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Physician Assistants May Sign Their Own Prescriptions Without Physician Countersignature (With Some Caveats, Of Course!)

Health Law Update Sarah E. Coyne, Kevin J. Eldridge

The new rule governing countersignature of physician assistant ("PA") prescriptions will relax significantly this fall, allowing PAs more authority and allowing physicians more flexibility in supervising PA prescriptions. This rule will significantly reduce hassles for hospitals and other organizations employing physician assistants.

Physician Supervision of PA Prescriptions: The 72-Hour Rule is Repealed and Replaced with Flexibility.

Under current regulations governing PA practice, a PA's supervising physician must review every prescription issued by the PA and countersign the prescription or patient record within 72 hours, or a week under some circumstances.

As of September 1, supervising physicians will be given wide latitude to determine the manner and frequency of their oversight of PA prescriptive authority, pursuant to a regulatory revision issued by the Medical Examining Board ("MEB"), which has regulatory authority over physicians and physician assistants.

The regulatory revision is expected to become effective September 1, 2009.

Under the revised regulations, supervising physicians will be required to conduct a periodic review of PA prescriptions. The supervising physicians may determine the method and frequency of their periodic review, based on the nature of the prescriptive practice, the PA's experience and patient welfare. At a minimum, the physician must do at least one of the following in the periodic review:

  • Review a selection of prescriptions prepared by the PA.
  • Review a selection of patient records prepared by the PA practicing in the supervising physician's office or at a facility or hospital at which the physician has staff privileges.
  • Review, by telecommunications or other electronic means, the patient records or prescriptions prepared by the PA who practices in an office facility other than the supervising physician's main office, or a facility or hospital in which the physician has staff privileges.

In addition, the supervising physician's process and schedule for review must indicate the minimum frequency of review and identify the selection of prescriptions or patient records to be reviewed.

The rule will no longer require supervising physicians to countersign at all if one of the alternative methods of supervision is used - the 72-hour timeframe is eliminated. Physicians are free to continue to countersign as a mechanism of exercising the required periodic oversight.

PA Dispensing and Written Guidelines for Prescriptions

The MEB regulatory revisions also clarify that PAs have the authority to both prescribe and dispense drugs as long as the prescription or dispensing occurs pursuant to written guidelines for supervised practice. Although the Pharmacy Examining Board was concerned that this revision would expand the PA scope of practice, the MEB confirmed that dispensing is already within the PA scope of practice, and the revisions simply reflect that reality.

The supervision guidelines must be kept on file at the practice site and must be available to the MEB upon request. The MEB will also require that the guidelines include categories of drugs for which prescriptive authority has been authorized by the physician.

Method of Communication for Supervision, Generally

Under the existing rule, supervising physicians (or their substitutes) are to be available to the PA for consultation at all times, either in person or within 15 minutes of contact by "telephone or by 2 way radio or television communication." The amended rule recognizes technological advancements in electronic communications by allowing such consultation to occur by "telecommunications or other electronic means." Neither the requirement of availability nor the time parameters have changed. This change applies to all supervision by the physician, not just the supervision of prescriptive practices. Although the MEB did not define the quoted clause, it was likely intended to include both electronic medical records and email, in addition to phone, radio, fax, etc.

What does this all mean?

The MEB regulatory revisions provide more flexibility to physicians in supervising the prescriptive practices of PAs and are likely to drive increased prescribing by PAs. When the revisions become effective, PA practice in Wisconsin will be aligned with current practice in neighboring states. The MEB acknowledged that the regulatory revisions were justified by advances in PA licensure and prescriptive authority as well as a record of safe prescribing.

For more details, or if you have any questions, please contact Sarah Coyne at 608-283-2435 / sarah.coyne@quarles.com, Kevin Eldridge at 608-283-2452 / kevin.eldridge@quarles.com or your Quarles & Brady LLP attorney.