thank you all so much for being here, these are right times but we, thank you for coming out. Today we're here to discuss house bill 468 72 hours and form can send by person, or phone this bill for obvious reason has gone at a lot attention work here today to explain the provision of the bill to explain what it does do, what it does not do, it does a lot of information there and we want to make sure that that's half the fact and what this bill does, this bill is and is always been about protecting women health, it did not least deduct that to abortion but doesn't show that we are promoting the health and welfare of women who seek abortion as well as the life of the unborn, so let me just this outline clarify the details of house bill 465, first of all I will stand important reporting requirements, it helps to protect more unborn lives every year by ensuring that the only abortions that are being performed are after North Carolina 20 week law are in cases in which pregnancy threaten the life or globally impairs the health the woman. Women who are facing the agonizing reality that their lives are in danger and they are under medical emergency they deserve protection of the law, we all believe that, we are all here to continue fighting for that, but we also need to ensure that that instance is the only exceptional on which is the late term abortion are occurring, so how does house bill 465 answer that, well it requires physician to really provide their medical reports and reasoning over to D. H. H. S to ensure that that law is being one very important point I want to make out is that there is a very important provision in the bill to maintain confidentiality of patients. There's no identifying information that is being transferred over to D. H. H. S and so we are abiding by our hypo requirement in that. The second point which understandably has gained the most attention has to do with the waiting period an informed consent women who were deciding whether or not to terminate a pregnancy they deserve support and information and right now the women right to know requires that women receive a certain amount of information from their physician 24 hours prior to receiving that abortion. I don't think anybody would disagree that providing true accurate information about what are the options are, what is the nature of the procedure is, what alternatives there are and the kind of support that is out there. Thats empowers women, so we want to make sure women have ample time to get this information. So, currently as the law stand they only have 24 hours in which the requirements is frame for hours and ofcourse they don't have to make the decision at 24 hours. We want to make sure women are having the ample time though we're extending that deadline or the waiting period if you will to 72 hours to make sure that they're not making an impulse decision. In committee, we heard a lot of great testimony from individuals who said, I wish I'd had more time or from doctors who said, the worst decision that we can make are important emphasis to work this is the good idea to ensure women have 72 hours at least 72 hours in which to get all of the facts all of the information as we said at the end of 72 hours the woman may still choose to terminate pregnancy, but we want to make sure that she is doing so armed with all the facts and as informed as possible, I don't think anybody would argue that that is a problem. Finally we have some verifying changes to make sure that the laws that are currently on the books regarding health care professionals who may have religious moral ethical objections to performing abortions that that law is being followed and we've just done a very small technical change on that point, in the end we feel that this bill is one that can be supported whether your pro life approach choice is about giving women information empowering them and thus making sure that they are making a good decision and that they have all the facts as they come to that decision and we believe that that's the power in and in the end that help that one in the end talk a little bit more about why you took out the provision and how far [xx] hospital in North Carolina what is it no longer in this version So, in the first point that we want to make very clear is that state law prohibit tax payer funds for being used for the performance for abortion, so there's a bit of an issue when we see that abortions are still being performed at our state into schools and so we wanted to make sure that that was not still occurring. However, we consulted with the UNC system with AGGS with folks really on both sides of the issue, we realised that there are really some logistical issues with
that, however, we've discussed that this is an issue that we do need to make sure that tax hail funds are not going perfomance in devotion and we've gotten the attention of the folks as well as just to make sure for that we're staying true to the law so we've taken that provision out of the bill so that we can the main portions of the Bill got forward but we do have a commitment that we're working kind of offline to make sure that we're still making sure that taxpayers funds are not going towards that performing portion. Could you elaborate a little bit on the concerns of DHHS and the ANC system. Again some of those logistical things one of the concerns that have been raised had to do the accreditation standards, quite frankly those concerns were not entirely valid because of what accreditation allows for UNC basically requires that there's access to that training and that training can happen off campus. But again trying to figure out the logistics of what does that really look like that's something that we need more time to figure out and as with all pieces of legislation we want to consider all the ramifications and what might be a good way to achieve something? What might be a better way to achieve something? And so we're committed to meeting those issues but