Bill Filing Ends for 2024

March 1 marked the last day for bill filing in the Missouri Capitol and the date could not have come soon enough as over 2500 bills were eventually filed by the deadline. Of these, many have healthcare implications, but only a few have been heard in committee to this point.

Legislators took a break the week of March 18 and returned to finish out the session on the 25th. By law, the session will end on May 17, so we have two months left.

Physician Advocacy Day a Success

Nearly 150 physicians and medical students joined us in Jefferson City on March 5 to celebrate Missouri Physician Advocacy Day. Members of MAOPS and the Missouri State Medical Association joined together for the largest physician advocacy event of the year. Participants met two days prior for a virtual briefing of the day, then hit the Capitol hallways advocating for reforms in prior authorization, prevention of scope of practice expansion, and elimination of non-compete clauses in physician contracts.

Bills of Interest

While participating in Physician Advocacy Day, physicians conveniently had the opportunity to view a committee hearing on HB 2446, a bill to license naturopaths in the state. Thank you to Jeff Davis, DO, for his in-person testimony in opposition to this bill. This bill establishes a license for naturopathic physicians, creates a naturopathic regulatory board, and defines their scope of practice – which sounds eerily like that of a physician even with prescriptive authority. Even with excellent testimony in opposition to this bill, the committee voted it “Do Pass.” It now awaits a vote of the full house. Most concerning about this bill are comments from legislators to physicians regarding two things, 1) the use of the terms “doctor,” and “physician,” and 2) legislator use of the terms/phrases “competition” and “patient choice.” Many in opposition expressed concern about patient confusion/deception when healthcare providers who have not attended medical school continue to use the terms “doctor” and “physician” to describe themselves in a healthcare setting. Arguing that this causes confusion but also sends a message of equal training and expertise, many physicians and groups representing physicians argued that there is a difference between a scholarly degree, “doctorate,” and the title “doctor” used in the healthcare setting. Patients have expectations, and it is felt when most hear the terms doctor or physician, they think of a medical school graduate. This discussion has occurred in multiple hearings this year, with a vocal group of legislators insisting that it doesn’t matter, and that “physicians” don’t have a monopoly on the terms. We continue to argue that expertise should not be devalued, especially when a person’s health is on the line. The second concern is related. A legislator commented that he felt that a citizen should make their own choice as to who they see, including educating themselves on the types of providers. He felt “competition” among providers was positive. Again, he seemed to be missing the point that the information needed to be presented to patients in a fair way, which most of these non-physician providers seem resistant to doing. MAOPS members are encouraged to discuss these issues with their legislators and educate them on the problems associated with discounting expertise and continuing to allow non-physicians to practice medicine. If common sense can’t prevail, members are encouraged to use their vote during the next election.

HB 2534, regarding advertisements for healthcare practitioners, was heard in the House Committee on Health and Mental Health Policy. MAOPS testified in support of the bill, which would make it mandatory for healthcare providers to clearly identify themselves by their credentials when in a healthcare setting. This would help solve some of the issues discussed above, and as you can imagine, some of the same legislators discussed above opposed this bill as well. In testimony, both in-person and written, opponents (mainly APRNs) stated they felt that they should be able to call themselves “doctors” since they had earned a doctorate degree. They, and some legislators on the committee, seemed to miss the point that this bill was not about using the term “doctor” but identifying oneself as a “nurse practitioner,” “physician assistant,” “physician,” etc. 

HB 2548 is a bill MAOPS strongly supports. It requires that any hospital advertising an emergency department to have a licensed physician on duty during that emergency department’s hours of operation. This might be the simplest bill you will ever see in the legislature at one sentence long! However, the vitriol we heard at the hearing made it anything but simple. The reason behind this bill is to ensure that those seeking emergency care see the most highly trained healthcare professionals – physicians. Can you imagine a loved one involved in a serious automobile accident arriving at an emergency room to find no physician on staff? It’s happening around the state and not just at critical access hospitals. You can imagine our opposition to this bill – nurses and hospital administrators. The nurses feel they are quite competent to handle emergent care, and the administrators just can’t afford physicians. So once again, we are faced with the reality that physician expertise and training is being 1) minimized by those with less of it and 2) discounted by those who don’t want to pay for it. Who suffers? The patients. Please be on standby to submit your support for this bill as the session progresses! If doctors continue to remain on the sidelines on these issues, their expertise will continue to be taken for granted.

In February, MAOPS issued a call to action on HB 1773, which would grant APRNs independent practice in the state with 2000 hours of “collaborative practice” with a licensed physician. However, it also removed any geographic proximity requirement for collaborative practice, which means it could be that the APRN and physician never interact. That, coupled with the fact that the 2000 hours of collaboration has no standards of required learning, means it is simply window dressing. MAOPS members responded with over 2/3 of the oppositional comments coming from the osteopathic profession! Great job! This week, the House Committee on Emerging Issues is rumored to be voting on the bill, and as has been the tendency for all scope of practice bills lately, we unfortunately expect it to be voted “do pass.” Be prepared for future calls to action on this and similar bills in the last months of the session. Keep the faith!

As you can see, the bills above have a common theme and common opponents. Non-physicians want more latitude to present themselves as more qualified than they are, and physicians want more transparency.

At the risk of sounding like a broken record, we encourage members to develop personal relationships with their legislators and educate them on these issues. You only have one Senator and one Representative, so the job is not insurmountable. Just a small amount of time each year can pay huge dividends. If you need assistance, please contact MAOPS Executive Director Brian Bowles.