Physician leaders and advanced practice nurses have different opinions on the Health Care Practitioners Truth and Transparency Act taking effect in Georgia on July 1.
Georgia Senate Bill 197—the "Health Care Practitioners Truth and Transparency Act," signed into law this month by Gov. Brian Kemp and taking effect on July 1—requires clinicians to include in their advertising their names and licenses they hold for specific services.
The law also prohibits use of the title "doctor" by nonphysicians in clinical venues. Advanced practice nurses and physician assistants with doctorates who identify themselves as "doctors" must make it clear in their ads that they are not a medical doctor or a physician. Georgia clinicians who violate the new law risk disciplinary action from their respective professional credentialing boards.
The new law has been endorsed by major physicians' associations, including the American Medical Association, which said the law complements the association's efforts to "vigorously defend the practice of medicine against scope of practice expansions by nonphysicians that threaten patient safety."
"Georgia's legislature passed SB 197, the Health Care Practitioners Truth and Transparency Act, which strengthens Georgia's truth in advertising law and increases health care transparency in the state," the AMA wrote in a blog post.
The American Society of Anesthesiologists sent out a press release congratulating Gov. Kemp in signing Senate Bill 197 into law, earlier this month.
"This new law makes it clearer for patients to make informed decisions because they know the qualifications of the professional providing their care. Every patient deserves to be certain of exactly who is performing and responsible for their care during a procedure or surgery," ASA president, Michael W. Champeau, MD, FAAP, FASA, said in a statement.
Advanced practice registered nurses had asked Kemp not to sign the bill, arguing that it isn't needed.
"Let me be very direct here…… WE already do this!!," Dr. Lisa Reyes-Walsh DNP, APRN, FNP-BC, PMHNP-BC, CARN-AP, wrote in a LinkedIn post.
"We need to start asking different questions and come together to solve healthcare-stop this nonsense of trying to divide the healthcare system," she wrote.
"I am extremely disappointed in GA's legislators calling out NPs and PAs only," she told HealthLeaders.
Likewise, April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners, questions the need for the bill.
"A strength of today's healthcare workforce is the growing number of healthcare providers with doctoral preparation," Kapu told HealthLeaders. "More than a dozen health professional disciplines—including nurse practitioners, pharmacists, physical therapists and psychologists—are educated at the doctoral level. That depth of preparation and knowledge should be welcomed and embraced by all in the health care space."
"We support the use of the title doctor in conjunction with licensure title for doctorally-prepared nurse practitioners and other health care providers in the clinical setting," she said. "AANP believes patients have the right to know who is providing their care, which includes the academic preparation of those individuals."
Carmen Kavali, MD, founding member of the Georgia Alliance for Patient Protection and Secretary for the Medical Association of Atlanta, says she's "ecstatic" that the bill she helped write is now law.
"(This) gives Georgia the most comprehensive policy in the nation to ensure clarity for patients regarding healthcare credentials. There should be no room for confusion when it comes to informed consent or patient choice," Kavali told HealthLeaders. "Uninformed choice leads to unintended consequences. Informed consent can only be given by a patient who understands exactly who is treating them, in addition to the care being given."
"Some may question the need for this law, but it's clear that patients are confused by healthcare titles and credentials," Kavali said. "In a survey done a few years ago by the AMA, 39% of patients thought a Doctor of Nursing Practice was a physician and 11% weren't sure. Half were either completely wrong or confused by a title. More than half (61%) thought a Doctor of Medical Science was a physician, which is completely incorrect."
Kavali also said the law goes further than clarifying healthcare titles for patients.
"It also clarifies training and specialization," she said. "For instance, you might search online for healthcare options and find someone who 'specializes in dermatology.' You would likely assume that person is a dermatologist, based on that language. In some cases, you'd be wrong, as the person listed isn't a physician at all."
Kavali added there is no reason for any appropriately credentialed clinician to oppose the new law.
"Every clinician will be able to accurately state their licensure, which is consistent with the board overseeing their credentialing," she said. "This law demands accuracy regarding licensure, which provides clarity to patients."
