Practice Strategies
Bringing Extenders Into The Practice? Watch Your Liability
As you consider staffing levels at your practice, consider this: Nurse Practitioners and Physician’s Assistants can be a real boon to your practice. They can see patients with routine problems, order X-rays and provide the extra attention that leads to happier patients.
But an improperly utilized practioner can also lead to problems. Like anyone else, midlevel practitioners make mistakes. If that mistake results in a malpractice action, you may very well find yourself charged with inadequate supervision or allowing the extender to work beyond his or her scope of practice and expertise.
Consider the following tips before bringing an NP or PA into your practice to make sure that you’re extending your practice — not your liability.
Hire carefully. The first step in limiting your liability is to check your applicant’s qualifications and credentials, review job history and experience, and run a criminal background check. Work directly with your new hire for several months to determine his or her level of competence.
Try before you buy. One way to find a good candidate is to intern a PA or NP student. Contact local universities with NP or PA programs. But, remember, this isn’t “free labor” — you’ll need to provide guidance and be available for consultations and assessments.
Notify your carrier . Inform your malpractice carrier right away when you add an NP or PA. Failure to do so could result in denial of coverage for failure to disclose.
Nonphysician providers often take out their own individual liability policies so they’re protected if they change jobs or if you close your practice before a malpractice claim is filed. Still, practices ought to consider purchasing separate medical malpractice insurance for the Nurse Practitioner. The cost is minimal: A $1 million/$3 million policy for an NP or PA working in a primary care practice generally costs less than $1,000 a year.
Protect your personal liability. If your practice isn’t already structured as a professional corporation, consider forming one in order to limit your personal liability. If you go that route, most carriers will require separate policy limits for the corporation and each physician. Of course, each nonphysician provider on staff increases your exposure, raising your corporate limit.
Inform patients. Make abundantly clear to your patients the distinction between physicians and nonphysician providers. For example, have your extenders wear nametags that clearly indicate that they’re an NP or PA, or have them wear a different color lab coat.
Next, provide your patients with written notice explaining that your office uses physician extenders, and define how often you must see patients who are seen routinely by a PA or NP. Your level of supervision depends on your state’s regulations. But, for example, you might say that all new patients are seen by the physician, as are patients whose symptoms persist. Such a protocol can prevent patients from claiming that they never knew they were being seen by anyone other than a “real” doctor.
Supervise appropriately. Again, depending on your state’s regulations, implement and document a formal pattern of supervision—regular meetings or random chart reviews—so that, in the event of a claim, you can demonstrate that you provided adequate supervision.
Even if not required by statute, make sure your NP or PA regularly consults with you about patients. Make yourself reachable. Encourage your NP or PA to ask for help when needed. Don’t unwittingly project the impression that you’re too busy to be bothered by questions.
For more information about our services to the healthcare industry, Contact:
Maxine Lawyer, Director of Healthcare Services at 972.448.6905.
The articles in this newsletter are general in nature and are not a substitute for accounting, legal, or other professional services. We assume no liability for the reader's reliance on this information. Before implementing any of the ideas contained in this publication, consult a professional advisor to determine whether they apply to your unique circumstances.
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