not in the piece of legislation. Next question. [xxx] I'm unclear, so does this mean that [xx] one such point is that we are talking a lot about what's not in the bill. I think it's going to be a good idea to kind of restrict our questions to what's really in the bill . The point that I make on that to answer your question then I can move on is that [xx] to be used for that [xxx] receives private grants and other ways of funding there's abortions. There's a question about allocation and where is that money going and so we want to make sure that [xx] it's still being followed but again let's focus on what's in the bill because that provision is not part of me. You talked about that provision about reporting about 12 physicians, you said that would have the effect of reducing the number of emotions, how does that work? Why would that have that effect? Well the short answer is that we have a 20 week fall in North Carolina and we want to make sure that that 20 week fall is being followed. We want to make sure that doctors are you know coming up with the statutory rationale that they need in order to perform these abortion that are post 20 weeks, we want to make sure that we're following the law here. How will this ensure that's happening, how would it result in fewer abortions? We found out that there are thousands abortion that are reported with no gestation knowledge, and we assume that those are probably after 20 weeks, so just to make sure that they are not after 20 weeks we were like for DHHS to gather that information on those other thousands that are not being reported properly Any question, thank you for coming now take it easy [xx] is
part of the I'll give you a copy between three million dollars per year is released. It has been reserved there for a while. We sent out a news release yesterday and this morning Yes I did mix that before [xx] hello This is [xx] [xx]. What are you [xx] between yesterday and today [xx] [xx] And you can put him in the chair Susan. [xx] would you guys like one of this? No thanks. Okay. We are sergeant at arms [xx] Okay. how many models Yeah, I'm Chris by the way.
Walter. I used to be a reporter [xx] How long ago was that? It's been five years now. There you go [xxx] say no more. Loud and clear, got you. There's one about a certain quote [xx] Alright, thank you so much. There he is, how are you? Good to see you. Good to see you [xx] [xx] I think you're here for the air pressure, that's all we're transacting right? I got some company. Lady sure I think it's three o'clock. Alright Alright man thank you for your help. Most welcome. You are in good hands here Would you get a couple
of nurses over here please, thank you sort of right about here. Right here just by the that's great but make this sort of crowded little bit. [xx] We can get maybe one person from this side so when Dr. [xx] speak we wont have a gap there, thank you very much sort of [xx] behind that. I'll [xx] behind that well answer that. Can I give you name, number. You know the address? I think this is it, and first of all, I say welcome this morning. I'm glad to have all of you here. Actually afternoon must had fast my day's been moving. Before I start, we have a cundary[sp?] of people here and I would like to take just a moment to introduce them. I will put your mind at ease, they're all not going to speak for 30 minutes per piece, so you're safe. But they will be available for questions if something comes up that will pertain to their particular area. First I would like to introduce Julie George, she is the Executive Director of North Carolina Board of Nursing, over here. And Megan Williams who is President of North Carolina Nurses Association and Family Nurse Practitioner. Dennis Taylor a cute-care nurse practitioner he's from Challorte and he's also Chair of the NCNA Commission Home Advance Practice Nursing. Sera Harbor is a family nurse practionor and she is a Chair of the council of North practitioners. Lazzly Shore a family nurse practitioners well and leads provider at the Southern Community Heath Center and it's no camp. And she quieted be talk family was practitioner and coloner of her own practice and Shannon Calos who has an aspiring certified nurse midwife and should graduate next month with the masters in midwifery from ECU, so you do have the buyers in your press kits and you can see what they do and involve with if you have questions
know who to direct it to, and before I turn this over to Senator Highes like any good politician I'm not going lose an opportunity to say a few words, and that's primarily the fact that every day we are here and the problems we have with Healthcare North Carolina, we got a crisis here and a crisis there, we don't have access, we don't have full service, we can't take of everybody and there's very unfortunate brain of twist all of those issues and we have here in North Carolina though the resource between our universities and our companies in RTP, our pharmaceutical companies or anybody connected with the medical industry where we should not be having those problems. And some of those problems, unfortunately, lay at the feet of Legislatures because of statutes we have in place that are outdated because of changes in technology, changes in education, the profession across the globe. And also, just because we put in a lot of restrictions that today don't really help us and that's one of the purposes of what we're here for with these bills. A lot of times, they served as the beginning to start a conversation. We don't want to rush into a lot of things, but we do want to begin to explore what changes can be made, how quickly they can be made to benefits and not problems, this seasons in North Carolina. An example of that is a [xx] profession. I don't know of a profession session right off the back that has changed so dramatically from the day I met my first nurse, probably been 50 plus and I'm not going to take exactly how many years [xx] because they now have levels of