Collaborative agreement question?

linearthinker, DNP, RN · Aug 3, 2011

In my state, just one.

Advanced Practice Columnist / Guide · Aug 3, 2011

You just need a collaborative practice agreement with one physician though you could definitely work with other physicians within the group. I quickly looked through the Kentucky BON website and it says that the collaboration agreement is required for writing prescriptions and that there are separate agreements required for non-scheduled and scheduled medications. The latter requires one year of NP experience and a DEA certificate. On the federal level, CMS requires a collaborative agreement for billing Medicare and Medicaid and there are numerous samples of these online. The practice that hired you probably already have the forms. Just as a FYI, some states have specific rules regarding collaboration. For instance, here in California, a physician can only enter into a collaborative agreement with no more than 5 NP's at a time.

buster4 · Aug 4, 2011

Thank you Juan, you are always so helpful, i know in Kentucky, there is no limit on the number of NP's a physician can collaborate with, but I just wasn't sure about having one with each physician in the practice........ and yes in KY you need a separate collaborative agreement for nonscheduled and scheduled drugs.. thank you so much for being so helpful to everyone!!

Trauma Columnist · Aug 4, 2011

I'm in IL so take it with a grain of salt. I work in a 15 MD practice. ALL my docs are listed on my collaborative agreement with one MD listed as my SUPERVISING MD.

mammac5 · Aug 4, 2011

In NC you have to have a collaborating, and then a back-up listed for when your collaborating is unavailable. There is a cost to the NCBON for each separate collaborating one has listed, so it wouldn't be practical here to have a whole slew of them in this state.

By the way, wouldn't it be splendid if there were national guidelines for this versus this hodgepodge?

buster4 · Aug 5, 2011

Juan, does your state requires a "supervising physician"?

Advanced Practice Columnist / Guide · Aug 5, 2011

Juan, does your state requires a "supervising physician"?

I guess in a way you can call it that here in California. What we have here is a complicated mess of bureaucratic redtape called "Standardized Procedures". This was the brainchild of the Board of Registered Nursing (grants NP certificate in CA) and the Medical Board of California (otherwise known as the Old Boys Club). It is very specific actually in that the law requires that the document contain the setting, degree of physician supervision, and the patient population that the NP can practice in. For instance, as an ICU NP, my standardized procedures states who the colaborating physician is, what population I provide care for (in-patient, adult), what my role involves (H&P's, progress notes, discharge, etc.), what procedures I can perform and under what circumstances would I receive training to perform them (central lines, arterial lines, intubations, conscious sedation, etc.), and the formulary of drugs I can furnish (or prescribe). It is in fact, very nitpicky and goes into minutia considering I used to work in a state where we did not have this. I, however, do not see much difference in the way I practice here as compared to where I was before. There is still a lot of autonomy in that the physicians are around physically but are smart enough to recognize/respect our abilities as clinicians.

BTW, I misquoted in my previous post..it's a maximum of 4 NP's to 1 physician in terms of collaborative agreements or standardized procedures.