[NPInfo] question for those who have a medical director

[David Mittman]

Lisa: In the mid to late 70s almost all PA laws and many NP laws were  
written with the word supervision. I'll tell you it was and IS a word  
chosen by the AMA and state medical associations as a "put us in our  
place" word. It says someone has to watch you. The NP societies  
battled this movement generally successfully, the PAs had much less  
power and it was not worth dying for.
In actuality it has not held PAs back as much as the assistant name  
has. Supervision in many states is the same as collaboration but the  
word is pejorative.
Hopefully, someday this will all be history.
Dave


On Jan 2, 2008, at 8:16 PM, Lisa Meyer wrote:

> Sue,
> I also practice in Michigan and, though I believe the spirit of the  
> law is something closer to "collaboration" and collaborative  
> agreements are required, the actual language says "supervision" in  
> Michigan.  I do not know whether the language of Michigan law calls  
> the agreements "collaborative" or simply calls them written  
> agreements--do you know?  I know this seems like splitting hairs,  
> but I do believe semantics are important when it comes down to how  
> physicians perceive us.  Many people on this list in the past have  
> suggested that it is not important how other professions perceive  
> us, but it does affect how they choose to work with us or against  
> us in the health care team.  Unless the MI law has changed, I  
> believe it still uses "supervision" and I don't believe this word  
> was accidentally chosen over collaboration.
>
> Lisa
>
> ----- Original Message ----- From: <suernfnp at iwon.com>
> To: <npinfo at nurse.net>
> Sent: Wednesday, January 02, 2008 6:47 PM
> Subject: RE: [NPInfo] question for those who have a medical director
>
>
>>
>> Gail, this would depend on the state where you practice. Protocols  
>> are different per state. Here in Michigan, the physician  
>> collaborates with the NP. A collaborative agreement with a  
>> physician is required for Michigan nurse practitioners to receive  
>> direct Medicaid and Medicare reimbursement. Collaborative  
>> agreements, which define the relationship of NPs working with  
>> physicians to deliver health care services, need to be carefully  
>> written and should not state that a physician is delegating or  
>> supervising when not required or not appropriate. Medicaid  
>> stipulates in the most detail what a collaborative agreement must  
>> include. Medicare requires that there must be a written agreement  
>> in place. Therefore, if NPs create and implement collaborative  
>> agreements which comply with Medicaid requirements, the agreement  
>> will likely be satisfactory to other payors, including Medicare.
>>
>> Prescriptive authority may be delegated to a NP by a physician.  
>> Delegation of non-controlled substances does not require a written  
>> document. However, delegation of Schedule 2, 3, 4 & 5 drugs does  
>> require written authorization of the delegation. This  
>> authorization must be updated annually.
>>
>> We do not have a requirement in Michigan for chart review of NP  
>> work by a physician. We are not required to have specific  
>> protocols or a drug formulary in the collaborative agreement. I  
>> would not put them in unless they are required by your state NP  
>> practice act.
>>
>> Here is the link to the Michigan Nurses Association site for  
>> sample collaborative agreeements regarding practice and  
>> prescription of scheduled medications, including "Recommendations  
>> for the Process to Develop a Collaborative Agreement." http:// 
>> www.minurses.org/apn/apn-npfaq.shtml#collab
>>
>> Sue D in MI
>>
>>
>>
>>
>> --- On Wed 01/02, GIN11153 at aol.com < GIN11153 at aol.com > wrote:
>> From: GIN11153 at aol.com [mailto: GIN11153 at aol.com]
>> To: NPInfo at nurse.net, prvpracnp at nurse.net,  
>> IndNursePrac at yahoogroups.com
>> Date: Wed, 2 Jan 2008 04:29:22 EST
>> Subject: [NPInfo] question for those who have a medical director
>>
>> I think I have finally found a new medical director to replace the  
>> one who <br>decided he couldn't take on another office. He's  
>> asking  what I would need  <br>from him besides being available to  
>> consult with the NP  and sign off  on <br>protocols. Does any one  
>> have an established list?<br>  
>> <br>Gail<br><br><br><br>**************************************See  
>> AOL's top rated recipes <br>(http://food.aol.com/top-rated-recipes? 
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