training that are phenomenal and we need to have legislation in place and processes in place to take advantage of every bid of that ability for the citizens of North Carolina. so I look forward to your questions and support for what we're trying to do and I'll mail it to Senator Highstake stage and he will be also you know, I'll speak about this today, but the study I think I found it very interesting. Thank you Thank you Representative Barbara and thank you everyone for coming to see this today and allowing us to present. As we already know I present real parts of Western North Carolina represents many of the mountains in this state, that are moving forward and one of the things that we're really seeing in Health Care is a difficulty in getting access to Health Care I myself for motor services outside the hospital doctor, is more than an hours drive to go to Asheville or Johnson City to get any significant services and Health Care and that's with the local hospital individuals for OB/GYN services and others, if we're fortunate enough to have someone one day a week that can come to the and provide those services otherwise it's moving to the much foreign areas, that separates us, you look at where we've come in that area and you compare to what else we're seeing with the ageing population that has more demands on Health care each and year and medical providers are retiring at a rate faster than we are graduating individuals into the medical professions all that is leading to major problems coming in their healthcare system, when you start going top on that all the major changes affordable [xx] for the last 3-4 years we need to maximizes that's what we are trying to do here with the Senate Bill 695 and House Bill 807. We're trying to create access. We're trying to firmly recognize, for legislative purposes, how much the role of nurses especially advanced practice nurses, have changed in the state. Other stuff to see, a nurse practitioner for everything that is done on the primary care level, I have primary care position, but when I'm on the just medication I want to talk about things they're doing we sent really fully recognize that in every State. Well we keep it under and so that's what we are trying to change here with this bill. I will say that the hardest thing in health care industry right now, as much as it's been shaken on its head in the last few years, is change. The industries don't want to change. They want to operate in the same structure and manner that we've seen for decades, and there are people that oppose this bill for that very reason, they want to keep their control and I want to keep their direction on health care even though
the're creating systems that are failing communities. We looking to remove some of those regulatory burdens with highly trained medical jobs, medical jobs that will serve in our own communities that are coming out, but it will also save millions of dollars. We have in the [xx] many of some of benefits of these bills we generate for our state recent study conducted by Christopher [xx] from Duke University, center for health policy and inequalities. Their research highlights the benefits of addressing the current regulatory burden placed upon [xxx] in our state and by removing many of these burdens, we show a weakened improvement access and improve the quality of [xx]. Before we go into some questions and others, I want to take the opportunity bring Mr [xx] over up and ask if he'd a few, the key points from the study and the information you have and then we'll go to questions. We appreciate very much thank you. So let me start by noting that throughout this report, we've deliberately selected conservative analytic assumption and that gives me high confidence that all of our lower bound estimates in the impact of removing restrictions on the practice of nurses, represent a true floor if what is going to happen, relative to what's actually going to happen. So whenever I use a lower bound figure I feel very comfortable and saying that less restrictive regulation of advance practice nurses is going to have an impact of at least that magnitude. So let me just focus on, you've got the handout on some of the facts and figures from the study. I want to highlight the impacts on health spending and on the physician shortage. The various studies have indicated that expanded use of advanced practice nurses by removing under less [xx] of legislation. We produce annual health system savings of any where from. 63% to 6.2% that's a big range obviously. In North Carolina annual spending we estimate was $69 billion in 2012 so these numbers translate into annual savings of any where from 443 million to $4.3 billion. That's a lot of money, that amounts to $44 to $437 for North Carolina. Now the lower figure is based on the results of a [xx] corporation study that was done for the State and [xx], it only focused on nurse practitioners and physician assistants, the higher figure is from a Texas study that looked at or all four categories of A. P. O. Ns that we looked at in our study. Now I haven't done a fine grained analysis of the difference in laboratory practices here compared to Massachusetts and Texas. But my sense is that we're closer to Texas in terms of our restrictions and our regulation than we are to Massachusetts. So I can't say with precision how much the annual savings is going to be but I think its going to be closer to the $ 4.3 billion than the $433 million figure. In terms of the impact on the physician study, a number of study of organisations including the North Carolina Institute of Medicine and the [xx] Corporation have projected potential shortages of physicians in North Carolina by the year 2020, and as you've already heard that already exists to some extent today. We did not try and replicate or update these estimates, we took them as they were except, that we did do the adjustments as necessary to take into account the expected impact of the affordable Care Act, we expect that if the ACA or something similar to it is fully implememnted the demand for care in North Carolina by 2020 will go up by 3.1% if we don't expand Medicaid, it will go up by 5.7 % if w do expand Medicaid, I'm not a political prognasticator so I don't know which will happen but I can just give you the range of what will happen. We project that less restrictive regulations of APRN's would result in a net increase of 1744 full time equivalent APRNS relative to the 2012 supply. Now we recognise the principle due to differences in the number of hours of work
