3 CCR 713-7.1 - EXTENT AND MANNER IN WHICH A PHYSICIAN ASSISTANT MAY PERFORM DELEGATED TASKS CONSTITUTING THE PRACTICE OF MEDICINE UNDER PERSONAL AND RESPONSIBLE DIRECTION AND SUPERVISION
A.
The requirements for a Supervisory Plan or a Practice Agreement applies
to all supervising physicians and physician assistants as of August 2,
2019.
B.
Responsibilities of the Physician Assistant
1. Compliance with these Rules. A physician
assistant and the physician assistant's supervising physician are responsible
for implementing and complying with statutory requirements and the provisions
of these Rules.
2. License. A
physician assistant shall ensure that his or her license to practice as a
physician assistant is active and current prior to performing any acts
requiring a license.
3.
Registration. A physician assistant shall ensure that a form in compliance with
Section 7.3 of these Rules is on record with the Board.
4. Identification As A Physician Assistant.
While performing acts defined as the practice of medicine, a physician
assistant shall clearly identify himself or herself both visually (e.g. by
nameplate or embroidery on a lab coat) and verbally as a physician
assistant.
5. Chart Note. A
physician assistant shall make a chart note for every patient for whom the
physician assistant performs any act defined as the practice of medicine in
section 12-240-107(1),
C.R.S. When a physician assistant consults with any physician about a patient,
the physician assistant shall document in the chart note the name of the
physician consulted and the date of the consultation.
6. Documentation. A physician assistant shall
keep such documentation as necessary to assist the supervising physician in
performing an adequate performance assessment as set forth below in Section
7.1(C)(6) of these Rules.
7. Acute
Care Hospital Setting
a. Physician assistants
performing delegated medical functions in an acute care hospital setting must
comply with the requirements of section
12-240-107(6)(b)(II),
C.R.S.
b. For purposes of this
section, "reviewing the medical records" means review and signature by the
primary supervising physician or a secondary supervising physician.
C.
Requirements
for and Types of Supervising Physicians and Their Scope and Authority to
Delegate
1. Supervising Physicians
must be actively practicing medicine in Colorado by means of a regular and
reliable physical presence in Colorado. For purposes of this Rule, to practice
medicine based primarily on telecommunication devices or other telehealth
technologies does not constitute "actively practicing medicine in
Colorado."
2. A supervising
physician must perform personal and responsible direction and supervision,
which may not be rendered through intermediaries. Section 240-107(6)(b)(II),
C.R.S., sets forth a statutory exception to this provision and specific
requirements pertaining to delegated medical functions in some acute care
hospitals.
3. Eight Physician
Assistant Limit. Except as otherwise provided in Section 7.1 of these Rules, no
physician shall be the primary supervising physician for more than eight
specific, individual physician assistants. The names of such physician
assistants shall appear on the form in compliance with Section 7.3 of these
Rules. The primary supervising physician may supervise additional physician
assistants other than those who appear on the form in compliance with Section
7.3 of these Rules. In other words, a primary supervising physician may also be
a secondary supervising physician, as set forth below, for additional physician
assistants so long as such supervision is in compliance with these
Rules.
4. Primary Supervising
Physician. Except as set forth in Section 7.1 of these Rules, a physician
licensed to practice medicine by the Board and actively practicing medicine in
Colorado as defined in Section 7.1 may delegate to a physician assistant
licensed by the Board the authority to perform acts that constitute the
practice of medicine only if a form in compliance with Section 7.3 of these
Rules is on record with the Board. The physician(s) whose name appears on the
form in compliance with Section 7.3 of these Rules shall be deemed the "primary
supervising physician." The supervisory relationship shall be deemed to be
effective for all time periods in which a form in compliance with Section 7.3
of these Rules is on file with the Board.
A physician assistant shall have at least one primary supervising physician for each employer. If the employer is a multi-specialty organization, e.g., a multi-specialty practice, hospital, hospital system or health maintenance organization, the physician assistant shall have a primary supervising physician, duly registered with the Board, per specialty practice area. When performing delegated tasks, the physician assistant's clinical practice should be consistent with and in the scope of the delegating physician's education, training, experience, and active practice.
