After months of deliberation, the Louisiana State Board of Medical Examiners (LSBME) and the Louisiana State Board of Nursing (LSBN) have issued congruent rules governing physician collaboration with APRNs required to have a collaborative practice agreement.
One of the goals in updating these rules was to minimize potential adverse effects on a patient’s continuity of care when a collaborating physician becomes unavailable. The LSBME now requires the physician to annually report on their status as a collaborating physician to the LSBME. Updated administrative APRN rules eliminated some initial paperwork burdens by creating an Attestation of Collaborative Practice Agreement form, which APRNs must use in lieu of submitting a copy of the collaborative practice agreement.
Below are some of the important provisions of the new rules1:
- Only Two. Every collaborative practice agreement that is executed is now limited to two collaborating physicians per practice site.
- Eligibility. The collaborating physician and any alternate collaborating physician (alternate) must be actively engaged in clinical practice and hold a current medical license issued by the LSBME, thus excluding retired physicians. Dentists may only serve as a collaborating professional with CRNAs for services relative to anesthesia care.
- Scope of Practice. Collaborating physicians and alternates must also be engaged in clinical practice in the same or a practice comparable in scope, specialty or expertise to that of the APRN.
- Contents of the Agreement. The collaborative practice agreement, which must be retained onsite at all times, should include formal statements addressing the parameters of the collaborative practice, which must be mutually agreed upon by all parties. These parameters include but are not limited to:
- the availability of the physician for consultation or referrals,
- the methods of management of the practice including clinical practice guidelines, and
- the coverage of the healthcare needs of the patient during the absence of the APRN or collaborating physician.
- Continuity of Care. Physicians must notify the APRN at least 30 days before the physician’s absence or unavailability. An alternate may step in at this point, provided formal requirements in the rules2 are met. In the event of a collaborating physician’s unpredictable or involuntary absence, special rules3 apply that give some leniency on who can serve as an alternate and for how long.
To comply with the new rules, here are some Risk Management considerations:
- The collaborating physician and APRN should thoroughly review the collaborative practice agreement prior to signing. Everything written should be followed.
- The collaborating physician and APRN should periodically review the clinical practice guidelines as recommendations and practices may change.
- Consultations that occur between the collaborating physician and APRN should be documented.
The LSBME considers violations of these new rules to be unprofessional conduct which may result in formal disciplinary action. For more information on collaborative practice agreements, please contact the LAMMICO Risk Management and Patient Safety Department at 504.841.5211.
 La. Admin. Code tit. 46, pt. 47, Ch. 45 (LSBN Rules) and La. Admin. Code tit. 46, pt. 45, Ch. 79 (LSBME Rules)
 La. Admin. Code tit. 46, §4513.D.1.f.iii.(b)
 La. Admin. Code tit. 46, §4513.D.3