per year between APRN and doctors, one advanced practice nurse doesn't completely substitute for a doctor in terms of the number of patients they can treat every year. So using appropriate substitution ratios from the literature, we calculated how much are the projected shortage of physicians by the year 2020 might be alleviated through greater use of APRNs, and you can see the results in the chart here. The lower bound number represent the worst case scenario in terms of the doctors shortage, that is the doctors shortage is very large. Any increase in the supply of APRN is going to have only have modes impact on the size of that shortage, conversely if the shortage of doctors is very pretty low than any given increase in APRN, this is going to have relatively greater impact, so we estimated that the combined increases for nurse practitioners and clinical nurse specialist would reduce the projected shortage of primary care physician exclusive of OBGYN by atleast 92%. The expected increase in nurse midwives alone would reduce the expected shortage of OBGYN by 17%. However, it is important to understand that those factors we knows and clinical nurse specialist also can use the domain for OBGYN depending on what stopers specialisation is. So hypothetically is [xx] for the extend use of APRN to completely eradicate the shortage of OBGYN in which case that would still reduce range of none OBGYN primarily shared docs by 83% the expected increase in CRNH would eliminate atleast 85% of the expected shortage of [xx] and possibly could eliminate that shortage entirely, that is why sizing the regulation of advanced practise noses has the potential to decrease shortage of all none federal positions by atleast 41% and possibly eliminate that shortage entirely in case that would be great news for north carolina. Am happy to take questions do we have any question from the audience? Just a point of [xx] some smaller than the other ones. Only because the nuts [xx] were only focusing on nurse midwives and their impacts and that's the reason I put the caviar and if you take into account what the increase in supply of nurse and clinical nurse specialist. It would change that bar entirely it would say we eliminate that shortage of OBGYNs though it's only because we are focusing on one error of the slice on the figure. Do we have a question or comment? Or this is amazing. We just covered everything. Okay, are there any questions? I won't keep anybody waiting. So I thought you are asking specifically the economy. I'm not opening floor for everybody. Okay I know what your arguments favor of irregulating and favor of the bill is of course that we would get more healthcare pressure in the rural areas. Why would nurses be more likely to go into rural areas and doctors aren't. I don't know the reason why, but the empirical evidence suggest that they do. And also that when you look at admissions into schools in North Carolina and individuals coming out in health practice, the highest rate right now of individuals practicing in rural areas and try to our health care on for nurses who come from rural areas and are trained in the Community College System. East Carolina and others can do some things with their practice, but most doctors we train to say Carolina we are having about 18, 19% that even stay within the state, and that's exclusive of urban and rural areas. They come back here in nurse practices we are having as much as 80% stay within the state those who are coming and for our rural areas it's the most success areas we have and getting practice there that has been the historical trend in expanding that code do nothing but continue that trend moving forward and give individuals opportunities to move up in a practice. You've been to the doctors stories but isn't there also nursing stories under out number decline also? Nursing school graduates hey
[xx] identify yourself please. Thank you I'm Julie George Executive Director for the North Carolina board of nursing and actually there's a lot of debate over whether there is or is not nursing authority, each at the national level, there's been a lot of work at Dr. Peter Beerhals and out of vanderbelt about that and the most recent numbers actually show that and this is true for North Carolina there's a slight increase in the enrollment and of the graduation and entering into practice of registered nurses. It's a bit of a downward trends for the licensed practical nurses, just as jobs and the job market has changed a bit but there's a huge upward trend in advanced practice registered nurses. So that's true in North Carolina and I would say throughout the country, they're growing in numbers. So, if we're sure some of the dirty and the care treatment into the nurses does that leave a void there with traditional services, traditional job functions or nurses Not from my perspective because the only this legislation does nothing to change anything about the scope of practice for either the LPN the REN all these advance practice registered nurses. So you sill have people practicing at their level providing those services I think the benefit of the bill is it for those advanced practice nurses it would reduce barriers and even be more desirable if you would for those practitioners to come to North Carolina. at the present time if value of practicing autonomously in other state there is a real concern about their willingness