5. Secondary Supervising
Physician. Other than the supervising physician whose name appears on the form
in compliance with Section 7.3 of these Rules, a physician licensed to practice
medicine by the Board and actively practicing medicine in Colorado as defined
in Section 7.1, may delegate to a physician assistant licensed by the Board the
authority to perform acts which constitute the practice of medicine only as
permitted by Section 7.1 of these Rules. Such physician shall be termed a
"secondary supervising physician." Secondary physician supervisors do not need
to be registered with the Board.
6.
Delegation of Medical Services. Delegated services must be consistent with the
delegating physician's education, training, experience and active practice.
Delegated services must be of the type that a reasonable and prudent physician
would find within the scope of sound medical judgment to delegate. A physician
may only delegate services that the physician is qualified and insured to
perform and services that the physician has not been restricted from
performing. Any services rendered by the physician assistant will be held to
the same standard that is applied to the delegating physician.
D.
Responsibilities of and
Supervision by the Primary Supervising Physician
1. Compliance with these Rules. Both the
supervising physician and the physician assistant are responsible for
implementing and complying with the statutory requirements and the provisions
of these Rules.
2. Responsibility
for Actions of a Physician Assistant. A primary supervising physician may
supervise and delegate responsibilities to a physician assistant in a manner
consistent with the requirements of these Rules. Except as provided in Sections
7.1 and 7.1 of these Rules, the primary supervising physician may be
responsible if a supervised physician assistant commits unprofessional conduct
as defined in section
12-240-121(1)(j),
C.R.S., or if such physician assistant otherwise violates these Rules. The
Board may take into consideration mitigating circumstances in determining
whether sanctions involving the primary supervising physician are necessary to
protect the public on a case by case basis. A primary supervising physician may
be responsible if a supervised physician assistant commits negligence, except
as exempted by section
12-240-114.5(5)(c),
C.R.S.
3. The primary supervising
physician shall not be responsible for the conduct of a physician assistant
where that physician assistant was acting under the supervision of another
primary supervising physician and there is a form in compliance with Section
7.3 of these Rules signed by that other primary supervising physician. The
primary supervising physician shall also not be responsible for the conduct of
a physician assistant where it is established by documentation or other
reliable means that the physician assistant consulted with a secondary
supervising physician and that the secondary supervising physician was clearly
overseeing, or was otherwise responsible for the conduct of the physician
assistant, for an episode of care.
4. License Status. Before authorizing a
physician assistant to perform any medical service, the supervising physician
should verify that the physician assistant has an active and current Colorado
license issued by the Board.
5.
Qualifications. Before authorizing a physician assistant to perform any medical
service, the supervising physician is responsible for evaluating the physician
assistant's education, training and experience to perform the service safely
and competently.
6. Performance
Evaluation
a. A primary supervising physician
who supervises a physician assistant shall develop and carry out a periodic
Performance Evaluation as required by these Rules and section
12-240-114.5(1)(a),
C.R.S. The Performance Evaluation should include domains of competency relevant
to the particular practice and utilize more than one modality of assessment to
evaluate those domains of competency. The Performance Evaluation should take
into account the education, training, experience, competency and knowledge of
the individual physician assistant for whatever specialty the physician
assistant is engaged.
b. The
statutory relationship between the physician and physician assistant is by its
nature a team relationship. The purpose of the Performance Evaluation is to
enhance the collaborative nature of the team relationship, promote public
safety, clarify expectations, and facilitate the professional development of an
individual physician assistant.
c.
