NJ-NAMSS Annual Educational Conference Tropicana Hotel Atlantic City, New Jersey April 19, 2018 Risk Distinctions with a Difference: Understanding the Roles of the Physician Assistant and the Nurse Practitioner Patricia A. Furci, RN, MA, Esq. Samuel J. Furci, MPA Principals FURCI ASSOCIATES, L.L.C. 1
Disclaimer This presentation is for instructional use only and is not intended as a substitute for individual professional and/or legal advice. While every effort has been made to verify the accuracy of these materials, legal authorities and requirements may vary from jurisdiction to jurisdiction 2
Session Roadmap To assist the Medical Staff Professional to further understand the differences between the Physician Assistant and the Advanced Practice Nurse when Privileging and Credentialing. At the end of the program with the information presented, the Participant will be able to: 3
Session Roadmap con t Identify the differences in the scope of practice between the PA and the APN under the current law in NJ; Describe Privileging and Credentialing requirements of the PA and the APN in NJ; Distinguish the differences between the Supervisory Agreement required for the PA and the Collaborative Agreement required for the APN as defined in the law; Discuss how credentialing and privileging differs between the PA and the APN in New Jersey. 4
New Jersey Statistics New Jersey, not unlike other areas throughout the U.S., is facing significant future shortages in both primary care and some specialty areas. By 2030, the United States will face a shortage of over 100,000 Primary Care Physicians overall. (AAAMC 2017) Even today, New Jersey is only meeting 34% of the Primary Care Physician needs. (Kaiser 2017). 5
Change or No Change? 6
The Primary Care Market Primary Care: A booming market Planning now for new solutions Training Regulatory Financial Cultural 7
On the Horizon: Primary Care Need In New Jersey 500k more newly insured How much care will they seek? Where will they seek care? 214,000 153,000 175,000 8
Who Can Practice Primary Care? Medicine Physicians Physician assistants (PAs) Nursing Nurse Practitioners (NPs) Clinical Nurse Midwives (CNMs) 9
Scope of Practice Training & complexity of care MAs CNAs LPNs RNs PAs APNs Generalist s Specialist MDs Subspecialist MDs Cost-effective care & providers, access 10
The Role of Mid-Level Practitioners MSPs need to understand the growing roles of APNs and Pas and how they integrate with the medical staff. Pursuant to 21 CFR 1300.01 (b28), the term mid-level practitioner, specifically means an individual healthcare practitioner, other than a physician, dentist, veterinarian, or podiatrist, who is licensed, registered, or otherwise permitted by the United States or the jurisdiction in which he or she practices, to dispense a controlled substance in the course of professional practice. 11
Examples of Mid-Level Practitioners Nurse Practitioners (NP); (APN or ARNP); Nurse-Midwives (CNM); (CM); (CPM and ANP-Midwifery); Certified Nurse Anesthetists (CRNA or ANP-Anesthesia); Physician Assistants (PA); Registered Nurse First Assistant (RNFA); 12
Dependent vs. Independent Practitioners The first step is to identify the difference in their state licensure and their role in the delivery of care. A dependent practitioner is one who is dependent on or overseen by another practitioner, such as a physician or other licensed independent practitioner (LIP) to perform certain functions. 13
Dependent vs. Independent Practitioners con t The Dependent or supervision requirement is described within NJ State law. An LIP does not require this level of guidance or dependence. The American Academy of Physician Assistants considers a PA a healthcare professional who is authorized by the state to practice medicine as part of team of physicians. 14
Physician Assistants The PA is graduate of an accredited educational program and is nationally certified and state-licensed to practice medicine with the supervision of a physician. PAs can perform physician examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling, and make rounds in hospitals and nursing homes. All 50 states allow PAs to practice and prescribe medications. 15
Physician Assistant Education The educational program for PAs is modeled on the medical school curriculum, with a combination of classroom and clinical instruction. The PA course of study is rigorous; the average length of a PA educational program is 27 months. The PA receives approximately 2,000 hours in surgical training. 16
PA Education The first one and one-half years of the curriculum consist of basic science and clinical science courses. The spring semester of the second year and the entire third year involve clinical experiences in a variety of settings under the close supervision of licensed physicians and the direction of the Physician Assistant Program faculty 17
Advanced Nurse Practitioner APNs have been providing primary, acute, and specialty healthcare to patients for nearly half a century. The American College of Nurse Practitioners states APNs (NPs) assess patients, order and interpret diagnostic tests, make diagnoses and initiate and manage treatment plans, including prescribing medications. 18
Advanced Nurse Practitioner Education Con t The DNP program consists of a minimum of 40 credits beyond the master s-level specialty content. The foundational & Universal Core Courses are taken by students in both the direct and the indirect track. After completing the universal courses, students move into a curriculum concentration to complete the cognate (Specialized)and capstone project (Thesis or research requirement). * Students who have not been in active practice may be required to take an additional 4 credits - the DNP Practice and Practicum course. 19
