Who is legally responsible for a PA's clinical practice?
Chapter 112, s. 9E states that "If a physician assistant is employed by a physician or group of physicians, the assistant shall be supervised by and shall be the legal responsibility of the employing physician or physicians." And "If a physician assistant is employed by a health care facility, the legal responsibility for his acts and omissions shall be that of the employing facility."
"When a PA's designated supervising physician is unable or unavailable to be the principal medical decision-maker, another licensed physician must be designated to assume temporary supervising responsibilities…." (263 CMR 5.04 (3)(g)).
A PA should consult his/her employer's risk management and/or legal advisors for guidance in specific instances.
How many physician assistants can a registered physician supervise?
Effective November 4, 2012, M.G.L. c. 112, § 9E was amended to eliminate the limitation on the number of physician assistants who could be supervised by a supervising physician. Board regulation 263 CMR 5.05(2) containing the same limitation was deleted by emergency regulation effective May 29, 2013. Physician assistants must continue compliance with 263 CMR 5.05, Scope of Supervision Required, and supervising physicians must continue compliance with 243 CMR 2.08, Physician Assistants.
Is a PA required to have his/her documentation signed by a supervising physician?
No. The Board regulations do not require a co-signature. In some instances, a physician co-signature may be a requirement of an employer or of a third-party payer.
Can a PA perform endotracheal intubation if his/her supervising physician is not physically present?
Massachusetts General Laws, Chapter 112, section 9E authorizes PAs to perform medical services when a supervising physician is not present. ["…supervision shall be continuous but shall not require the personal presence of a supervising physician or physicians."]
Can a PA care for and adjust epidural catheters?
"A physician assistant may, under the supervision of a licensed physician, perform any and all services which are: a) within the competence of the PA in question, as determined by the supervising physician's assessment of his/her training and experience; and b) within the scope of services for which the supervising physician can provide adequate supervision to ensure that accepted standards of medical practice are followed." (263 CMR 5.04)
What restrictions does the Board place on billing for a physician assistant's services?
Board regulations found at 263 CMR 5.06 state that, "A physician assistant may not bill separately for services rendered. The services of the Physician Assistant are the services of his or her supervising physician, and shall be billed as such."
The Board may consider a number of factors to determine whether a particular billing activity conforms to the requirements of 263 CMR 5.06. While the Board is aware that government programs such as Medicare and certain private payers in Massachusetts may require the use of a physician assistant's name or unique identification number on a billing form seeking reimbursement for services provided by the physician assistant, such use of a physician assistant's name or identification number, by itself, does not constitute "billing separately" in violation of Board regulations. It is the opinion of the Board that any determination as to whether a particular billing practice violates 263 CMR 5.06 must consider the totality of circumstances under which the billing takes place.
Notwithstanding the use of a physician assistant's name and/or identification number on a claim form, additional factors may indicate that a physician assistant is not "billing separately" in contravention of Board regulations. Such factors may include:
The identity of the supervising physician may be determined from the claim form.
The physician assistant has no responsibility for, or control over, the billing activities.
Funds are paid directly to the supervising physician or other employer, who subsequently provides payment to the physician assistant.
Please bear in mind that, pursuant to Board regulations, the physician, group of physicians or health care facility that employs a physician assistant is legally responsible for the acts and/or omissions of that physician assistant at all times. Also, the Board offers no opinion as to the billing requirements of Medicare or any other public or private payer. It would be advisable, therefore, for the physician assistant and the employer to seek legal counsel as to additional statutory and regulatory restrictions on billing practices.
How does a temporary supervising physician meet 263 CMR 5.04 (g) in an Emergency Room setting?
To meet this regulation the following must be done:
The name and scope of responsibility of the physician providing such temporary supervision must be readily ascertainable from records kept in the ordinary course of business which are available to patients.
These points can be met by ensuring the following:
The name of the temporary supervising physician who serves as the PA supervisor when the supervisor of record is not available, and who is the MD/DO that day, is listed on the official ER schedule (that hospitals usually keep on file).
A memo should also be kept on file that states the MD/DO of the day will serve as the de facto PA supervisor when the supervisor of record is not available and explains their scope of responsibility. This memo is signed by all ER physicians who agree to accept the responsibility as a temporary supervising physician (and must also be in compliance with the regulation that each physician can serve as a supervisor of a maximum of 4 PAs).
Therefore, the records available to the patient include the official ER schedule and the memo on file that states the MD/DO of the day will serve as the de facto PA supervisor when the supervisor of record is not available and that explains temporary supervising physician's scope of responsibility.