Sample Delegation of Services Agreement Physician Assistant

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(3)… [A]dopt[ing] pro­to­cols to reg­u­late the per­for­mance of a physician‘s assis­tant for some or all of the tasks … The pro­to­cols are pre­pared by the doctor, taken from texts or other sources or ref­er­enced. Pro­to­cols must be signed and dated by the attending physi­cian and the physician‘s assis­tant. . ; The new law fur­ther pro­vides that “nothing in the reg­u­la­tion requires a physi­cian and sur­geon to review or coun­ter­sign a med­ical record of a patient being treated by a med­ical assis­tant, unless required by the agree­ment of prac­tice.” Bus. & Prof. Code § 3502©, amended by SB 697 (valid from 1 Jan­uary 2020). To this end, sec­tion 3502.3 of the Busi­ness and Pro­fes­sions Code, as amended, pro­vides that the agree­ment with the prac­ti­tioner must cover “poli­cies and pro­ce­dures to ensure ade­quate super­vi­sion of the physi­cian assis­tant, including, but not lim­ited to, appro­priate com­mu­ni­ca­tion, avail­ability, con­sul­ta­tions and ref­er­ences between a physi­cian and sur­geon and the physi­cian assis­tant in the pro­vi­sion of med­ical ser­vices.” Bus. & Prof.

Code § 3502.3(a)(1)(B), amended by SB 697 (valid from 1 Jan­uary 2020). Under the new Act, a prac­tice agree­ment is defined as “the letter devel­oped in the course of col­lab­o­ra­tion between one or more physi­cians and sur­geons and one or more physi­cian assis­tants, defining the med­ical ser­vices to which the physi­cian assis­tant is enti­tled under sec­tion 3502 and autho­rizing physi­cians and sur­geons to be staffed by an orga­nized health care system, super­vise one or more med­ical assis­tants in the orga­nized health system. » Bus & Prof. Code § 3501 (k), amended by SB 697 (valid from 1 Jan­uary 2020). An “orga­nized health care system” is defined as licensed clinics, ambu­la­tory care facil­i­ties, a “health facility” within the meaning of sec­tion 1250 of the Health and Safety Code, a doctor‘s office or “any other entity that law­fully pro­vides med­ical ser­vices …”. Bus & Prof. Code § 3501(j), amended by SB 697 (valid from 1 Jan­uary 2020). In addi­tion, sec­tion 3502.3, as amended, pro­vides that the con­tract of prac­tice must be signed by “one or more physi­cians and sur­geons or a physi­cian and sur­geon autho­rized to approve the con­tract of prac­tice on behalf of the staff of physi­cians and sur­geons of the per­sonnel of an orga­nized health care system.” Bus & Prof. Code § 3502.3(a)(2)(B), amended by SB 697 (valid from 1 Jan­uary 2020).

The new law elim­i­nates these require­ments. Instead, it states: “Super­vi­sion as defined in this sub­sec­tion shall not be con­strued as requiring the phys­ical pres­ence of the physi­cian, but shall require: (A) com­pli­ance with appro­priate super­vi­sion as agreed to in the agree­ment with the prac­ti­tioner. B) The physi­cian and sur­geon are avail­able by tele­phone or other elec­tronic means of com­mu­ni­ca­tion when the PA exam­ines the patient. » Bus. & Prof. Code § 3501(f)(1), amended by SB 697 (valid from 1 Jan­uary 2020). Finally, SB 697 expands the pre­scribing authority of PAs by elim­i­nating spe­cific med­ical sur­veil­lance require­ments and elim­i­nating the require­ment that the name and con­tact infor­ma­tion of the super­vising physi­cian be included on a PA‘s pre­scrip­tions. See Bus. & Prof.

Code § 3502.1, amended by SB 697 (valid from 1 Jan­uary 2020). Instead, the prac­tice agree­ment should specify the super­vi­sion to be given to the PA when pre­scribing med­ica­tions, although a super­vising physi­cian “must be avail­able by tele­phone or other means of elec­tronic com­mu­ni­ca­tion at the time of the patient‘s exam­i­na­tion.” Bus. & Prof. Code § 3502.1©(2). (2) the coun­tersig­na­ture and dating of all med­ical records written by the physi­cian assis­tant within thirty (30) days after the treat­ment pro­vided by the physi­cian assis­tant; Under applic­able law, PAs are required to enter into a del­e­ga­tion of ser­vice agree­ments that des­ig­nate “any super­vising physi­cian.” Title 16 JRC Article 1399.540(b). The scope of activity of each agent is lim­ited by the spe­cific tasks assigned to the agent by their agree­ment on the del­e­ga­tion of ser­vices. Id. See also Bus. & Prof.

