Significant changes to practice by physician assistants in Michigan will take effect on March 22, 2017. Any physicians (medical, osteopathic and podiatric), health facilities, and health agencies that work with PAs should take the steps needed to ensure compliance with the requirement by the effective date.
Under the new statute, a PA cannot engage in practice as a physician assistant unless a “practice agreement” that contains the required provisions is in place by March 22, 2017. The failure to have practice agreements in place could result in the unauthorized practice by PAs, with the potential for risks in areas such as licensing, liability, billing, and compliance.
There are important benefits under the new law. If the requirements are met, PAs have the ability to engage in a broader scope of practice without some of the administrative and supervisory burdens currently imposed on physicians. Generally, the statute removes the current supervision and delegation requirements in favor of physician oversight within the practice agreement.
“Practice agreements” replace delegation and supervision
PAs can only practice under the terms of a “practice agreement” with a “participating physician.” A group of physicians may designate one or more physician members to serve as the participating physician. Health facilities and agencies may also designate one or more physicians to serve in that role.
The practice agreement must include the following terms:
- A process between the PA and participating physician for communication, availability, and decision making when providing medical treatment to a patient. The process must utilize the knowledge and skills of the PA and participating physician based on their education, training, and experience.
- A protocol for designating an alternative physician for consultation in situations in which the participating physician is not available for consultation.
- The signature of the PA and the participating physician.
- A termination provision that allows the PA or participating physician to terminate the practice agreement by providing written notice at least 30 days before the date of termination.
- The duties and responsibilities of the PA and participating physician. The duties and responsibilities may not include an act, task, or function that the PA or participating physician is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the PA or participating physician.
- A requirement that the participating physician verify the physician’s assistant’s credentials.
Expanded scope of practice
A PA may engage in the following acts if a proper practice agreement is in effect:
- Have ultimate responsibility for the quality of medical care services.
- Enter orders in patient charts without being countersigned by a physician.
- Make calls or go on rounds in private homes, public institutions, emergency vehicles, ambulatory care clinics, hospitals, intermediate or extended care facilities, health maintenance organizations, nursing homes, or other health care facilities in accordance with a practice agreement, without restrictions on the time or frequency of visits by a physician or the physician's assistant.
- Prescribe a drug and order, receive, and dispense complimentary starter dose drugs, including Schedule 2 to 5 controlled substances, using the PA’s name and DEA registration number. (The definition of “prescriber” now includes PAs with controlled substance licenses.)
The statute allows the Bureau of Professional Licensing and the relevant licensing boards (Board of Medicine, Board of Osteopathic Medicine and Surgery, and Board of Podiatric Medicine and Surgery) to adopt rules restricting the delegation of specific services and requiring a higher level of supervision. The boards may also adopt rules governing the ratio of PAs to physicians under practice agreements.
The new statute makes very significant changes in the roles and responsibilities of PAs in the health care team. While eliminating the delegation-supervision model of practice provides many benefits, it is important to ensure that PAs have the required practice agreements and individual controlled substance licenses needed under the statute.