APP appointment: Stay within statutory bounds
This week, CRC Daily covers vetting, competency assessment, and governance strategies for advanced practice professionals (APP), whose presence in the workforce often surpasses their representation on the medical staff. One barrier to medical staff membership and leadership opportunities is the patchwork of state statutes governing APPs’ scope of practice and participation on the medical staff.
Under CMS’ hospital Conditions of Participation, a medical staff’s membership must include MDs and DOs, but may also encompass “other categories of physicians … and non-physician practitioners who are determined to be eligible for appointment by the governing body,” as relevant state scope-of-practice laws permit (42 CFR § 482.22(a)). Under these broad parameters, the following practitioners are potential candidates:
• NPs
• PAs
• Clinical nurse specialists
• Certified registered nurse anesthetists
• Certified nurse-midwives
• Clinical social workers
• Clinical psychologists
• Registered dietitians
Although the federal regulations provide a wide range of viable medical staff recruits, state statutes can whittle down the possibilities considerably, says Jennifer A. Hansen, JD, partner at the San Diego office of healthcare law firm Hooper, Lundy & Bookman, PC.
“It’s really important to consult with your attorneys when looking at this because you not only have to be in compliance with the federal law but also with the state law,” says Hansen.
In addition, organizations that are interested in appointing APPs to the medical staff (or awarding additional rights to members with restricted standing) must adhere to accreditation standards, the specific terms of contracts with third-party service providers (e.g., a group practice that dispatches all of the hospital’s affiliated dietitians), and their own bylaws, Hansen says.
To improve navigation in this complex landscape, the medical staff at Arkansas Children’s Hospital (ACH) enlists its affiliated APPs in verifying that their privileges and medical staff designations adhere to applicable internal and external requirements. “We have several APRNs [advanced practice registered nurses] here who are just marvelous. They can almost quote you line by line what the national standards are and what the statewide standards are, and it is extremely helpful,” says Becky Foor, RN, BBA, CPMSM, medical staff administration director at the Little Rock facility.