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Texas law failed to provide nurse practitioner independence


Texas lawmakers loosened supervision requirements for nurse practitioners last session in theory, but not in practice according to a recent article from the Texas Tribune.

Rose Okoro is a nurse practitioner, specializing in family medicine.  She opened the Daystar Family Clinic in Katy last fall.  A few months later, she has enough patients to work part time.  It’s not due to lack of patients, it’s because of the law. 

State rules do not allow Okoro, even with her doctorate in nursing practice, to be reimbursed by insurance companies unless the physician who supervises her has a contract with those companies.  That binds the providers financially and professionally.

“Any approval the collaborating physician does not have, I cannot get — even if I’m qualified,” said Okoro, who has worked as a nurse practitioner for five years and as a registered nurse for 10 years before that. “It’s so frustrating for us to open a clinic and then we’re not able to see everybody.”

Physicians argue nurse practitioners don’t have the training or experience to be entirely independent. 

Nurse practitioners say the law ties their hands and limits their ability to treat patients in a state with a looming shortage of primary care physicians.  They also say the bill passed last year should have allowed them to be approved by state-contracted insurance companies even if their supervising physician would not treat Medicaid patients because of the low reimbursement rates.

State officials say the interpretation of the bill was never agreed upon.

Further details about the issue are available from the Texas Tribune.