Guest column: Eliminate barriers to crisis-ready health care

An emergency is no time to trifle with bureaucratic red tape. At the outset of the COVID-19 crisis, many feared a surge of patients would overwhelm hospital capacity. Health officials sounded the alarm and identified policy changes that would enable them to meet the coronavirus challenge. And, in many cases, government responded.

In March, Gov. Tom Wolf issued executive orders designed to expand the state’s health care capacity, including temporarily suspending regulations that restricted where and how nurses and other health care professionals could practice.

For those aiming to ensure our health care system is always prepared, this raises an important question: If we cut the red tape during times of crisis, why not cut it permanently?

The fact is, before these regulations were suspended, our health system was suffering serious consequences. In April, PennLive reported that thousands of medical professionals across the country were getting furloughed or laid off. Though postponed elective procedures were partially responsible, another major factor was licensing requirements that made it difficult for medical staff to transition from their previous roles to help care for those suffering due to COVID-19.

Jess Poole, who previously worked out of Greensburg, is one such medical professional. Despite being a licensed nurse anesthetist with the training to intubate and manage patients, Pennsylvania wouldn’t recognize her specialty. Licensing restrictions made it impossible for her to contribute.

Health care heroes like Jess were forced to sit on the sidelines just when they were needed most. Thankfully, some state lawmakers are determined to keep this from happening again.

State Rep. Christopher Quinn (R-Delaware County) recently introduced legislation, HB 2779, that everyone concerned about conquering the virus should care about. Rep. Quinn’s bill would extend the suspension of certain bureaucratic regulations holding back our health system for one year — and establish a panel to determine which of those counterproductive regulations should be done away with for good.

Telehealth, or remote medical appointments often conducted via video calls, is a great example of a health care innovation that would have been limited under prior overly-restrictive regulations. The contagious nature of COVID-19 made telehealth an essential service in 2020, and utilization skyrocketed by 50 to 175 percent. This expanded use was made possible because Pennsylvania took steps to guarantee provider reimbursements by insurance companies and relaxed licensing restrictions that prevented providers from serving patients across state lines.

Even after the crisis subsides, telehealth promises increased access to care and reduced patient costs. For example, a Vermont Veterans Association saved almost $19,000 a year from reduced travel costs after offering telehealth options. A 2017 study found that patients experienced a cost savings of $156 per consultation due to reduced time and travel burden.

The removal of antiquated barriers to telehealth and the lifting other unnecessary regulations should be made permanent to expand access to care. For example, maintaining newly-increased practice flexibility for Advanced Practice Registered Nurse Practitioners would empower over 7,000 nurse practitioners in Pennsylvania to care for more patients.

Rep. Quinn isn’t alone in seeing an opportunity to improve health care access and reduce cost for all Pennsylvanians. Senate Bill 25 and HB 100, together sponsored by over 70 lawmakers, create a path for nurse practitioners to practice independently after a minimum of 3 years and 3,600 hours under the supervision of a physician. Empowering them to provide primary care could bring down the patient load per primary care provider from almost 1,000 patients per provider to 667 patients per provider.

Two other proposals, HB 1997 and HB 1998, would give doctors more flexibility over how to work with physician assistants. The result? Greater access by patients to customized care.

Another bill would allow pharmacists to offer flu shots to individuals 9 years of age or older, creating an additional 9,000 access points for flu vaccinations across the state. Empowering pharmacists to provide vaccinations to a wider age range can free up physicians to focus on their most urgent cases.

It is impossible to predict what the future holds for COVID-19. But by repealing unneeded health care regulations that are barriers to patient care, lawmakers can ensure Pennsylvania’s health system is always prepared for crisis.

Stephen Bloom is vice president for the CommonwealthFoundation, Pennsylvania’s free market think tank.

Published in The Pottstown Mercury

Pennsylvania SRNA Receives National Accolades

A Pennsylvania nurse anesthesia student received the 2020 AANA Student Excellence Award.

Ryan Wade, a senior at the Allegheny School of Anesthesia/La Roche University, accepted the award during the virtual Annual Congress.

The national award is an annual honor presented to a student in good academic standing who demonstrates outstanding leadership and professionalism, participates in activities that help foster a positive public image of nursing, and engages in activities that support health care.

Wade demonstrated his capacity for leadership and professionalism during his first clinical rotation when he took swift action to help a nurse found unresponsive on the floor. He immediately began CPR and called out for help, remaining calm as he continued providing care. Wade’s actions and competence helped her survive the cardiac arrest, intact cognitively. Her subsequent care uncovered additional complications, and though she later passed away, the family kept in contact with Wade, inviting him to attend her memorial service.

He also maintained academic excellence while being active with PANA. Wade has been an advocate for CRNAs in Pennsylvania by serving on PANA’s Government Relations Committee. He was an active member of the committee for two terms, having participated in numerous events. Wade met with state legislators and committees, including legislative leaders such as former Speaker of the House Mike Turzai and the House Veterans Affairs & Emergency Preparedness Committee. His efforts also extended to the federal level, having met with Vice-President Mike Pence.

"Ryan is a leader among his peers and has consistently exceeded our expectations these past two years,” said PANA Director of State Government Affairs Jessica Poole, DNAP, CRNA. “His drive and enthusiasm is contagious and his wisdom and insight exceeds well beyond his level of training. He represents our profession with tact and professionalism."

Locally, he displayed his professional promise and capabilities of serving the community by serving as a PANA spokesperson to WTAE, a Pittsburgh news channel. During the broadcast, he demonstrated proper use of PPE and informed the public of PANA’s purchase of 3D N-95 masks, intended to support Pennsylvania CRNAs working with COVID-19 patients.

“I envision he will continue in his efforts to privately and publicly represent our profession as a knowledgeable, competent and pre-eminently invested CRNA after graduation,” said Allegheny School of Anesthesia Program Director Deborah Davison, DNAP, MS, CRNA. “I am very proud of his accomplishments and feel confident that he is deserving of this award as recognition for his hard work.”

PANA applauds Ryan Wade’s achievements as an SRNA and congratulates him on this well-deserved national recognition.

PANA works with Wolf administration on new Ketamine prescribing guidelines

The administration of Gov. Tom Wolf today announced new guidelines for subanesthetic dosing of Ketamine, Guidelines for the Safe Administration of Subanesthetic Ketamine, to assist physicians and advanced practice nurses working to treat patients.

These guidelines were developed by the Safe and Effective Prescribing Task Force, which included a representative of the Pennsylvania Association or Nurse Anesthetists.

Jessica Poole, DNAP, MHS, CRNA, and Government Relations Director for PANA, represented the profession on the Department of Health committee, which studied the issue for roughly two years before issuing the guidelines.

CRNAs are playing a major role in curtailing the opioid epidemic by manipulating their anesthetic to provide narcotic-sparing and often narcotic-free anesthesia. Additionally, anesthesia professionals utilize subanesthetic doses of Ketamine to treat opioid-tolerant patients, chronic non-cancer pain patients, and those in palliative care.

The ketamine guideline differs from previous prescribing guidelines by addressing administration of a non-opioid.

The ketamine guideline provides best practices for the subanesthetic administration of ketamine for a variety of conditions. This includes recommendations for the treatment team, treatment location, patient selection, and patient monitoring.

Learn more about this important decision HERE. Or access the Guidelines for the Safe Administration of Subanesthetic Ketamine directly.