Advance Nurse Practitioner Education After nurse practitioners complete a master s degree graduates are eligible to obtain professional certification as NPs. NP programs normally focus on one specialty area of nursing, and graduates generally choose to seek certification in the same specialty. DNP, although recommended, is not required. 20
Advance Nurse Practitioner Education con t The American Academy of Nurse Practitioners and the American Nurses Credentialing Center are two credentialing bodies that offer certifications in nursing. These certifications must be renewed every five years to continue development within the profession. 21
Distinctions that make a difference APN and PA Educational Curriculum Different Focus? Different Training?? Different Privileging Criteria??? 22
Hospital Credentialing Based on state statutes regarding licensure and certification Institutional guidelines typically developed by the credentials committee of the medical staff through amendments to the medical staff bylaws Specifies privileging criteria to address variations in education, training and experience for like privileges 23
Regulatory and State Requirements State law defines the Scope of Practice of each mid-level practitioner APNs and PAs have their own respective Boards to regulate and designate Scope of Practice. 24
Health Care Facility Requirements Mid-level practitioners defined by Facility in Bylaws, Rules and Regs, as well as Policy and Procedure Delineation of Privileges Important Privileges must comport with State Law Facility can limit the Scope but they cannot exceed scope as prescribed by State Law Privilege criteria should be flexible to reflect differences in education, training and experience for like privileges 25
What about those Agreements? Collaborative Agreements - Advanced Practice Nurse Supervisory Agreements Physician Assistant 26
APN New Jersey Requirements Certification via the New Jersey Board of Nursing is required to be an Advance Practice Nurse in New Jersey. N.J.A.C. 13:37-7.1 (a) Any nurse who wishes to practice as a nurse practitioner/clinical nurse specialist, or present, call or represent himself or herself as a nurse practitioner/clinical nurse specialist must be certified by the Board. On November 1, 1999, Advanced Practice Nurse became the title in New Jersey for Nurse Practitioners and Clinical Nurse Specialists. Advanced Practice Nurses may sign their credentialing as R. N., A.P.N. Presently, there are more than 6,800 Certified Advanced Practice Nurses in 17 specialties. 27
APN NJ con t An APN in New Jersey has prescriptive authority and is required to have a joint protocol with a collaborating physician who is licensed in New Jersey, prior to prescribing any medication or medical device The regulation regarding a Joint Protocol with a Collaborating Physician, N.J.A.C 13:37-6.3, 28
Joint Protocol for Prescribing In New Jersey, a joint protocol is a state- mandated written document that describes the guidelines for prescribing medications and devices for an APN in a specific practice setting; this joint protocol must be cooperatively agreed to and signed by the APN and her/his designated collaborating physician. It must be reviewed, updated and co-signed, at least annually. Though the particular language in the joint protocol may vary from practice to practice, each joint protocol must follow the outline defined by New Jersey state Board of Nursing regulations at 13:37-6.3http://www.state.nj.us/lps/ca/nursing/nurjon.htm. For an example of how the joint protocol can be written go the NJSNA website http://www.njsna.org/suggested_template.htm 29
Joint Protocol for Prescribing con t The joint protocol required for prescribing must conform to the standards established by the Director of the Division of Consumer Affairs: the Joint Protocol was developed by a joint committee of the BON and the BOME, but the BON alone maintains regulatory authority over APN's. 30
PAs in New Jersey The Licensing process is overseen by the Physician Assistant Advisory Committee (PAAC), which is under the supervision of the Board of Medical Examiners. NJ physician assistants are required to notify the PAAC any time they take on a new supervising physician. There is a "Verification of Supervision/Employment" form on the PAAC website. This form should be submitted to the PAAC within 10 days of beginning work with a new supervising physician. This is NOT a Supervisory Agreement! 31
PAs in NJ con t The Physician Assistant Advisory Committee, which falls under the supervision of the State Board of Medical Examiners, is responsible for the regulation of physician assistants in New Jersey. 32
PA Prescribing Authority PA may prescribe Schedule II-V controlled substances if authorized by a supervising physician, and if the PA has registered with and obtained authorization from the appropriate state and federal agencies. N.J. ADMIN. CODE 13:35-2B.12 33
PA Supervision SUPERVISION The PA may not render care unless supervising physician or designee is continuously or intermittently present on-site with constant availability through electronic communication in the inpatient setting; supervising physician or designee is constantly available through electronic communication in outpatient setting. N.J. ADMIN. CODE 13:35-2B.10 CHART CO-SIGNATURE The Supervising physician regularly reviews practice of PA and reviews all charts and countersigns all orders within 24 hours in the inpatient setting and within 7 days in the outpatient setting. Charts that contain medication order or prescription in outpatient setting must be reviewed and countersigned within 48 hours. N.J. ADMIN. CODE 13:35-2B.10 34
PAs and ANPs How do we decide and document who provides particular types of care at particular times and places? 35
Questions? Thank you! FURCI ASSOCIATES, L.L.C. INFO@FURCIASSOCIATES.COM