2 Miss. Code. R. 601-1.3

Current through December 10, 2024

Rule 2-601-1.3 - Requirements for Collaborating Physicians

Primary and secondary collaborating physicians must:

A. hold a current unrestricted license in the state of Mississippi and actively provide direct patient care at least eight (8) hours weekly;

B. notify the Board within seven (7) working days of entering into or termination of any collaborative agreement;

C. insure that the primary collaborative physician(s) name(s) is/are displayed for public view at the APRN's practice site; and

D. enter into a collaborative agreement with the APRN, which is written, signed and dated by both the APRN and physician, and which must:

1. remain in the practice site of the collaborating physician should there be a site visit by the Board;

2. define the scope of practice, including mutually agreed upon collaborative agreements and guidelines for the healthcare provided;

3. agree upon medication formulary to be used by APRN and physician in practice. The collaborative physician has the right to use the Mississippi Prescription Monitoring Program to review the APRN's controlled substance prescribing practices;

4. describe the individual and shared responsibilities of the APRN and physician;

5. be reviewed and updated annually by the physician and the APRN; and

6. set out a procedure for handling patient emergencies, unexpected outcomes or other urgent practice situations.

A physician shall not enter into a collaborative agreement with an APRN whose training and practice is not compatible with that of the physician (it is recognized and accepted practice that surgeons, obstetricians and dentists have collaborative arrangements with CRNAs). It is recognized that CRNAs commonly work in the anesthesia care team model where one anesthesiologist may be collaborating with up to four CRNAs concurrently. In the model, a group of anesthesiologists may collaborate with a group of CRNAs. In this instance, it is acceptable to list multiple collaborators on the CRNA's protocol. If the usual practice is for one anesthesiologist to collaborate with more than four CRNAs concurrently, then a waiver must be requested and approved by the Board. Any other arrangement must adhere to the standard rules of collaboration that exists for an APRN. Unless otherwise waved, this rule applies to hospital settings and surgical suites only. This same model shall also apply to emergency medicine group practices.

The collaborative agreement shall not include medications the physician does not use in his or her current practice and about which the physician is not knowledgeable and competent.

Before entering into a collaborative agreement, a physician should consider the following when determining the degree of autonomy the agreement provides:

A. the physician's personal knowledge and ability to provide the time to the collaborative agreement;

B. the type of practice;

C. the scope of practice of the APRN;

D. the educational training and experience of the APRN;

E. the geographic location of the physician's practice and the practice of the APRN and their ability to consult in a manner that assures patient safety; and

F. the technology available to the physician and APRN to allow effective communication and consultation.

Physicians are prohibited from entering into a collaborative agreement with an APRN whose practice location is greater than forty (40) miles from the physician's practice site, unless a waiver is expressly granted by the Board for that particular collaborative agreement. However, a collaborative physician (primary or secondary) must be within 40 miles from the actively practicing APRN. Collaborative agreements which have previously been granted as waivers at the time of adoption of these rules will continue to be exempt from this requirement.

Anytime a collaborating physician is working with an APRN who is working in and/or staffing an emergency room the collaborative physician (primary or secondary) must be physically present in the building or no more than ten (10) minutes from the facility. An exception to this policy would be Board approved telemanagement arrangements.

Anytime a collaborating physician is working with an APRN who is working in and/or providing care in an acute care facility, there must be evidence reflected in the patient's chart that a collaborative physician has seen and examined the patient within twelve (12) hours of the APRN initially seeing the patient on admission.

Physicians are prohibited from entering into primary collaborative agreements with more than four (4) APRN's at any one time unless a waiver is expressly granted by the Board for that particular collaborative agreement. However, a physician may be in collaboration as the secondary physician on four (4) additional collaborative agreements and no QA, as defined under Rule 1.4, will be required for these additional APRNs. A secondary physician status may be given to a physician who is collaborating with up to two (2) APRNs who are working less than 20 hours per week at another clinic not in the same practice as the APRN's primary place of work. A QA review will be required quarterly.

The Board will consider the factors listed above, as well as any other factors that the Board deems relevant, in determining whether to grant a waiver. Such waivers may be granted to medical practices with multiple physicians including, but not limited to, the following settings:

A. emergency rooms;

B. intensive care units;

C. labor epidural services on obstetrical suites

D. State Department of Health;

E. State Department of Mental Health; and

F. federally funded health systems (e.g. FQHCs, VAMCs);

G. community mental health centers.

Physicians shall complete a questionnaire pertaining to APRNs upon initial licensure and during each annual renewal process.

2 Miss. Code. R. 601-1.3

Miss. Code Ann. § 73-43-11 (1972, as amended).