The Frustration of Nurse Midwives and Corporate Practice of Medicine Bans

By Christina Thielst via Multibriefs

Kaiser Health News recently reported on the failure of California's AB 1306 to expand the scope of practice for certified nurse midwives — allowing them to practice independently. The bill failed to pass because the California Medical Association opposed it after an amendment was removed that would prohibit hospitals from employing nurse midwives, some of whom are already employed by hospitals in the state.

The result is frustration among women and their families who want more choice and affordability in their options.

California has one of the most comprehensive bans on the corporate practice of medicine — established in 1928 to protect consumers from unnecessary care simply for the benefit of profit to the corporation. Both the California medical and hospital associations support the concept of nurse midwives being able to practice independently. This points to a need to reassess the ban as a result of changing payment and care delivery models.

The U.S. healthcare delivery system is undergoing a transformation that includes increasing the number of insured, expanding access and paying for more efficient and quality care. This transformation coincides with shortages of professionals and strategies that have medical professionals practicing at the top of their license.

In an April 2016 paper, The California Research Bureau of the California State Library examined the corporate practice of medicine (CPoM) in a changing healthcare environment. Their review of the key policy issues included a deliberation on whether the CPoM ban is still necessary, especially related to employment.

They point to inconsistencies from the fragmented way the ban has been extended and erosion of the policy rationale by the number of exemptions. They also highlight the recent changes in healthcare for policy makers to consider:

• the move away from per-procedure payments to pay-for-performance/value models
• increases in patient access to information and disclosures for informed decision making
• other methods of protecting provider autonomy, such as, physician unions

The Research Bureau's outline of options for policymakers to consider includes clarifying the types of entities that may or may not employ practitioners, elimination of the ban and examination of the costs to hospitals and physicians of current alignment strategies as compared to direct employment models. They also offer the option of expanding the nurse scope of practice and support for professional nursing corporations owning retail clinics.

Conflicts between innovation and public policy can be expected across the nation as the healthcare system continues along its transformation journey. The impact is being felt by not only physicians, surgeons, advance practice nurses, opticians, dentists and other independent practitioners, but also consumers — especially those in underserved communities.

As policymakers continue to push for lower health costs and improved access, they will also need to address and eliminate barriers that stand in the way of innovation. The skills of all providers need to be leveraged, while balancing consumer protections and safeguards.

Making public policy more responsive to the changing environment of healthcare may mean finding new ways to protect practitioner autonomy, so patients can get the care they need.

Christina Thielst, FACHE, is a skilled and innovative hospital and healthcare administrator and entrepreneur with a deep desire for continually improving the health of the community being served. Christina is also the author of "Applying Social Media Technologies in Healthcare Environments."