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.

 (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.