Health License Defense » PA

Can Physician Assistants & Nurse Practitioner’s Own Clinics?

Jon Porter — Thu, 16 Dec 2010 00:20:14 +0000

Currently, there is no law that prohibits this practice. With the legislature coming to town, there may be a push by the Texas Medical Association to ban this practice, but I do not see the legislature doing so this session. There are too many other issues to tackle and it is anti-free market.

However, the Texas Medical Board and the Texas Physician Assistant Board have formed an Ad-Hoc Committee to see if this issue needs to be prohibited, curtailed, regulated or ignored. They recently had their first meeting. The Boards well-know that such clinics currently exist. The fear for the Board’s is the relationship between the mid-level provider, who is the owner and employer and the supervising physician, who is the employee (actually independent contractor) in this relationship.

Such a relationship is currently, and technically legal as long as the physician is an independent contract who maintains independent medical judgment. The argument is a physician cannot maintain independent medical judgment and supervise a mid-level provider while also reliant upon the mid-level provider for a pay check. One Texas Medical Board member expressed a concern that “fringe” doctors are more likely to enter into this relationship than other physicians.

There was a lot of brain-storming on possible regulation that could occur. The Executive Director, Mari Robinson, correctly informed the members of the Boards that regardless of the direction the Boards take they are likely to get sued. She also pointed out to the PA Board that they are obviously limited to Physician Assistants, thus any regulation they put into place; it does not affect Nurse Practitioners. Likewise, with the Medical Board, the regulation only affects the supervising physician.

Nothing was resolved at this first meeting of the ad-hoc committee. The next meeting will be February 3^rd.

Budget Troubles Will Effect Health Licensing Board

Jon Porter — Thu, 09 Dec 2010 15:41:31 +0000

On December 7^th, the Governor, the Lt. Governor, and the Speaker of House sent a letter to all state agencies, including all the health licensing board, and directed them to cut 2.5% of their budget for rest of the 2011 Fiscal Year. The FY 2011 began on September 1^st. The FY 2011 began with a directive to cut 3% of their budget; thus budgets have now been cut 5.5%. As the vast majority of budget for health licensing agencies are salaries for staff, this has meant hiring freezes in some agencies.

For FY 2012 and 2013, the Governor, the Lt. Governor, and the Speaker of House told agencies to offer budget 10% less than their FY 2011 budgets. This will mean lost of more staff, slower time to process new licenses and slower time to investigate cases. The Texas Medical Board reports it believes it will generate less income for the state for due to its budget cuts. The Board did not explain how this would occur.

It is possible, the further cuts will occur. It is even more likely professional renewal fees will increase as will new licensure application fees. The reason these things will occur is the projected budget deficit is 23 billion dollars. Even if the legislature ends all state programs other than education, prisons, roads, law enforcement, and Medicaid, there will still be deficit; therefore, it seems logical to assume more cuts and larges fees are a matter of when, and not if.

Texas Physician Health Program Update

Jon Porter — Thu, 09 Dec 2010 15:26:18 +0000

According to public information on December 3, 2010, the Texas Physician Health Program, which also serves Physician Assistants and Acupuncturist, now has more than 100 people enrolled in its monitoring program.

The two big issues that are still unsettled is how to deal with licensees who agree to cease their practice altogether. The Medical Board and the Texas Physician Health Program are working on finding a method that permits a physician to cease practicing without a form a public disciplinary action. The second issue is how to appropriate deal with people who have “dual issues:” An impairment issue that is more appropriately handled by the Texas Physician Health Program and some other issue that the licensing Board wants to handle with public disciplinary action. Again, this is something that agency staff and the Texas Physician Health Program are attempting to determine the best method to proceed. Some resolution to these issues should be determine in early February.

Delegation Waivers Limited

Jon Porter — Thu, 30 Sep 2010 22:23:04 +0000

At the August 25^th meeting of the Standing Delegation Committee, there was an open discussion that it was the possession of the committee is that requests for waiver of the mid-level supervision rules filed appear, in the opinion of the committee, were being requested too often for the physician’s convenience with no benefit to the patients. As such, it is the position of the committee that without compelling evidence of public benefit, the committee will generally lean towards denying requests.

