Non supervising physician signing charts!

[Guest ERCat]

If a non supervising physician signs off on all my charts and reviews the cases with me (I work with as many as 20 different docs) how does that affect my liability and their liability if something goes down?

[jmj11]

I don't know in your state, but here in Washington state, if you read the fine print, the practice agreements wants all physicians who will be reviewing your work to be listed as a SP, Sponsoring or Alternative physician. You also have the option of listing a group (if there are many and they come and go). If they are not on the list, they should not be signing your charts. They could be held liable in the case of your malpractice claim (I wish that would change).  Here is the Washinton state language:

 

 (9) "Supervising physician" means a sponsoring or alternate physician providing clinical oversight for a physician assistant.

(a) "Sponsoring physician" means any physician licensed under chapter 18.71 RCW and identified in a delegation agreement as providing primary clinical and administrative oversight for a physician assistant.

(b) "Alternate physician" means any physician licensed under chapter 18.71 or 18.57 RCW who provides clinical oversight of a physician assistant in place of or in addition to the sponsoring physician.

[Poetsiren]

I would get on this FAST. At the least they need to be listed as a alternative supervising physician to be added to your state board cert. 

Here is KY state law regarding PAs and SPs: (also the website states that the board must be informed within 3 business days of any changes regarding supervising physicians or the penalties listed will occur.)

311.854 Approval of supervising physician -- Requirements -- Application -- Number of assistants -- Restrictions on practice and supervision. (1) A physician shall not supervise a physician assistant without approval of the board. Failure to obtain board approval as a supervising physician or failure to comply with the requirements of KRS 311.840 to 311.862 or related administrative regulations shall be considered unprofessional conduct and shall be subject to disciplinary action by the board that may include revocation, suspension, restriction, or placing on probation the supervising physician's right to supervise a physician assistant. (2) To be approved by the board as a supervising physician, a physician shall: (a) Be currently licensed and in good standing with the board; (b) Maintain a practice primarily within this Commonwealth. The board in its discretion may modify or waive this requirement; © Submit a completed application and the required fee to the board. The application shall include but is not limited to: 1. A description of the nature of the physician's practice; 2. A statement of assurance by the supervising physician that the scope of medical services and procedures described in the application or in any supplemental information shall not exceed the normal scope of practice of the supervising physician; 3. A description of the means by which the physician shall maintain communication with the physician assistant when they are not in the same physical location; 4. The name, address, and area of practice of one (1) or more physicians who agree in writing to accept responsibility for supervising the physician assistant in the absence of the supervising physician; and 5. A description of the scope of medical services and procedures to be performed by the physician assistant for which the physician assistant has been trained in an approved program.

[DizzyJ]

Agree with above.  When I practiced in Ohio every single SP must have a supervisory agreement with me in order to "supervise".  I was able to use that to my advantage sometimes and say well Dr. So-and-so isn't on my list and thus he can not review and sign my notes.  In California we keep our "delegation of services" agreement in the practice and list only one SP and can list 1-2 alternative SPs for backup.  So, we can modify this document at any time if I would need to add an alternative in an emergency.  Much better set up in CA then OH.  

[ventana]

works great for you

 

if the doc signs it - they are liable for it

 

not sure it makes much difference for you - but I would get them all listed as alternates just to keep clean

[Guest ERCat]

Ventana - that's exactly what I was thinking. They always put a blurb in the chart that says something like "I independently examined and evaluated the patient and agree with the physician assistant's assessment and plan." Then they sign the chart. I'm thinking the reason they do it this way so they can bill at the level of a physician. And I would think that would mean less liability for me, because if I am working with a physician I would think that ultimately they hold the greatest liability. On the other hand, if something bad happened one could actually hold me at fault for working closely with the doc who is not my supervising physician and having them sign off on my chart? I did look at my state laws and they are very vague...and there is nothing that says I have to have an agreement with every doc I work with.

[Guest Paula]

Do all the signing physicians independently examine and evaluate the patient? 

 

How long will you be under this model of care?  It seems burden some to me, but if you are a fairly new grad, then might be ok for a year or so.

 

They are doing it this way to capture 100% reimbursement, but it is not efficient and in the long run are probably going to lose out on collections eventually. 

[Guest ERCat]

90 percent of the time they do, yes. But some of the time they'll tell me "I don't need to see them right?" If it's something simple. Yes - it works great for me as a new grad but I don't understand why they even hire me because it doesn't seem very efficient.

[Guest Paula]

Just make sure that if they do not see the patient and still sign the chart, that the blurb IS NOT IN IT.  If it is, it is fraud. 

 

Are all your charts co-signed? 

[rev ronin]

Just make sure that if they do not see the patient and still sign the chart, that the blurb IS NOT IN IT.  If it is, it is fraud.

Just to play devil's advocate here... it may be fraud, but it's not HIS fraud, because 1) He didn't write the blurb, 2) He didn't sign off on it, and 3) The entire point of the blurb is that they're not billing it under his NPI, but under that doc's NPI.

 

Am I wrong here?

[Guest Paula]

Hmmm...I think with fraud, CMS anyway, both the PA and the PAs collaborating physician are liable for the fraud.  Even if the PA did not write the blurb or sign the chart, both are responsible.  I might be confusing the "incident to" rules? Do they differ in the setting, i.e. primary care vs. EM?

 

I think ERCat is a her. 

[Guest ERCat]

I think they use a different blurb when they don't see the patient - as in "I was available for questions for this patient." However they do say they indepdently saw the patient even if they stop by and "say hi" for 10 seconds.

[rev ronin]

I think ERCat is a her. 

Statistically, most of our posters should be. :-) However, unless I specifically remember, I tend to refer to all posters who don't have gender-specific avatar photos or usernames as male ("generic he"), with no insult intended if reality is otherwise.

[CAdamsPAC]

One of my pet peeves about physician supervision is "Residents" ' running the case & telling PAs how to manage patients. It's not their knowledge but the absence of being "Licensed Physicians" as required by state laws and regulations. Yes the attendings make appearances , but we all know just how sparse attending physician presence can be especially in academic institutions.

[Cideous]

Statistically, most of our posters should be. :-) However, unless I specifically remember, I tend to refer to all posters who don't have gender-specific avatar photos or usernames as male ("generic he"), with no insult intended if reality is otherwise.

 

 

Don't feel bad, I'm from CA but live in TX, and everytime I walk into an exam room with more then one person I say, "Hi guys, how's it going?"   Even if it's a room full of women lol. It's a west coast thing, and so help me I will never say..."Ya'all".

[GetMeOuttaThisMess]

"Ya'all" takes too much time.  It's "y'all", just like the proper pronunciation Texas style is "pee-con" for pecan.

[delco714]

You sure they aren't listed on license as secondary or alternative SP? I have 6 md on my license but one primary sp.