Physician Supervision Requirements of Non-Physician Practitioners

The purpose of this policy is to provide for the provision of supervisory guidelines for contracted physicians employing non-physician allied health care professionals in compliance with Federal "credentialing" mandates of Lakeside’s contracted health plans.

The scope of this policy encompasses all contracted physicians who employ the following type of allied health care professionals within the following specialty fields:

Type of Allied Professionals:

Physicians Assistants

MFCCs, LCSW, MFTs

Certified Medical Assistant practitioners are purposely "excluded" and not credentialed by Lakeside HealthCare, Inc.

It is the policy of Lakeside HealthCare, Inc. to ensure physicians appropriately supervise and monitor non-physician practitioners who see and/or treat Lakeside patients in compliance with Federal QISMC and HCFA standards. It is the policy of Lakeside to credential non-physician practitioners (also known as "allied healthcare practitioners") who have a role in the care of patients. The non-physician practitioners must hold a current California license.

It is the policy of Lakeside HealthCare, Inc. that any employed allied health care practitioner is to limit his/her services to the scope described by the practitioner’s licensing or certifying agency. All definitions and practice parameters of allied health care practitioners are delineated in the appropriate section(s) of the Medical Board of California, California Code of Regulations and associated regulations.

It is the policy of Lakeside HealthCare, Inc. to provide any new physician in the above fields with a copy of this policy, procedure and attachments upon approval of the physician’s application.

It is the policy of all supervising physicians will have continuing responsibility for all medical services provided by the allied professional under his/her supervision.

Protocols:

1. Practitioners employing physician assistants must obtain and maintain a current, valid license to supervise issued by the Medical Board of California. Practitioners employing nurse practitioners do not need a license to supervise. A copy of a physician’s supervisory license is maintained in Lakeside’s physician credentialing file.
2. Physician Assistants may perform those medical services as set forth by the regulations of the Medical Board of California when the services are rendered under the supervision of the licensed physician. At all times, the supervising physician must be physically or electronically available to the physician assistant for consultation, except in emergency situations. The supervising physician may supervise a maximum of no more than two (2) physician assistants at one time.
3. Medical services, drugs and/or devices furnished by a Nurse Practitioner must be in accordance with standardized procedures and protocols developed by the nurse practitioner and supervising physician. The supervising physician may supervise no more than four (4) nurse practitioners at one time. The supervising physician is not required to be physically present, as availability by telephone is adequate.
4. Members will be informed by the practitioner office when the patient will be seen by either a physician assistant, nurse practitioner, or other appropriate allied health care professionals.

Physician Procedures:

1. Review this policy, protocols and attachments.
2. Collect and maintain licensure and/or certification of the allied professional at alltimes. These documents are to be made available to Lakeside staff upon request.
3. Physician extenders will have malpractice liability coverage in the amounts of $1,000,000/$3,000,000.
4. Delegate "services" for the allied healthcare professional as appropriate to the professional’s licensure, level of training, and experience utilizing the attached set of Practitioner Service & Medical Record Guidelines.
5. Identify those medical records that require physician intervention, oversight, and counter-signature using the attached set of Practitioner Service & Medical Record Guidelines.
6. Utilizes the attached set of Physician Supervisory Guidelines to assess and reassess the performance of each allied professional to ensure all patient’s medical care is rendered appropriately and timely.
7. Physician is responsible to notify Lakeside any time the physician employs or terminates allied professionals and ensures the allied professionals complete and return credentialing or recredentialing information in a timely manner.
8. Physician notifies any allied professional seeing Lakeside patients that Lakeside will share serious "adverse" credentialing information to ensure patient safety. Practitioner Rights to Review & Correct Erroneous Information The scope of this policy encompasses any potential and contracted practitioner and/or facility interested in affiliation with Lakeside HealthCare, Inc., and its affiliates, during the credentialing or recredentialing processes. It is the policy of Lakeside HealthCare, Inc. that all practitioners and/or facilities have the right to review their credentialing file and the information obtained during these processes, excluding peer review protected information.

Procedure:

1. Upon discovering information, which varies substantially from that which is supplied by the practitioner and/or facility, the Credentialing Specialist calls the practitioner and/or facility within three (3) days of receipt of the information to discuss the variance(s).
2. The Credentialing Specialist notifies the practitioner and/or facility that they are allowed to review information submitted in support of their application that is not protected by peer review privilege or is not prohibited by law and regulation. Appointments are made on an individual basis at the corporate offices of Lakeside HealthCare, Inc.
3. The Credentialing Specialist asks the practitioner and/or representative from a facility if he/she would like to view the information or respond. The practitioner and/or facility’s request and/or information may be faxed or mailed. However, information from a NPDB query is to be given directly to the practitioner, not to any other person under any circumstances. All mailed or faxed information is considered confidential in nature.
4. The Credentialing Specialist advises the practitioner and/or representative from a facility that he/she or they have 15 days in which to respond to the verbal communication(s).
5. Upon receipt of any corrected or amended information, the Credentialing Specialist reviews the information with the Credentialing Manager prior to preparing the file for review by the Credentialing Committee.