IBM Considers New
PA Supervision Rules

Date of Publication June 16, 2017

The Iowa Board of Medicine (IBM) held a public hearing on Tuesday to receive input on new administrative rules regarding the supervision of physician assistants (PAs). The rules, ARC 3069C, are a result of a growing number of complaints filed with the IBM regarding inappropriate or questionable supervision arrangements. IMS has similarly seen an increase in member inquiries regarding what constitutes appropriate supervision.

As you may recall, over the past two years IMS has worked as part of a joint rulemaking process between the IBM and the Iowa Board of Physician Assistants (IBPA) to develop minimum PA supervision standards. That process stalled after IBM adopted jointly-developed rules and the IBPA’s refused to move forward with the same rule. This past session, the legislature intervened. HF 591 nullified the joint rules, required the IBPA to start sharing disciplinary records with the IBM when inappropriate supervision was alleged, and prohibited the IBPA from amending its supervision rules without the consent of the IBM. This legislation did not, however, address the underlying concern that Iowa physicians continue to lack clear guidance from their licensing board regarding what minimum expectations exist for supervising physicians.

Ahead of this week’s public hearing, IMS submitted written comments in support of these proposed rules. IMS highlighted concerning employment trends that have come to light over the past two years, including IBM complaint investigations that have uncovered instances where physicians had been designated a PA’s supervising physician without the physician’s knowledge. Such arrangements are not only unfair to the physician who is ultimately responsible for the care provided by the PA, but also a danger to patient safety.

The proposed draft rules seek to provide greater clarity for supervising physicians and PAs by requiring that a written supervisory agreement be completed before a physician begins supervising a PA. This form, to be completed and maintained at the practice site, clearly delineates practice protocol including what specific medical services the supervising physician is delegating to the PA and the procedures for obtaining alternative supervision if the PA’s supervising physician is not available.

Minnesota has had similar requirements in place for more than 20 years. As part of the IMS rules review process, we reached out to the Minnesota Medical Association (MMA) for their insight on how the process has worked. The MMA feedback, submitted as an attachment to the IMS written comments, confirm that written practice agreements have no negative impact on PA employment, however, they serve to establish clear expectations and improve the quality of care.

What Practices Need to Know Now

ARC 3069C is currently still in draft form as the IBM reviews feedback submitted during the public comment period and this week’s public hearing. The earliest this rule could take effect is August 23, 2017. While the IBM joint PA supervision rules that took effect in June 2016 have now been nullified, the IBPA rules governing supervision that predate this joint rulemaking effort, remain in effect. For questions regarding practices’ current legal obligations for PA supervision, please contact Kate Strickler, General Counsel with the IMS Center for Physician Advocacy. For questions about the newly proposed IBM rules or to share your thoughts on the proposed rules, please contact Dennis Tibben, Director of Government Affairs with the IMS Center for Physician Advocacy.

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