Collaborative Practice Agreement? - armedicalboard.org

1 Arkansas State Medical Board 2100 Riverfront Drive Issue Number Forty-four little Rock, AR 72202-1747. Winter 2010. Peggy Pryor Cryer Collaborative Practice agreement ? Executive Secretary 2100 Riverfront Drive William H. Trice, III, Attorney for the Board little Rock, AR 72202-1747. 501-296-1802. Physicians often call the Arkansas State or other health care professionals as Medical Board inquiring as to what is indicated by a patient's health care this thing called a Collaborative Practice needs. (emphasis added). Board Members: agreement . Trent P. Pierce, Chairman The Arkansas legislature further required West Memphis, AR Your Arkansas legislature passed through 17-87-310(c) that a Col- 17-87-310(a)(2) that provides that an ad- laborative Practice agreement shall in- Joeseph M.

2 Beck, II, Vice-Chairman vance Practice nurse (APN) may obtain a clude but not be limited to provisions ad- little Rock, AR certificate of prescriptive authority from dressing: Bob E. Cogburn, the Arkansas State Board of Nursing if Secretary the advance Practice nurse has a Collabo- (1) The availability of the collaborating Mountain Home, AR. rative Practice agreement with a physi- physician for consultation or referral, or Omar T. Atiq, cian who is licensed under the Arkansas both;. Pine Bluff, AR. Medical practices Act, and who has a Harold B. Betton, Practice comparable in scope, specialty or (2) Methods of management of the col- little Rock, AR. expertise to that of the advance Practice laborative Practice , which shall include Jim C.

3 Citty, nurse on file with the Arkansas State Searcy, AR protocols for prescriptive authority;. Board of Nursing. Ms. Rose Crane little Rock, AR (3) Coverage of the health care needs of a As you are probably aware, advance patient in the emergency absence of the William F. Dudding, Practice nurses provide various levels of advance Practice nurse or physician; and Fort Smith, AR. health care to patients. If the advance (Continued on Page 2). Roger Harmon, Practice nurse is desirous of obtaining Jonesboro, AR. prescriptive authority, then pursuant to John E. Hearnsberger, II, Arkansas law, they must enter into a Col- Inside This Issue: Nashville, AR. laborative Practice agreement with a Collaborative Practice agreement .

4 1-2. Patty K. Pettway, physician who is licensed to Practice Booneville, AR Scheduled Board Meetings ..2. medicine in this state, and whose medical Physician Reminders ..3. Sylvia D. Simon, Practice is comparable in scope, specialty Allied Healthcare ..3. Monticello, AR. and expertise to that of the advance prac- Board Actions and License Adjust- Douglas F. Smart, tice nurse. little Rock, AR ments ..3. Profile Of A Board Member ..4. John B. Weiss, The legislature also defined a Collabora- ASMB and CCVS Workshop ..4. Fayetteville, AR. tive Practice agreement in 17- About CAQH 4. Legal Counsel: 87-102(2) as a written plan that identi- CCVS Launches New Site ..4. William H. Trice, III fies a physician who agrees to collaborate Official Board Appointments.

5 4. 211 Spring Street with an advance Practice nurse in the ASMB State Medical Board 09 Re- little Rock, AR 72201. 501-372-4144 joint management of the health care of the advance Practice nurse's patients, and New Respiratory Therapist Committee outlines procedures for consultation with Member .5. or referral to the collaborating physician Page 2 Issue Number Forty-four Collaborative Practice agreement ? (Continued from Page 1). As you can readily see, the Arkansas legislature and thus your Ar- the APN and the collaborating physician are not comply- kansas State Medical Board views that the Collaborative Practice ing with the requirements of the statute. agreement will require a physician to be involved in the joint management of the healthcare that is rendered to patients by an (2) The collaboration process as envisioned by the Arkan- advance Practice nurse.

6 All physicians in this state are familiar sas statute defining Collaborative agreements could fall with quality assurance programs within their own clinics and under HIPAA's definition of treatment ( coordination or hospitals. It is the position of the Board that these same safe- management of health care and related services by one or guards should be provided to patients who are being treated by more health care providers or HIPAA's definition of advance Practice nurses by having the patient's healthcare man- health care operations ( quality assessment and im- aged jointly through the Collaborative agreement with a physi- provement and reviewing the competence of health care cian. professionals, evaluating practitioner and provider per- formance.))

7 There is not a conflict between the Arkansas law setting forth Col- laborative Agreements and the Federal laws governing privacy of (3) There is no question that an APN and his or her col- medical records, commonly referred to as HIPAA. laborating physician can disclose PHI about the same pa- tient, since the two of them are jointly managing the health Physicians are not violating HIPAA when receiving or sharing care of that patient under state law. This is allowed under Private Health Information (PHI) in their role as a collaborating both the treatment and health care operations provi- physician. sions of HIPAA. 45 defines treatment as the provision, coordina- (4) Similarly, a second physician, other than the collabo- tion, or management of health care and related services by one or rating physician, can disclose PHI to the collaborating more health care providers, including the coordination or manage- physician under either the HIPAA treatment provision or ment of health care by a health care provider with a third party; the HIPAA health care operations provision.

8 The patient consultation between health care providers relating to a patient; or is a patient of the non-collaborating physician. The pa- the referral of a patient for health care from one health care pro- tient's health care is also being jointly managed by the vider to another. APN and the collaborating physician pursuant to the col- laborative agreement with the APN. Therefore, the two 45 defines health care operations to include (1) physicians can disclose PHI to one another for quality as- conducting quality assessment and improvement activities, includ- surance and evaluation purposes (operations) as well as for ing outcomes evaluation and development of clinical guide- coordination or management of care purposes (treatment).

9 And (2) Reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider per- Scheduled Board Meeting Dates for the Arkansas State Medical Board Finally, HIPAA provides at 45 (c) that a provider may disclose PHI (1) for its own treatment, payment or healthcare operations, (2) for treatment activities of another health care pro- February 4-5, 2010. vider, (3) to another health care provider for that provider's pay- April 8-9, 2010. ment activities, or (4) to another health care provider for that pro- June 3-4, 2010. vider's health care operations, if each entity has or had a relation- August 5-6, 2010. ship with the individual who is the subject of the PHI and if the October 7-8, 2010.

10 Purpose of the disclosure is one of those listed in paragraph (1) and December 2-3, 2010. (2) of the definition of health care operations. (These are the very The Board will hold called meetings when paragraphs quoted from in the preceding paragraph defining health Necessary care operations.). Meetings will be held in the An analysis of these statutory provisions and HIPAA regulations W. Ray Jouett, Conference Room at leads to the following conclusions: 2100 Riverfront Drive little Rock, Arkansas (1) An advanced Practice nurse's patients are jointly managed by the APN and the APN's collaborating physician. Otherwise, Meeting dates and times are subject to change. Page 3 Issue Number Forty-four Physician Reminders From The Board And CCVS!