to even see us as the verbal or attractive place to work. So as I said just someone it was 1981 President Ronald Reagan was in office when we amended the Nursing Practice Act. The last time within change and people were listening to eight track tapes in their car. So this really just moving us into the 21st Century and I think its time for that, and I really applaud the bill sponsors for being willing to do this. Thank you. Can I add just one point? The practice environment is actually critical we shouldn't think of a fixed supply of nurses, the supply of nurses is going to respond with the incentive or system in terms of regulation so in order to do our estimates predicting how many more APRNS will be if you loosen those restrictions we looked at states that did have lucid restrictions and they experience 24% higher growth or more Apier ends after a seven year period compared to states like North Carolina that has more restrictive practices so that's the whole point. If you can remove those restrictions now you're going to attract more APRNs, you are going to need even and send people within North Carolina to go into that kind of training or you're going to attract other people from outside of North Carolina [xx] from [xxx] North Carolina perspective, I see for the nursing in the last few years, you've had western Carolina open a nursing school down in [xx], you've had upper large to State University waiting on accreditation now to begin offering their nursing program, Mercer university has also begun offering their nursing programs in addition to expansion to all our community college I work community college.community college is known for open admission except when it comes to the nursing programs with where we are are turning down students every year to get into our nursing programs and we are prepared to respond and the state we need more faculty and others that we can put more nurses out in a quick time period turning around both on the advance side which the university is responding to and at the RN level which both the universities and the community college respond to you've seen no changes in our medical school. So are you expecting any financial impact with any legislative changes? I don't think at this point that we have budgetary impact within the by union for the changes that are coming in but I shall see in the study I expect long term when we talk about more than 60 days in spending in North Carolina health care when you have 20% of our state population on medicaid 6% of your state population on the state health plan if were reducing the cost of health in the state there is a forth coming [xx] impact on the state budget. I'd like to make a comment along this line too because I don't see nurses sub-slanting[sp?]
doctors or replacing doctors with this growth in the advanced practice nurses and other specialist nurses I see them it's expanding the availability of services because of the bulk storage and just the fact that there may be things of high level they could be concentrating on while we have people at the advance practice level and others taking care of health issues and be enabled to serve more people and the completely eliminating the big question we've got here in the state and that is primarily access to literally having enough people to supply the needs of our citizens Can I ask this will pain a little bit but heard that regulations have been changed since [xx] administration, many of the states have changed them and why have we not? Well it's interesting dynamic and there's a lot stuff going on every session and there have been changes to the act as we added things to it but in looking at the entire scoop of nursing in relationship to the health care profession and exactly how we set it up that has not been looked at in that period of time but I think it's partly driven as much by the changes in the education level we've got nurses now with masters and Phds and you're taking about a system that hadn't been it's, how old is my son? 34 years since they looked at this so I think it's way past time because things have changed dramatically in that 30 year period. Has the medical society weighted at all this [xx] conflicts or are they supporting this? It maybe more about segment from my opinion to their response than hurries is that when you have a monopoly on a system you tend to fight things that may changes to that monopoly when you are moving forward and get forward, we've had a lot of good conversations with the medical society and others in there they has been very aware of the development put forward this. But we've had even better conversations with the hospitals and practices I see this kind of duplicative role advanced registered nurses work with doctors every day and whatever setting that they are in there role is established within that and it's been an incredible relationship sometimes when you're representing the legislative theory of this whole thing you one should be, they take much more hard lines to stand for the individuals who will hand over a lot of the working practice to them every day, but directly I don't know they'll suspect the medical society will ultimately be in support of this. We [xx] house bill 200 as well in that case the changes seem to be, I know a [xx] may be producing to [xx] is it fair perspective to characterise this bill as being one that would, maybe not quite an overhaul but at least change the regulations to a larger degree especially compared to say out of 200? I think in terms of effect bigger steps with 200 or much more impact and I believe that lying now the direction that they're headed here that we will see we can unwind without a lot of really upsetting fix in the procedure, a lot of this is simply going to be changing people way of thinking how the supervision and how the oversight should be handled and particularly what I've looked at is one of the key thing that we did examine and possibly change. Any other questions for anybody?