The top executives of UCLA Hospital System and Houston Methodist spoke with HealthLeaders about lessons learned from the ongoing pandemic.
Two health system CEOs reflected on their respective experiences navigating the ongoing COVID-19 outbreak and how each of their organizations plans to utilize the lessons learned in a post-pandemic landscape.
U.S. News & World Report hosted a webinar Thursday afternoon, as part of their "Healthcare of Tomorrow" virtual event series, where hospital and health system executives share how they have responded strategically to the pandemic.
Assistant Managing Editor for U.S. News & World Report Elizabeth Whitehead opened the event by hosting a conversation with the Eric Topol, MD, founder and director of Scripps Research Translational Institute, about the ongoing vaccination trials, COVID-19 studies, and the politicization of the pandemic.
Whitehead then led a roundtable discussion where hospital and health system executives shared the challenges their respective organizations have faced due to the COVID-19 pandemic, how they've innovated to meet the care expectations of their patient populations, and what work still needs to be done.
Panelists included:
Houston Methodist President and CEO Marc L. Boom, MD.
UCLA Health President, UCLA Hospital System Chief Executive Officer, and UCLA Health Sciences Associate Vice ChancellorJohnese Spisso
Premier President Michael J. Alkire
After the roundtable, Spisso spoke with HealthLeaders about how the pandemic is affecting her organization and what advice she would give to fellow academic medical center executives facing similar challenges.
This transcript has been lightly edited for clarity and brevity.
HealthLeaders: During the event, Dr. Topol and Dr. Boom discussed an attack on science emerging from the pandemic. What have you noticed around this topic while leading an academic health system through the crisis?
Johnese Spisso: It has been a great benefit being at an academic health institution because we are an evidence-based organization and use science to guide our decisions around medicine. We're so fortunate that we have a wealth of researchers and research scientists in every specialty that help us design our patient care protocols and our decision making, so that we are following science.
While there has been a lot of noise in the external environment, we've stayed true to our core mission of an academic institution and making sure our decisions are evidence-based.
HL: Opening the event this afternoon, [Elizabeth] Whitehead spoke with [Dr. Eric] Topol about details surrounding the ongoing COVID-19 vaccine trials. What is your take on a potential COVID-19 vaccine, and what will your strategy be in rolling out a vaccine when one is available?
Spisso: At UCLA Health, we've been an active participant in three of the vaccine clinical trials. As a research organization we are active participants. We will work carefully with our public health department once the vaccine is available for release, and with our hospital association to make sure that we have a unified plan for safe and effective distribution. We've begun preparing since we are such a large organization of what that plan would look like.
We have an active and large flu vaccine plan that we execute on every year, so it will be building on that plan. Some unique things with the COVID-19 vaccine will be some of the storage requirements and making sure that we can achieve all of those to deliver the vaccine in the best way.
HL: What advice do you have for academic health system executives who are leading their systems through the pandemic?
Spisso: My advice is that we continue to stay true in delivering on our mission of improving the health of the public by delivering that leading-edge care, research, and training of the next generation. The pandemic has brought into light the importance of the investments that we make in our infrastructure, not only in emergency preparedness, but in infection prevention and disaster planning.
It reinforces some of the great practices that we've had in the past, and we now have time to test them and refine them. We've learned from this pandemic, and the changes that we've had to manage, and the resiliency through those, will serve us better in the future.
HL: What has the pandemic looked like at UCLA Health and what are your forward-looking plans for the next few months of the pandemic?
Spisso: We have come through the first phases of this pandemic in a remarkable way thanks to the extraordinary efforts of our staff and the resiliency of our staff to adapt to so many changes. What we've learned, particularly over the past several months, is how to care for COVID patients, and all of the other patients who need care, because for about a two month period we had to decant some of our regular types of services and cancel things that weren't emergent or urgent.
Now we are back to resuming full care for all. And so, looking at how we do that safely and effectively which we can, it has taken a lot of additional efforts and protocols, but we've learned that we can take care of all of our patients. Going forward, if we have another surge of COVID patients, I believe we'll be able to manage that without disrupting the rest of the health care system.
