Physician Assistants Legal Handbook

This book, written for PAs, PA students, institutional and physician employers of PAs, and health care lawyers, is a comprehensive reference on laws impacting physician assistant practice. In addition to offering a detailed account of the evolution of the PA profession, including its continuing expansion in today's health care environment, this book provides thorough coverage of a wide range of legal issues related to the PA practice; including academic training and certification, licensure, scope of practice and prescriptive authority, employment laws, peer review and credentialing, malpractice, risk management, professional liability insurance, medical records, reimbursement, ethics, and employment issues related to PAs in hospitals and other practice settings.

Editorial Board

vii

(2)

Preface

ix

(2)

Acknowledgments

xi

Chapter 1 -- Physician Assistants and the Law

1

(10)

Introduction

1

(1)

Sources of Regulation

1

(4)

Profession Profile

5

(1)

Practice Settings and Special Legal Issues

5

(6)

Chapter 2 -- Education and Certification

11

(50)

Introduction

11

(1)

Historical Background

11

(5)

Program Accreditation

16

(6)

Education Programs

22

(14)

Certification

36

(9)

Appendix 2-A Accredited Physician Assistant Programs

45

(16)

Chapter 3 -- Licensure and Scope of Practice

61

(42)

Introduction

61

(1)

Historical Background

61

(4)

Licensure under State PA Practice Laws

65

(4)

Scope of Practice under State PA Practice Laws

69

(12)

Regulatory Boards and Their Powers

81

(6)

Appendix 3-A AAPA Model State PA Practice Legislation

87

(10)

Appendix 3-B AAPA Guidelines for State Regulation of Physician Assistants

97

(6)

Chapter 4 -- Prescribing and Dispensing

103

(34)

Introduction

103

(1)

Evolution of Prescriptive Authority

103

(2)

PA Prescribing Patterns and Qualifications

105

(2)

The Politics of Prescribing

107

(2)

Federal Drug Laws

109

(7)

Prescribing and Dispensing under State PA Practice Laws

116

(9)

Appendix 4-A Physician Assistant Prescribing Privileges

125

(2)

Appendix 4-B Application for DEA Registration

127

(8)

Appendix 4-C Physician Assistant Dispensing Privileges

135

(2)

Chapter 5 -- Liability

137

(34)

Introduction

137

(1)

Negligence

137

(6)

Informed Consent

143

(2)

Imputed Liability

145

(4)

Direct Liability for Supervisors

149

(1)

Damages

150

(2)

Balancing Legal and Ethical Issues

152

(6)

What To Expect When a Lawsuit Is Filed

158

(13)

Chapter 6 -- Quality Review and Risk Management

171

(44)

Introduction

171

(1)

Historical Background

171

(4)

Quality Improvement Management Theory

175

(1)

Joint Commission Standards

176

(1)

NCQA Standards

177

(1)

Components of Quality Improvement Programs

178

(13)

Risk Management

191

(8)

Clinical Practice: Reducing Malpractice Risks

199

(10)

Appendix 6-A Risk Indicators for the Physician's Office Practice

209

(6)

Chapter 7 -- Medical Records

215

(16)

Introduction

215

(1)

Patient Record Requirements

216

(1)

Recordkeeping Practices

217

(4)

Consequences of Maintaining an Incomplete Medical Record

221

(1)

Access to Medical Records Information

222

(2)

Record Security

224

(1)

Computerized Medical Records

225

(2)

Liability for Unauthorized Disclosure of Medical Record Information

227

(4)

Chapter 8 -- Credentialing and Peer Review

231

(34)

Introduction

231

(1)

Credentialing

231

(2)

Peer Review

233

(1)

Medical Staff Membership

233

(4)

Clinical Privileges

237

(2)

Reporting Adverse Credentialing Actions

239

(5)

Immunity for Peer Review Participants

244

(2)

Procedural Protections from Adverse Decisions

246

(3)

Antitrust Implications of Credentialing

249

(2)

Appendix 8-A Credentialing Process for Allied Health Professionals

251

(2)

Appendix 8-B Physician Assistant Privilege Sheet

253

(4)

Appendix 8-C Delineation of Privileges for Emergency Department Physician Assistant

257

(4)

Appendix 8-D Reporting and Querying--The National Practitioner Data Bank

261

(4)

Chapter 9 -- Employment Laws

265

(26)

Introduction

265

(1)

Determining Employee Status

265

(3)

Overview of Federal Antidiscrimination Laws

268

(1)

Legal Theories of Discrimination

269

(1)

Race Discrimination

270

(1)

Sex Discrimination

270

(6)

National Origin Discrimination

276

(1)

Religious Discrimination

276

(1)

Age Discrimination

276

(1)

Disability Discrimination

277

(2)

Federal Laws Governing Wages, Hours, and Benefits

279

(4)

Occupational Safety and Health Act

283

(2)

Employee Substance Abuse

285

(2)

Wrongful Discharge

287

(4)

Chapter 10 -- Third-Party Reimbursement

291

(36)

Introduction

291

(1)

Medicare

291

(8)

Medicaid

299

(3)

Rural Health Clinics

302

(1)

Military Health Programs

303

(2)

Federal Employees Health Benefits Program

305

(1)

Workers' Compensation

305

(1)

Private Insurance Companies

306

(1)

Billing and Coding Issues

306

(3)

Contesting Reimbursement Decisions

309

(6)

Appendix 10-A Medicare Policy for Physician Assistants

315

(2)

Appendix 10-B HCFA 150 Form

317

(2)

Appendix 10-C State Medicaid Programs Coverage for Physician Assistants

319

(4)

Appendix 10-D State Workers' Compensation Programs

323

(4)

Chapter 11 -- Participation in Government Affairs

327

(36)

Introduction

327

(1)

AAPA and State PA Associations

327

(1)

State Chapter's Government Affairs Committee

328

(12)

Participating in State Legislative Process

340

(4)

Participating in State Regulatory Process

344

(7)

Appendix 11-A Legislative Efforts: How the AAPA Can Help

351

(2)

Appendix 11-B State Legislative Document Offices

353

(6)

Appendix 11-C Summary of State Model Administrative Procedures Act

359

(4)

Appendix A -- Physician Assistant National and Specialty Organizations

363

(2)

Appendix B -- State Regulation of Physician Assistants

365

(18)

Table of Cases

383

(4)

Index

387

(12)

About the Authors

399

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Physician Assistants Legal Handbook

Summary

Table of Contents

Supplemental Materials