Utilization of advanced practice nurses,
such as nurse practitioners, and physician assistants has been increasing over
the past few years. Laws with respect to
these health care providers have also changed, both on a Federal and State
level. On May 4th, Governor
Mike Pence signed into Indiana law House Bill 1183 which included changes for
both advanced practice nurses and physician assistants. Further, on April 16th President
Barack Obama signed into federal law H.R. 2 which included various changes for
nurse practitioners. These changes are
outlined below.
Physician
Assistant
Physicians assistants engage in a dependent
practice with physicians in which the physician delegates authority to the
physician assistant. Nevertheless, House
Bill 1183 substantially changes many requirements related to physician
supervision. These changes include that
a supervising physician no longer is required to name each drug or drug
classification in which the physician assistant has been delegated authority to
prescribe, a supervising physician does not need to cosign any prescriptions
ordered by a physician assistant, and patient encounters between a patient and
a physician assistant should be reviewed by the supervising physician within
ten (10) days as opposed to seventy-two (72) hours. Another large change relates to chart
reviews. Previously a supervising
physician had to review at least 25% of the physician assistant’s patient
charts. Now, this is required only in
the first year of employment and thereafter the physician can determine a
specific number of charts that needs to be reviewed. Finally, a supervising physician can now
supervise a maximum of four (4) physician assistants at any time as opposed to
two (2).
Advanced
Practice Nurses/Nurse Practitioners
An advanced practice nurse includes a nurse
practitioner, nurse midwife, a clinical nurse specialist, or a certified
registered nurse anesthetist. Advanced
practice nurses are independent members of the health care team that make
independent decisions related to the health care of patients. For advanced practice nurses that seek
prescriptive authority, a collaborative agreement is required with a
physician. House Bill 1183 had one
change that is applicable to both advanced practice nurses and physician
assistants. Both are now able to
prescribe and treat patients with a Schedule III and Schedule IV controlled
substance for the purpose of weight reduction or to control obesity. Although advanced practice nurses have been
able to prescribe Schedule II through IV controlled substances, they now can
offer treatment for weight loss. H.R. 2
now authorizes nurse practitioners to document the face-to-face encounter
required for durable medical equipment orders.
Previously, a physician needed to be involved to document such an order.
These changes may have a significant impact
on how your organization utilizes these healthcare professionals. If you have any questions or concerns related
to these recent changes in laws, or the utilization of these providers in your
organization, please contact Alex T. Krouse at (574) 485-2003.