As we highlighted here, on March 26, 2021, Governor Evers signed Assembly Bill 125 into law as Wisconsin Act 23 (“Act 23”) significantly updating the laws related to the licensure, regulation and the practice of physician assistants (“PAs”) in Wisconsin. The change is intended to improve access to quality medical services for Wisconsin patients by reducing barriers for PAs to provide services. While the updated laws do not create an independent practice for PAs they do, among other things, change the physician/PA relationship from supervision to collaboration and eliminate the one physician to four PAs ratio requirement. A new Subchapter VIII, Physician Assistant Affiliated Credentialing Board, found in chapter 448 of the Wisconsin Statutes is also created by Act 23 for the regulations that govern the practice of PAs.
Act 23 is set to take effect on April 1, 2022 as the current guidance, found in Chapter Med 8, is repealed. The regulations setting forth specifics for PA collaboration were published Monday, March 28, 2022 and can be found here.
Given the change from supervision to collaboration, there are a number of updates that can be made to organizational documents so that the documents are consistent with the revised standards and do not create additional liability:
- Supervisory Agreements between PAs and their supervising physicians can be terminated. They may be replaced by collaboration agreements, or an employer of PAs may choose to forego the written agreement so long as there is evidence that a physician is primarily responsible for the overall direction and management of the PA’s professional activities and for assuring that the services provided by the PA are medically appropriate.
- Medical staff bylaws, rules and regulations, policy and credentialing forms should be reviewed and can be revised so that physician supervision is no longer required, and new collaboration requirements are met as applicable. Remember that the individual PA’s clinical privileges (and any FPPE, OPPE or other conditions of privileges) should be based upon that individual’s experience, education and training.
- Hospital policies should be reviewed and can be revised so that references to the supervision of PAs can be removed.
- PA employment agreements that require supervision should be reviewed and may be amended, as applicable.
- Physician employment agreements that require the provision of supervision of one or more PAs should be reviewed and amended, if applicable. In addition, organizations should consider if physician compensation plans (or any stipend payments for supervision) should be modified.
Additional considerations include:
- Payor coverage and payment requirements for PAs continue to change allowing them to provide and get paid for more services. Providers should review the recent changes to the Medicare coverage rules for PAs. Additionally, coverage and billing rules for Medicaid and private payors should be reviewed. Specifically, providers should review Wisconsin Medicaid coverage and payment requirements because those rules do not incorporate these changes and require physician orders and supervision for several services.
- Does your professional liability carrier need to know of this change?
- Nothing in Act 23 prohibits PA supervision as, for example, a condition of employment (temporary or otherwise). However, continuing to document a requirement of supervision while allowing staff to conduct their practice under the new collaboration standards, creates a risk of negligent supervision.
For additional information or assistance, please contact:
- Robin Sheridan at rsheridan@wp.hallrender.com or at 414-721-0469;
- Lori Wink at lwink@wp.hallrender.com or at 414-721-0456;
- Jenny Kumosz at jkumosz@wp.hallrender.com or at 414-721-0931;
- Your primary Hall Render attorney.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer an individual’s questions that may constitute legal advice.
