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Health care for rural Georgia

POSTED: December 7, 2017 7:00 p.m.

If you get sick or badly injured in Georgia, you could find yourself slap out of luck if you live in one of the state’s rural counties.
In places like Clay County, an impoverished rural county in Southwest Georgia, there is no hospital. The county’s only doctor sees patients in a building that used to house a fast-food franchise.

The residents of Clay County are comparatively lucky, however.
There are nine rural counties in Georgia that have no physicians, 63 counties that have no pediatric physicians, and 79 that have no OB/GYN physicians. There are 22 counties that have no advanced practice registered nurses (APRNs), which is a nurse who has obtained at least a master’s degree in nursing.
It is a situation that has gotten worse, not better, in recent years. Since the beginning of 2013, there have been six rural hospitals in Georgia that have shut down.

It’s no coincidence that all of those hospitals closed after Gov. Nathan Deal decided Georgia would not participate in the expansion of Medicaid coverage under the Affordable Care Act. That decision cost the state more than $9 billion in federal funding that might have enabled some of those rural hospitals to keep their doors open.
We find ourselves in a situation where people in many rural areas have long distances to drive before they can see a doctor for even the simplest of medical problems.

A legislative study committee has come up with perhaps a partial solution to the problem.
The committee chaired by Sen. Renee Unterman (R-Buford) is recommending that the Legislature amend state law so that APRNs can do some of the things that physicians traditionally do, such as prescribe drugs and order imaging tests.
There are already 22 states that give APRNs full authority, or “scope of practice,” to do these things.
Georgia, on the other hand, is one of the 12 states that place the most restrictions on what APRNs can legally do.
Unterman, who was once a nurse herself, said her committee will draft legislation that would give APRNs a wider scope of practice if they agree to work in counties that are defined as medically underserved.

These would be counties that have little or no availability of physicians, a high percentage of the population that is uninsured, and larger than normal numbers of low birth-weight babies and cardiovascular deaths.
“The goal is the enticement of APRNs to locate in rural counties,” Unterman said at the committee’s final meeting last week. “We’re facing insurmountable problems and there’s not an easy way to fix it.”
“What we’re doing now is not working,” said Brenda Rowe, past president of the state Board of Nursing.
The idea of allowing APRNs to fill the gaps caused by a shortage of physicians is not new.

A report issued three years ago by the consumer organization Georgia Watch concluded: “As one of the lowest scoring states in terms of overall health, Georgia needs to encourage the ability of non-physician providers, like APRNs, to practice more autonomously, particularly in rural parts of the state, in order to ensure that Georgians have an adequate system of care.”
Unterman’s committee is also recommending the expansion of a tax credit program to include physician assistants and APRNs, and a provision that would allow APRNs to bill health insurance providers such as Medicaid.

“I think you could quantify this as baby steps,” Unterman said.
Who would oppose the idea of giving Georgians in rural counties more access to healthcare services? Physicians, to start with.
The state’s physicians are represented by a powerful lobbying group, the Medical Association of Georgia. MAG has traditionally opposed any and all attempts to widen the scope of practice of non-physicians.
The organization said last week that it “believes that APRNs should continue to work under collaborative practice agreements with physicians to ensure patient safety. MAG also believes that nurses in the state should be governed by the Georgia Composite Medical Board.”

In other words, APRNs should be kept under the tight control of physicians so that they don’t threaten their fees and revenue streams.
Unterman said her response to MAG would be: “We’re not encroaching on your turf.”
Will her legislative colleagues agree with her and pass her bill? Let’s wait and see.

Crawford is editor of The Georgia Report. He can be reached at tcrawford@gareport.com.

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