The domains of competency may be dependent upon the type of practice the
physician assistant is engaged in and may include but are not limited to:
(1) Medical knowledge;
(2) Ability to perform an appropriate history
and physical examination;
(3)
Ability to manage, integrate and understand objective data, such as laboratory
studies, radiographic studies, and consultations;
(4) Clinical judgment, decision-making and
assessment of patients;
(5)
Accurate and appropriate patient management;
(6) Communication skills (patient
communication and communication with other care providers);
(7) Documentation and record
keeping;
(8) Collaborative practice
and professionalism;
(9) Procedural
and technical skills appropriate to the practice.
d. The modalities of assessment to evaluate
domains of competency may include but are not limited to:
(1) Co-management of patients;
(2) Direct observation;
(3) Chart review with identification of
charts reviewed;
(4) Feedback from
patients and other identified providers.
e. A primary supervising physician must
maintain accurate records and documentation of the Performance Evaluations,
including the initial Performance Evaluation and periodic Performance
Evaluations for each physician assistant supervised, and the Supervisory
Plans.
f. The Board may audit a
supervising physician's performance assessment records. Upon request, the
supervising physician shall produce records of the performance assessments as
required by the Board.
7. Supervisory Plan.
The purpose of the initial Supervisory Plan is to lay the foundation for the ongoing growth and professional development of the physician assistant's clinical practice and abilities and to promote the collaborative relationship between the physician assistant and supervising physician. This initial Supervisory Plan should also be used to address any gaps and/or deficiencies identified in the physician assistant's clinical competencies during the initial performance period.
Elements that should be incorporated into the Supervisory Plan may include, but are not limited to:
a. Nature of the Clinical Practice
(areas of specialty, practice sites, populations served, ambulatory and
inpatient expectations, etc.);
b.
Specific expectations and duties of the physician assistant;
c. Expectations around physician(s) support,
supervision, consultation and back up;
d. Methods and modes of communication,
co-management and collaboration;
e.
Specific clinical instances in which the physician assistant should ask for
physician back up;
f. Plan for
on-going professional education, skill acquisition, gap analysis and career
development;
g. List of secondary
supervisors anticipated to participate in the PA's practice;
h. Schedule of performance assessments and
anticipated modalities by which the practice will be assessed and domains that
will be assessed.
i. Other
pertinent elements of collaborative, team-based practice applicable to the
specific practice or individual physician and physician assistant.
8. Availability of the Supervising
Physician
a. The supervising physician must
provide adequate means for communication with the physician
assistant.
b. If not physically on
site with the physician assistant, the primary or secondary supervising
physician must be readily available by telephone, radio, pager, or other
telecommunication device.
E.
Responsibilities of the Secondary
Supervising Physician
1. If a
physician who is not the primary supervising physician consults with a
physician assistant regarding a particular patient, the physician is a
secondary supervising physician. The physician assistant must document the
consultation date and name of all physicians consulted in the patient
chart.
2. Responsibility for
Actions of a Physician Assistant. Such supervising physician may be responsible
for any action or omission involving the practice of medicine supervised by the
secondary supervising physician involving the particular patient. The Board may
take into consideration mitigating circumstances in determining whether
sanctions involving the secondary supervising physician are necessary to
protect the public on a case by case basis.
F.
Waiver of Provisions of these
Rules
1. Criteria for Obtaining
Waivers.
a. Upon a showing of good cause, the
Board may permit waivers of any provision of these Rules, except waiver of the
primary supervision of more than eight physician assistants.
b. Factors to be considered in granting such
waivers include, but are not limited to: whether the physician assistant is
located in an underserved or rural area distant from the supervising physician;
the quality of protocols setting out the responsibilities of a physician
assistant in the particular practice; any disciplinary history on the part of
the supervising physician or the physician assistant; and whether the physician
assistants in question work less than a full schedule.
c. All such waivers shall be in the sole
discretion of the Board. All waivers shall be strictly limited to the terms
provided by the Board. No waivers shall be granted if in conflict with state
law.
2. Procedure for
Obtaining Waivers.
a. Applicants for waivers
must submit a written application on forms approved by the Board detailing the
basis for the waiver request.
b.
The written request should address the pertinent factors listed in Section 7.1
of these Rules and include a copy of any written protocols in place for the
supervision of physician assistants.
c. Upon receipt of the waiver request and
documentation, the matter will be considered at the next available Board
meeting.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.