Missouri law may boost health-care access in rural areas

The way nurse practitioners now can care for patients with a doctor's supervision may help alleviate a shortage of accessible health care in rural areas of Missouri.

New allowances in state law on the practices of nurse practitioners was prompted by legislation filed by Kathy Swan, who represents Cape Girardeau in the Missouri House of Representatives.

Language from Swan's House Bill 936 was added during the legislative session ended May 17 in the Senate as an amendment to House Bill 315, recently signed into law by Gov. Jay Nixon.

The law will allow nurse practitioners to treat patients under a doctor's supervision using electronic forms of communication, such as phone, email or video. The practice is commonly referred to as "telehealth."

Before the passage of the bill, nurse practitioners were restricted from traveling more than 50 miles from their collaborating physician to provide health care.

Kathy Swan

"This can significantly increase access for a lot of rural Missourians right now, where there is such a shortage of physicians," Swan said.

Health-care industry experts warned for some time that new mandates of the Affordable Care Act may overload physicians because more people will become insured at the start of 2014.

That possibility, when added to a shortage already existing in parts of Missouri, could mean accessible health care may become increasingly difficult to find.

Scores that represent a shortage of primary-care physicians in Missouri communities recently were released by the U.S. Department of Health and Human Services. Some Southeast Missouri counties ranked among those in the state with the highest scores, meaning there are more problems with access to primary health care. Counties received scores ranging from 1 to 25.

Pemiscot County in the Missouri Bootheel region received one of the highest scores: 22.

Mississippi, Stoddard and Wayne counties came in at 20, while Butler and Ripley counties scored 19.

Scott and New Madrid counties received an 18, and Bollinger, Dunklin and Iron counties took a 17.

Cape Girardeau and Perry counties fared better with scores of 14 and 12, respectively.

Swan said the collaboration allowed by law has a six-year period before a sunset occurs -- basically for the reason once the collaboration has been allowed for some time so legislators see how well the telehealth methods are working.

No opposition to Swan's bill was heard when the bill was introduced in the House, but she said there initially were some concerns by physicians who misunderstood how the nurse practitioner would see a patient under a doctor's supervision -- they believed the patient would be in a remote location and health care would be provided in some way through electronic means.

Swan said once the physicians' questions were answered and they understood the nurse would physically see the patient and communicate with the doctor, the bill gained full support from medical industry interests.

The Missouri Nurses Association, the Missouri Association of Rural Health Clinics, the Missouri Dermatological Society Association and a physician testified as proponents of the bill in committee hearings.

In addition to Swan's bill, other ways around the 50-mile requirement for nurse practitioners as a means to provide more health care access to rural areas of Southeast Missouri have been found in recent years, most notably through a partnership that began last year between Southeast Missouri State University and SEMO Health Network using the SHOW Mobile mobile clinic.

The partnership allowed the university to offer mobile medical and dental services further south in the region through the SHOW Mobile because SEMO Health Network has brick-and-mortar clinics in Dunklin, Mississippi, New Madrid, Pemiscot, Scott and Stoddard counties.

eragan@semissourian.com

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