Boom, the CEO of Houston Methodist, also spoke with HealthLeaders after the event in a brief Zoom interview.
HL: Will the experiences of 2020 mark a turning point for reimagining care delivery?
Marc Boom, MD: There's no question that if we seize the moment, in many realms we can use the lessons of 2020 to drive the future in positive ways.
One aspect is in healthcare innovation. Over the last few years, we've begun to see digital health innovation take hold and make true differences in healthcare. I have often been frustrated that it's been difficult in healthcare to get digital innovation to truly make a difference in outcomes, but [we can] certainly make a difference in efficiency, expenses and improve the experience for patients, physicians, and nurses.
We've turned that corner over the last few years and COVID truly is going to be one of those pivotal moments and the year 2020.
Virtual health and meeting people where they want to be met. Recognizing that sometimes they want to drive in and see their physician and be in a personal, high-touch environment. Sometimes they just want a quick answer and it's not that important which clinician they see and sometimes they want to be cared for at home.
Another innovation for us was using care pathways that are digitally enabled. It's straightforward, simple text-based, HIPAA compliant and allows a patient to interact before, during, and after their stay and have that guidance in an anticipatory fashion.
Our patients have absolutely loved it. It has huge patient satisfaction, it cuts calls to offices, it's resulted in decreased readmissions and has resulted in better outcomes where we've implemented this, and there are so many opportunities to do that and I'm optimistic that some of those kinds of tools will actually be a turning point on getting cost efficiency into healthcare.
The other piece that that I would say, hopefully, is transformative about this year is around health inequities and health access issues. This was a rallying call to say, 'Come on, in the United States of America, we certainly can figure out a truly American-unique scenario and solution that's going to improve access and address these inequities once and for all.'
HL: The pandemic has blown up conventional wisdom on supply chain and staffing. How will healthcare adjust?
Boom: If you look at supply chain, the whole mantra for a long period of time has been 'just in time' because it is potentially more efficient and cost effective. But what that has meant is we don't have the stockpiles and we were unable [to do so] with a global supply chain, so we have to build redundancy into their supply chains.
A lot needs to be looked at it. How diverse is our supply chain? Where's it coming from? It doesn't mean it can't come in bulk from other countries, but it also needs to be domestic. It needs to be diversified across many different areas, and we need to rethink how we can collectively, as a country and as an industry, work together so we do have more flexibility.
Staff is probably the most perplexing of the problems because we can't grow people on trees and you don't have people at the ready to come in and flex up, there's just no way to do that. That's always going to be a challenge.
But there are ways around that to technologically enable, expand and extend people's abilities and experiences to care for additional people. Obviously, keeping them safe is first and foremost. We didn't have to have as bad a pandemic had we been better prepared as a world and a country. We could have gotten a lid on this in a much better fashion early on and that's going to be the number one fundamental issue coming out of here.
HL: Has the pandemic affected cooperation among rival health systems?
Boom: No question! In Houston, we have the Texas Medical Center [along with] 60-something educational and healthcare institutions. I look out my window and I can see my major collaborators and competitors.
From almost day one of this pandemic through the months of March, April, and May had daily 7 A.M. meetings of the CEOs of all those institutions. Even through the second wave where we knew that we were in better control, [our meetings] have [occurred] a couple times per week, and the collaboration has been nothing short of breathtaking.
That group standardized data reporting so if you go to tmc.edu, you'll see our collective data it. I challenge you to find a better, more real-time source of on-the-ground information around COVID-19 anywhere on the planet because it covers about 70% of the Greater Houston market. That will be one of the long-lasting benefits of the pandemic.
Now make no bones about it. One of the reasons we have so many great institutions in Houston is that when institutions compete around the fundamentals of care, safety, quality, service, and innovation. When we are vigorously competing, our patients win because it makes all of us better and drives better care forward.
But when we collaborate around education, research, and a disaster response like this, our patients and community wins.
We all knew each other before this, but, boy, we know each other well now, and it's been great because the lines of communication are open. You pick up the phone. You text each other. We've coordinated every step of the way.
