- Ordering labs
- Scheduling and monitoring drug therapy
- Ordering, interpreting, and performing more tests
The bill would permit physical therapists to independently evaluate and treat disability, injury, or disease. PTs may also order imaging as part of their treatment plan.
The concern: The bill expands podiatrists scope of practice to allow:
- apply anesthesia as part of treatment; and
- administer vaccines and injections.
The details: See the analysis from G2L Law Firm on the podiatrists' provisions
The solution: This bill amends Paragraph (14) of D.C. Official Code § 3-1201.02(14) to define "Practice of podiatry” to include the administration of local anesthesia, monitored anesthesia care, and conscious sedation. Other scope of practice expansions for podiatry include care of human hand and wrist, and administration of injections, vaccinations, and immunizations. Podiatrists should not be administering monitored anesthesia care. Podiatrists do not have the qualifications and training to manage a patient's airway so this language should be stricken.
Throughout the bill, restrictions on nursing scope of practice are removed or loosened throughout. Specific language outlining what and how nurses can practice is removed and replaced with more vague language giving the Mayor (read DC Health) the ability to dictate scope. This applies to many different nursing types, like APRNs and NPs.
Articles on scope of practice
Information on Free Telehealth Laptops and Licenses for Medicaid Providers
At the onset of the COVID-19 public health emergency, the Department of Health Care Finance (DHCF) immediately recognized that providers would need to leverage the use Health IT - and telemedicine services in particular - to ensure continuity of care for a Medicaid patient population at high risk for coronavirus exposure. After assessing District providers’ needs and potential obstacles they face in meeting key patient engagement objectives, the District made it a priority to ensure that the ability to participate in telehealth services is an option available to as many Medicaid providers and beneficiaries as possible.
To broaden its telehealth engagement efforts, DHCF recently applied and received approval from CMS to implement an emergency telehealth project to support the District’s continued effort to combat coronavirus (COVID-19). Now officially established, the District’s telehealth emergency response initiative will operate through the end of Fiscal Year 2021. Its goals are to assist providers who are actively participating in the Promoting Interoperability Program to meet the increasingly challenging patient engagement objectives and measures, and position other District Medicaid providers to optimize their telehealth service delivery capabilities during the COVID-19 public health emergency. DHCF’s Telehealth Emergency Response initiative will be managed by the District of Columbia Primary Care Association (DCPCA), in partnership with Enlightened Inc.
What Types of Assistance will be Offered to Providers through this Initiative?
DCPCA will distribute 14” touch screen laptops that are configured to support provider and clinical staff access to telehealth applications and services. Each laptop will be paired with a mobile hot spot that includes a 1-year unlimited data service plan. Please note that the laptop devices will remain the property of DHCF and must be returned to the agency by no later than September 30, 2021.
DCPCA will also distribute a limited number of telehealth platform licenses to provider organizations that would like to begin using telehealth services to enable continuity of care for their patients. The telehealth platform licenses offered under this initiative will allow providers to access a HIPAA-compliant web-based service to conduct patient encounters. Provider access to a telehealth platform license will be prepaid to cover 1 year of telehealth operations.
Who is Eligible to Participate?
Provider organizations that are (1) authorized to deliver health care services to Medicaid beneficiaries who are residents of the District of Columbia and (2) targeted to receive technical assistance services under the DC HIE Connectivity Grant are eligible to participate in this program. Eligible practices will be prioritized as described below to receive telehealth devices and/or licenses (i.e., telehealth support tools):
Tier 2: Independent ambulatory care practices, including primary care and prenatal care practices, with priority given to practice sites located in Wards 5, 7, and 8
Tier 3: Behavioral health practices, with priority given to practice sites located in Wards 5, 7, and 8
Tier 4: Other provider organizations (e.g., long-term care facilities, skilled nursing facilities, home health agencies, etc.)
Provider organizations that have already received a grant award this year through FCC’s COVID-19 Telehealth Program will not be eligible to request additional telehealth support tools under DHCF’s Telehealth Emergency Response initiative.
How do I Request Telehealth Emergency Response Assistance for My Practice?
Provider organizations that would like to receive telehealth support tools through this initiative can submit a request to DCPCA that indicates the type(s) of support needed (i.e., laptops and/or telehealth platform licenses), and contains baseline data about the size of the practice, including the number of clinical staff employed and number of patients served annually. The Telehealth Emergency Response questionnaire and request for assistance may be accessed by clicking here.
DCPCA will collaborate with Enlightened to evaluate all requests that have been submitted for telehealth emergency assistance on a first-come, first-served basis, in accordance with the priorities outlined above. The available telehealth support tools will be allocated to each practice based on the practice’s identified needs, as indicated in their questionnaire response and request for assistance. Limits on the quantities of laptop devices and telehealth platform licenses will be applied based on the practice size (i.e., # of patients seen annually and/or # of practice staff requiring telehealth platform access) to ensure that the greatest number of requests for support can be accommodated. We expect to notify all provider organizations that submitted response about the status of their requests for assistance by no later than September 30, 2020.
What Obligations must My Practice Meet to Receive Telehealth Support under this Initiative?
- Provider organizations that are selected to receive support through DHCF’s Telehealth Emergency Response initiative will be asked to agree to the following requirements as conditions of participation:
The practice will submit baseline telehealth services data and provide quarterly telehealth utilization updates, beginning with the quarter ended December 31, 2020, to support program monitoring and evaluation efforts.
• The practice agrees to accept responsibility for tracking the assignment of laptops to practice staff, and coordinate the return of all allocated devices to DCPCA as directed, by no later than September 30, 2021.
Provider organizations that would like to apply for telehealth emergency assistance under this initiative are asked to submit their questionnaire response and request for support as soon as possible. The deadline for submissions is September 14, 2020. Meeting this deadline will allow DCPCA and Enlightened to evaluate all requests, allocate the available telehealth resources and schedule deliveries to selected practices by no later than September 30, 2020. Please forward any questions and/or requests for additional information to: dctelehealthemergencyresponse@dcpca.org.
Resources
FAQ on scope of practice expansion
One page summary of concerns with B25-545
Physician Townhall on B25-545
April 22, 6 PM
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