Supervisory or collaborative agreements and APPs’ delineation of privileges
The following is an excerpt from the webinar, Privileging APPs: Issues and Solutions, now available on-demand.
As physician shortages grow, the number of advanced practice professionals (APP) applying for hospital and ambulatory privileges is rising rapidly. Carol Cairns, CPMSM, CPCS, advisory consultant with The Greeley Company and president of PRO-CON, an Illinois-based medical staff services consulting group, discusses supervisory or collaborative agreements and delineation of privileges.
Q: Can a supervisory or collaborative agreement be considered an addendum to an APP’s delineation of privileges, or should the agreement’s contents be incorportated into the actual delineation form?
A: It depends. I’ve seen some collaborative and supervisory agreements that are fairly detailed and others that are more generic. Depending on the contents of the agreement in question, it’s important to do a couple of things. Number one, learn exactly what your state requires for a collaborative or supervisory agreement. Then, with those requirements in mind, examine the relevant delineation of privilege form and ask, “Have we captured everything that the state requires?”
Consider, for example, a surgical PA. In some states, the licensure allows PAs to do anything that their physician supervisor permits. That provision is much too broad for a privileging form. Instead, you should define exactly what surgical PAs will be allowed to do in your facility. Will their sole responsibility be to provide surgical assistance, or will they perform certain procedures, such as lumbar punctures, themselves? If the latter is true, the PA will require special privileges. Remember, you cannot grant practice authority that exceeds the state’s allowance. You can, however, grant a narrower scope of practice.
Imagine, for example, that a supervising physician does not want a PA to prescribe opioids, even though the state has granted the PA prescriptive authority to do so. If that’s the case, then this restriction should be outlined in the supervisory agreement, and you should ensure the individual isn’t granted prescribing privileges for opioids.
As another example, more and more states are awarding NPs full practice authority. In these states, NPs hold independent licenses and don’t require a collaborative or supervisory agreement. That said, depending on the acuity of their patient population, many medical staffs require NPs with independent licenses to work under a collaborative agreement. In such cases, the medical staff must verify that the NP privileging form reflects this across-the-board requirement.
These examples illustrate how the privileging form and collaborative/supervisory agreement complement—but don’t necessarily mirror—each other. To foster necessary alignment between these materials, start by reviewing the agreement, and then ensure the delineation form doesn’t overstep it. Also, ensure APPs and their partnering physicians have easy access to the finalized documents. (Click here for more guidance on collaborative agreements.)