New Rules for Website

Jon Porter — Thu, 01 Jul 2010 22:09:26 +0000

For Physicians, Physician Assistants and Acupuncturist, if you have a website for yourself or your practice effect July 1, 2010, the Board has instituted new rules that directly affect you. The rule, I believe is some what onerous and vague. I think it may be difficult for some people to comply with; but if you want to keep the Board off your back, you best attempt to adjust your website accordingly.
The rule is 164.6.Required Disclosures on Websites.
(a) Disclosure. A licensee that maintains a website in relation to the license’s professional practice must clearly disclose:
(1) ownership of the website;
(2) specific services provided;
(3) office address and contact information;
(4) licensure and qualifications of physician(s) and associated health care providers;
(5) fees for online consultation and services and how payment is to be made;
(6) financial interest in any information, products, or services;
(7) appropriate uses and limitations of the site, including providing health advice and emergency health situations;
(8) uses and response times for e-mails, electronic messages, and other communications transmitted via the site;
(9) to whom patient health information may be disclosed and for what purpose;
(10) rights of patients with respect to patient health information; and
(11) information collected and any passive tracking mechanisms utilized.
(b) Accountability. Licensees must provide patients with a clear mechanism to:
(1) access, supplement, and amend patient-provided personal health information;
(2) provide feedback regarding the site and the quality of information and services; and
(3) register complaints, including information regarding filing a complaint with the Texas Medical Board as provided for in Chapter 178 of this title (relating to Complaints).
(c) Advertising/Promotion of Goods or Products. Advertising or promotion of goods or products that a licensee sells outside the normal course of business from which the physician receives direct remuneration or incentives is prohibited.
I would strongly advise you to review your website to ensure it complies with this rule and the information demanded of it is complied with. You may want to consult a professional to ensure compliance.

New rules for APRNs and PAs by the Texas Medical Board

Taralynn Mackay — Wed, 09 Jun 2010 22:18:16 +0000

There are new prescriptive delegation rules drafted by the Texas Medical Board and many physicians, APRNs or PAs may not be aware of the changes. The rules apply to prescriptions, delegation by physicians, practice sites, and review of charts. One of the big areas that can impact an APRN or PA is the requirement for registration (the forms and further info can be found on the Medical Board’s website). Physicians that delegate prescriptive authority to PAs or APNs are required to register with the Texas Medical Board. This became effective on 1/31/2010.

New Proposed Reporting Rules for Physician Assistants

Jon Porter — Thu, 03 Jun 2010 13:15:25 +0000

The Texas Board of Physician Assistants has proposed new rules on information that a Physician Assistant is required to affirmatively report to the Board within 30 days. The proposed rule is:

New §185.27, relating to Duty to Report Certain Conduct to the Board, sets out requirements for physician assistants to report certain events to the PA Board within 30 days of their occurrence.
Rule 185.27 requires reporting within 30 days of:
A) address change,
B) incarceration in a state or federal penitentiary,
C) Any activity concerning a felony offense,
D) Misdemeanors relating to
a. PA responsibilities,
b. morale turpitude,
c. assaultive offenses (except fine only offenses),
d. registering as a sex offender,
e. violating a protective order, including offenses involving bias or prejudice.
f. Being found guilty of offenses involving
i. controlled substances & dangerous drugs
ii. inhalant paraphernalia
iii. guilty of felony under Drug Abuse Prevention & Control Act

If you support or oppose this rule change, you may voice your opinion to the Board as these rules currently are in its comment period.

Changes Coming in Delegation of Prescriptive Authority?

Jon Porter — Thu, 12 Nov 2009 15:37:26 +0000

Texas Medical Board staff met with the representatives of the Texas Nursing Board and the Department of Public Safety regarding prescriptive delegation for mid-level providers. They discussed the two methods that mid-level providers to prescribe scheduled drugs:

(1) The mid-level providers can obtain there own certification with the DEA and DPS. Their individual certification number must appear on their prescription pad and they are required to have a supervisor relationship with a licensed physician. This person is viewed as a “sponsor.”

(2) There must be a standing protocol for the mid-level provider to prescribe using the physician’s prescription pad for the listed symptoms and only prescribe medications that are listed in the protocol for the symptoms.

The parties meet to discuss creating a field on the Texas Medical Board’s Physician Profile that will list all of the mid-level providers under the physician’s sponsorship who have prescriptive authority.

The Texas Medical Board’s Standing Delegation Committee voted to create a sub-committee with the Physician Assistant Board and the Nursing Board to look into the guidelines for supervising physicians over PA’s and APN’s who have prescriptive authority under the physician’s supervision. Their goal is to have everyone on the same page as to what the rules are and the risks involved in prescriptive delegation.

My Take: First, physicians and mid-levels need to be sure they are in full compliance with current level and the correct paper work is in the Board denoting the supervisor relationship. Second, look for the rules to be changed in the future. If you have three boards get together, I can assure you the rules will change. Given the current regulatory climate, I suspect that rules will tighten-up. I just hope that before the Boards publish any rule changes, they talk and meet with “stake holders” in this area as any changes to mid-level prescriptive authority will have significant affect over thousands of providers. Please continue to monitor this blog for changes.