Grassroots effort to change health care law under way

Published 12:00 am Saturday, April 24, 2004

A local health care provider is hoping a new law before the Alabama legislature will improve the situation for her patients as it further streamlines the process of getting well.

Certified Registered Nurse Practitioner (CRNP) Melissa English, who practices at Greenville’s Stabler Clinic, says she and fellow nurse practitioners are frustrated by the current state of affairs for the large number of their patients covered by Blue Cross/Blue Shield health insurance.

&uot;We feel we are one of the anchors in health care for our community, yet we aren’t currently recognized as such by Blue Cross,&uot; English explains.

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Under current law, providers like English cannot bill many Blue Cross contracts unless a physician also is on hand to look in on the patient.

This forces &uot;an unnecessary duplication of services&uot; in a state where health care services are already strained, the nurse practitioner says. Of Alabama’s 67 counties, 61 (including Butler) are classified as underserved rural communities.

A lack of continuity

Over the last several years, many physicians have come to the Camellia City – and left. It’s a frustrating scenario.

&uot;We’ve seen tens of thousands of dollars spent in our community to recruit a physician time and again, only to have them complete a three year contract commitment and move on,&uot; says English, adding, &uot;The physicians we have been able to recruit have been primarily foreign medical graduates here to satisfy a J1 Visa requirement, many of whom have no intention of ever remaining in an underserved area. This definitely impacts the quality and continuity of health care in this community.&uot;

Other complicating factors include cultural issues and language barriers, English says.

Filling the void

Because recruiting and retaining qualified health care providers in Alabama’s many underserved rural communities is a constant battle, English says advanced practice nurses, including Nurse Practitioners, Nurse Anesthetists and Nurse Midwives, play a vital role in filling the void &uot;when you just don’t have enough physicians to ‘go around.’&uot;

English is one of several CRNPs serving the health care needs of Butler County and the surrounding area. Nicole Laird (who formerly worked for Dr. Robert Ruth of Pineapple and is preparing to open her own practice), Anne Harmon Keen (who has an established pediatrics practice at Greenville Pediatrics) and Debbie McBride (who works with Dr. John Hollis at the Family Rural Medical Clinic of Georgiana) are among the others. Lisa Monroe is a local resident who works in Dothan as the clinical administrator/nurse practitioner for Montgomery Aids Outreach.

English says all these health care professionals (who are required to have a Master’s Degree in Nursing and National Board Certification in order to receive provider status and be able to bill federal programs such as Medicare and Medicaid) are &uot;actively delivering high quality primary care, pediatric care and acute adult care to our community – yet they aren’t ‘official’ by current Blue Cross standards.&uot;

No seal of approval

Blue Cross does not officially recognize nurse practitioners as health care providers – &uot;only physicians,&uot; English says. This translates into more time spent in doctor’s offices and clinics for many Alabama patients.

&uot;My patients sometimes have to wait an extended period of time after I’ve seen them, before a physician can take the time to come into the room and give the official ‘Blue Cross blessing’.

Currently, the bill for patient care is always submitted to Blue Cross in the physician’s name, in spite of the fact the doctor may have spent considerably less time with the patient than the nurse practitioner did.

When physician coverage is not available on a particular day, English says, she is unable to even see patients since Blue Cross always requires a physician’s presence.

&uot;This is so inconvenient for our patients at the clinic. Basically, I think everyone of us deserves to see the right to see the healthcare provider of our choice,&uot; she adds.

Change for the better

The situation may be about to change for the better, English says.

On Tuesday, February 24, House Bill 482 was introduced to the Alabama legislature.

&uot;This legislation would allow advanced practice nurses to bill the insurer of any patient who chooses to use a Nurse Practitioner,&uot; she explained.

If the bill passes, English believes it will do away with &uot;the inconvenience of having to schedule appointments around our practice rather than your own schedule.&uot; She said it would also eliminate the time Alabama patients waste sitting and waiting for a doctor to see them after the nurse practitioner.

English hopes a grassroots effort will promote a change in the law, and she is asking for local citizens’ support. &uot;If enough of us contact our legislators, I believe we can get this law passed. If this issue is important to you, let your elected representatives know.&uot;

Representative Charles Newton, who serves Butler, Crenshaw and Lowndes Counties, may be reached by mail at 11 South Union St. Room 541 E, Montgomery, Alabama 36130.Newton’s phone numbers are (334) 382-8700 or (334) 242-4460 and his e-mail address is

Senator Wendell Mitchell may be reached by mail at 11 South Union St., Montgomery, Alabama 36130; by e-mail at or by phone at (334) 242-7883.

Mitchell did contact English recently to tell him he supported the measure and would continue to support it.

&uot;Tell your legislators you want them to support an amendment to Section 27-51-1 of the Code of Alabama 1975, to cover healthcare services, plans and health maintenance organizations in Alabama,&uot; English urges.

With Greenville and Butler County poised on the brink of new growth, the nurse practitioner says she wants to see the local health care delivery system also move ahead.

&uot;The ultimate goal of all these efforts is to improve access to affordable, high quality health care for our residents. They deserve it,&uot; says English.

Help for all

According to Holley Midgley, executive vice-president of the Alabama Academy of Family Physicians, many view the legislation as a good thing.

He said his group remains neutral in the matter because they have not met as a group. However, he said he thinks it would help all.

&uot;I think this might be a help to all in the medical industry,&uot; he said. &uot;It is important to remember that CRNPs cannot operate at the same level as physicians because they don’t have the advanced training.

However, they are trained to a level to take some of the burden off the physicians. In those cases, they should be able to bill insurances companies for the services they do offer.&uot;

Midgley said when they began allowing CRNPs a few years ago, many thought there would be problems distinguishing between doctors and the CRNPs.

He said those fears were quickly laid to rest.

&uot;They are under the control of the Alabama Board of Medical Examiners and the Alabama Board of Nursing, so their work is closely scrutinized,&uot; he said. &uot;They cannot prescribe the same things as physicians and they cannot prescribe narcotics.&uot;

He also pointed out that CRNPs practice under the supervision of a local physician, although they do not have to be in the same building. A doctor does have to visit the practice on a routine basis and check in.

&uot;The supervising doctor can be as far away as 30 miles,&uot; he said. &uot;This is important to those communities that cannot afford to support a medical practice, but can afford a nurse practitioner.&uot;