Ohio has expanded the classifications of health care practitioners who can admit under state law.   This offers some relief to admitting physicians whose documentation obligations have increased under Medicare’s recently adopted  “Two-Midnight Rule”.  Advanced practice registered nurses and physician assistants are enthusiastic about their new role in the delivery of health care services.

On February 18, 2014, Ohio Governor John R. Kasich signed into law Ohio House Bill 139, allowing clinical nurse specialists, certified nurse-midwives, certified nurse practitioners (“APRNs”) and physician assistants (“PAs”) to admit patients to a hospital if certain conditions are met.  Certified registered nurse anesthetists are not included in this list, but they are not likely to treat patients needing admissions.  The new law is expected to take effect on May 19, 2014.

Currently in Ohio, only a doctor, dentist, or podiatrist can admit patients to hospitals, assuming such practitioner has admitting privileges.  The new law allows APRNs and PAs to admit patients if the following conditions are met:

  1. APRNs must have a standard care arrangement with a physician or podiatrist who is a member of the medical staff on file at each site where the APRN practices;
  2. PAs must be listed on a supervision agreement, on file with the State Medical Board, with a physician or podiatrist who is a member of the medical staff;
  3. The patient admitted must be under the medical supervision of the collaborating physician or podiatrist;
  4. The hospital must have granted the APRN or the PA admitting privileges and appropriate credentials; and
  5. The new law also requires the APRN or PA to provide advanced notice to the collaborating physician or podiatrist of the planned admission.

What Should You Do?

  1. APRNs should seek admitting privileges at appropriate hospitals and revise their collaboration agreements to (i) address the ability to admit in accordance with the new law and (ii) ensure the collaborating physician or podiatrist will assume the medical supervision for the admitted patients.  
  2. PAs should work with their supervising physicians and seek admitting privileges at appropriate hospitals.   
  3. Collaborating and supervising physicians and podiatrists need to make sure that they are well informed of these developments and necessary updates to the collaboration agreements to which they are a party.
  4. Hospitals are encouraged to assess their resources in terms of adding additional credentialed practitioners and use the next three months to consider revising their medical staff bylaws to extend admission privileges were appropriate.  Come May 19, admitting physicians will be glad their hospitals did.