Code §§ 3501(a)(10), 3502.3. The new law, as amended by SB 697, removes the require­ment for an agree­ment on the del­e­ga­tion of ser­vices and replaces it with a require­ment for a “prac­tical agree­ment”. See Bus & Prof. Code §§ 3501(k), 3502.3, amended by SB 697 (valid from 1 Jan­uary 2020). The cur­rent law requires physi­cians to super­vise PAs in one of four ways: It is impor­tant to note that the new law does not require health sys­tems to replace their existing del­e­ga­tion of ser­vices agree­ments with prac­tice agree­ments. See Bus & Prof. Code § 3502.3(a)(3), as amended by SB 697 (valid from 1 Jan­uary 2020). Instead, prac­tice agree­ments are only required if new PA agree­ments are con­cluded after 1 Jan­uary 2020. How­ever, for the above rea­sons, health sys­tems could con­sider replacing all their existing ser­vice del­e­ga­tion agree­ments with PA agree­ments and avoid dif­ferent types of paA agree­ments within the same health system being based solely on the date of drafting of the PA agreement.

Thus, instead of requiring an agree­ment between a par­tic­ular PA and cer­tain treating physi­cians, the new leg­is­la­tion sim­pli­fies PA agree­ments by allowing the use of the same prac­tice agree­ment for mul­tiple PAs, not requiring spe­cific super­vising physi­cians to be appointed, and not requiring the agree­ment to be signed by pa super­vising physi­cians. This should lead to a sig­nif­i­cant sim­pli­fi­ca­tion of THE PRACTICE OF PA in health sys­tems, where PAs are often mon­i­tored by mul­tiple physi­cians and, in the past, were required to del­e­gate ser­vice agree­ments in which each of these physi­cians was appointed. (1) the exam­i­na­tion of the patient by a super­vising physi­cian on the same day the treat­ment is car­ried out by the physician‘s assis­tant; (i) The attending physi­cian and the sur­geon shall, within 30 days after the date of treat­ment by the physician‘s assis­tant, examine, coun­ter­sign and date a sample con­sisting of at least 5% of the med­ical records of patients processed by the physician‘s assis­tant working in accor­dance with the pro­to­cols. (ii) The attending physi­cian, sur­geon and physician‘s assis­tant shall hold a med­ical record review meeting at least once a month for at least 10 months of the year. Does anyone have an example of a prac­tice con­tract that I can edit and create for my office? At first, I used and mod­i­fied Capa‘s old del­e­ga­tion con­ven­tion to meet our pri­vate prac­tice needs. Thanks in advance! Taken together, these new reg­u­la­tions mean sig­nif­i­cant changes that will give health sys­tems much more flex­i­bility to decide how PAs are super­vised in their orga­ni­za­tion. Instead of PAs and physi­cians being lim­ited to one of the four forms of over­sight set out in the existing leg­is­la­tion, each health care system is free to create a single struc­ture for PA over­sight that makes the most sense in the con­text of the orga­ni­za­tion (pro­vided it meets the over­sight require­ments con­tained in the amended leg­is­la­tion). This brings the prac­tice of PA much closer to the prac­tice of nurses (“NPs”), whose over­sight is deter­mined by stan­dard pro­ce­dures devel­oped by each health care system.

(iii) The attending physi­cian and sur­geon review a sample of at least 10 med­ical records per month, but not less than 10 months per year, using a com­bi­na­tion of the coun­tersig­na­ture mech­a­nism described in sec­tion (i) and the med­ical record review mech­a­nism described in sec­tion (ii). . Senate Bill 697 (“SB 697″), a bill that sig­nif­i­cantly changes the over­sight require­ments for med­ical assis­tants (“PAs”) in Cal­i­fornia, was signed into law by Cal­i­fornia Gov­ernor Gavin Newsom on October 9, 2019 and takes effect on Jan­uary 1, 2020. Among the most sig­nif­i­cant changes made by SB 697 is 1. the can­cel­la­tion of the require­ment for a del­e­ga­tion of ser­vices agree­ment with a panel physi­cian and the require­ment for a “prac­tice agree­ment” with an orga­nized health care system as a whole; 2. the removal of most of the pre­vious spe­cific super­vi­sory require­ments for paying agen­cies and the estab­lish­ment of appro­priate super­vi­sory arrange­ments for the organ­ised health system; and 3. Approval of PAs to pre­scribe med­ica­tions without spe­cific med­ical super­vi­sion or med­ical con­tact infor­ma­tion on the pre­scrip­tion. The net impact of these changes is to increase the inde­pen­dence of PaAs and bring their field of activity closer to that of nurses (“NPs”), who have long enjoyed a more inde­pen­dent field of activity. Hos­pi­tals and other providers working with PAs must be pre­pared to imple­ment the new “prac­tice agree­ments” under SB 697 as of Jan­uary 1, 2020 for all PAs with whom they enter into new agreements.

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