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Wednesday, May 22, 2013

Recent Changes: Scope of Practice for NPs and PAs

Recent Healthcare Update

Recent Changes Regarding Scope of Practice for Nurse Practitioners and Physician Assistants

With the ongoing shortage of primary care providers, many states are expanding the ability of physician extenders to practice independently. These providers consist of nurse practitioners (NP) and physician assistants (PA).  This recent trend has come to New York as well, evidenced by the recently passed New York State 2013-2014 budget.

In the recent budget process, the Legislature expressed a strong interest in providing further independence regarding NP’s scope of practice.  The proposed legislation was not included in the final budget, but nevertheless appears to be an issue that the Legislature will take up again in the near future. The 2013-2014 budget did, however, make changes to the scope of practice of PAs; amending New York State Education § 6542(3 and 5), to increase the number of PAs that a physician can supervise in their private practice, from two to four. 

For many of our physician clients, the use of these physician extender providers has been quite valuable to their practice, both for covering on-call, hospital rounding, as well as increasing efficiencies in the private office setting.  For an NP, the independence provided in the statute is greater than that for a PA, in that an NP does not need to be supervised by a physician, but rather is in a collaborative relationship with the physician pursuant to a statutorily required written collaboration agreement (8 NYCRR § 64.5).  A NP collaboration agreement provides for resolution of conflicts between the NP and collaborating physician, protocols for practice, a chart review every three months by the collaborating physician, and any additional provisions as determined between the NP and physician to be appropriate.  In addition, the collaboration agreement is required to identify the area of practice to be performed by the NP.  The collaboration agreement must be maintained in the office where the NP provides services, and available for inspection by the New York State Department of Health upon request.

With the growing urgency to resolve the nationwide shortage of primary care providers, and increased reimbursement for such primary care preventative measures expected in the implementation of the Accountable Care Act, we expect that the State will continue the trend of increasing the role of physician extender providers as primary treatment sources.


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