In Florida, a licensed physician can provide supervision of healthcare providers that are not physicians under certain circumstances. Understanding who a physician can cover and under what circumstances can help protect your license and avoid receiving a complaint by the Florida Department of Health.
In every case, when a physician agrees to supervise another provider, Florida law requires certain documentation and notice to be filed.
A physician entering medical practice in the State of Florida can obtain a State Medical License by either examination or endorsement. However, to qualify for either avenue to licensure, the physician must be at least 21 years of age, be determined by the Florida Board of Medicine (the “Board”) to be of good moral character, and must not have committed any other act or offense that the Board has determined would constitute the basis for discipline here in Florida. Moreover, the physician applicant must have graduated from a qualified medical school and completed residency training. If the physician applicant attended medical school outside of the United States, the physician applicant must demonstrate competency in the English language to the satisfaction of the Board. Finally, the physician applicant must submit fingerprints and submit to a criminal background check. Once this criteria is satisfied, the physician applicant may pursue licensure by either examination or endorsement.
Nearly half of U.S. States have already expanded the scope of nursing practice and several more are analyzing whether it is appropriate. The debate between physicians and nurses regarding how much autonomy a nurse should be given is a political hotbed that will likely be revisited by the legislature in the near future. Until that time, the Board of Medicine and the Board of Nursing will quietly continue to enforce the present requirements. Here’s how they stand today:
Under Florida’s current laws, in addition to the practice of professional nursing, an advanced registered nurse practitioner (“ARNP”) may perform acts of medical diagnosis, treatment and prescription. However, for the most part, such acts must be performed under the general supervision of a physician. The nature of such a supervisory relationship should be identified in a protocol which identifies the medical acts to be performed and the conditions for their performance.
The Florida Board of Medicine reviewed Rule 64B8-9.003, Florida Administrative Code which provides standards for the adequacy of medical records. The underlined portions below are the new standards required for medical records as it relates to compounded medications. These standards are effective September 9, 2013.
via Florida Board of Medicine 6-10-2013 — In accordance with s. 456.44, F.S., a physician licensed under chapter 458, chapter 459, chapter 461, or chapter 466 who prescribes any controlled substance listed in Schedule II, Schedule III, or Schedule IV, as defined in s. 893.03, F.S., for the treatment of chronic nonmalignant pain must designate himself or herself as a controlled substance prescribing practitioner on the physician’s practitioner profile. If the physician does not prescribe controlled substances for the treatment of chronic nonmalignant pain, the “Controlled Substance Prescriber” field will indicate “NO,” but as long as the physician holds a DEA prescribing license, he or she is still authorized to prescribe controlled substances.
The Stark Regs (1) forbid doctors and their immediate family members from referring their patients to businesses they own which provide “designated health services,” and (2) contains a long list of permitted financial relationships between health care providers. The list of what constitutes a “designated health service” (DHS) includes PT, rehab, diagnostic imaging, clinical lab, DME, and home health. A “physician” means an M.D., D.O., chiropractor, podiatrist, optometrist or dentist. An “immediate family member” is a husband or wife; birth or adoptive parent, child, or sibling; stepparent, stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild; and spouse of a grandparent or grandchild. In short, if you or your family member owns a DHS, don’t refer to it. Unless of course your situation falls within one or more of the gazillion exceptions.
A few key changes from the third set of revisions (so called Stark III) which affect physicians are helpful to keep in mind. For instance, the way fair market value of physician compensation is determined in the Stark II regs has been simplified and now depends on an amorphous consideration of the transaction, its location and other factors. The clear formulas contained in Stark II was dropped and this makes the need for an expert FMV study even more compelling.
Florida laws that pertain to telemedicine are precious few. In fact, there is really only one regulation dead on target, and that requires face to face physician contact with a patient in order to write a prescription. The impact of the hormone replacement therapy (HRT) providers was pretty immediate, but the legal issues related to telemedicine are just not currently addressed in Florida law. Does providing a telemedicine consult create a physician patient relationship? What are the requirements related to the medical records arising out of the consult, and who owns the records? These issues and many more are simply not handled. And yet, if it is true that telemedicine will be an important tool in the effort to both broaden the availability of care while reducing associated costs, we can be sure that Florida law will evolve on these issues.
The recently passed House Bill 7095 affects more than just pain management specialists. Practitioners who prescribe controlled substances for individuals with “chronic nonmalignant pain” also are required to comply with new state regulations, including designation “as a controlled substance prescribing practitioner on the physician’s practitioner profile”“with the state Board of Medicine by January 1, 2012. What follows is a bulleted summary of the new regulations.
Prescription s for controlled substances must be either written or electronic. Telephone prescriptions no longer are allowed.
Must have quantity in textual and numerical format
Must be dated with the abbreviated month written out
Must be written on a standardized counterfeit-proof prescription pad produced by a DOH approved vendor
Physicians who prescribe any controlled substance for the treatment of “chronic nonmalignant pain” must designate him or herself as a controlled substance prescribing physician on the physician’s practitioner profile and must comply with statutory requirements and applicable board rules
Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the healthcare industry and its patient and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.