Why giving full practice authority to Nurse practitioners not only makes good health sense for Arkansas but also good business sense Prior to opening a small rural clinic in Arkansas I had really honestly had not thought much about why I would want full practice authority. I had always had a salaried position working in a clinic and was content with my role. However in September of 2012 my husband and I recognized the need for a clinic in our small town of Elkins Arkansas. It was soon after I realized the constraints placed by collaboration agreements. My husband and I put our life savings into our dream of not only owning our own business but also providing care to our community. We first were made very aware that because I am not a Physician we get paid twenty-five percent less than MD’s for any and all services I provide. However my overhead does not decrease because of my title. Then on top of that we pay a fee to provider who agrees to collaborate with me on this endeavor. This fee can range anywhere from 10%-25% of gross receipts. Since nurse practitioners can not be considered primary care providers (PCP) under Medicaid any Medicaid patient that I have must sign up with my collaborating Physician as their PCP. This means that if at any time my collaboration agreement dissolves, the provider moves or something happens with his license 35%-40% of my patients would have to change PCP’s or leave my practice and see him for their medical care. Although most of them have never seen my collaborating physician they are officially attached to him through Medicaid guidelines. The collaboration fee and the 25% mandated discount for services puts me at a completive disadvantage. Our state should be encouraging small rural clinics instead of imposing more regulations. When we signed the collaboration agreement my collaboration physician mandated that all insurance reimbursements be sent to his business account so that they could be dispersed to the clinic accordingly at the end of the month once accounting was completed. This worked well until over $25,000 was embezzled from the account. We then went three months before he notified us as to why payments were not forthcoming. At this point he notified us that we could get our own billing company and use our Tax ID and pay him a fee rather than him paying us. Little did we know at that time that many companies require us to reapply for credentialing when you change tax ID’s. We know that embezzlement is not uncommon but its hard when you are fiscally tied to someone for your income and you are forced to just move on like it never happened despite of the struggle it is to keep a small business open with losses like that. So even though I am taking on all of the financial burden and risk of running my own clinic, I am still at the mercy and whims of my collaborating physician. Arkansas ranks 49th in healthcare (http://www.americashealthrankings.org/AR) I believe it has a lot to do with the lack of rural primary care. Many of my patients have never seen a provider and never have had preventative care. Without preventative care many health issues go unnoticed until they become very costly disease processes. Nurse Practitioners can fill this gap by giving cost effective preventative primary care in many areas that currently not serviced by healthcare providers. I have heard some people say that we are trying to replace physicians. This simply isn’t true. For example in my community the only physician that had even considered opening a clinic in Elkins told the Mayor he would only do so if the city paid him a stipend. Actions like this only increase the cost of healthcare rather than helping to ensure cost effective care. Many of the 2,000 patients I have seen in my clinic have told me that prior to coming to my clinic they frequented the ER. The ER is not a place for primary care. When a Medicaid patient visits an ER the PCP office is required to sign an authorization for that visit. I fill out approximately one authorization a month that means for about 790 Medicaid patients who said they used to use the ER for all their visits only one patient is going a month now. That’s a significant cost savings especially when the current average of an ER visit ranges around $1,200 vs an average reimbursement of $75 for visiting a clinic. Many Physician organizations oppose independent practice. They express concerns about misdiagnosis diagnosis prescribing errors. They state that we lack the skills manage complex patients. For over 40 years now nurse practitioner practice has been studied and these concerns are just not validated. NP case management has been proven to dramatically reduce hospital visits resulting in significant decreases in health care cost. Dr. Kenneth Brummel-Smith chair of the department of geriatrics at the Florida State University College of Medicine recently wrote in the online newspaper, Tallahassee.com: “There simply is a ton of evidence that physicians often do not do a good job of prescribing [controlled drugs] and very little [evidence] that nurse practitioners do a bad job. Giving authority to nurse practitioners will improve patients’ access to needed care and should be approved.” I am not trying to replace physicians, but work hand in hand with them on a daily basis. T I do feel however that forced partnership with physicians is an antiquated policy that prevents access to healthcare and hinders small business owners. I live in fear daily that if my collaborating physician decides to relocate that my husband and I will be forced to close this small clinic that we built from the ground up. I spent my life training for this career. I was a junior volunteer at age 14, a nursing assistant at 16, an LPN at 20, RN at 25 and finally achieving my Masters with post masters certificate at 35. It’s hard to believe that my life long dreams and small business depend on the whims of the physician that I am tied to.