I live in a town of 100,000, in west texas. I have recently opened my own practice.  Our BIG local community hospital has their own insurance, they also manage claims for 10 other local companies with a large number of employees.  So  the provider just applies to this one company, they ccrediental you and you have priviledges with all the insurances. The problem is that the board that decides who is admitted is made up of local Physicains, they allow NPs and PAs that work for physicians to become members, but states that they think it is illegal for me to own my own practice, and since we are not a remote area, they don't need Np's. I have a collaboratiing MD, they interpret our BNE statement of alternate site to mean that the MD must own it? Have you heard of this? 

basinfamilycare,

 

I am by no means an expert on this issue, but it is my understanding that you can own your practice and employ a physician collaborator as long as the BNE requirements of oversight, collaboration, chart review and co-signing, Dr. availability by phone, and physican presence in the practice every 10 days ( I think it is 10 days) are met. I am new at this and I am just graduating, but I have read and re-read those by-laws/ rules and there is no statement that the physician must own the alternative site.

Just an opinion

 

Brian

They may be confusing NPs with PAs ( I don't know what their regulations are). I am self-employed, own my practice, and share office and expenses with my collaborating physician in the Houston area. As I interpret regulations,you must have some sort of oversight by delegating physician. This is accomplished by direct supervision as in office or if not in office, chart reviews with a log of reviewed charts and consultations. It makes it a little difficult to be independent.

The physician's need you to educate them and, in my opinion, they could face liability if they wrongfully restrict your right to practice.

MESSAGE BY: elderexpert

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They may be confusing NPs with PAs ( I don't know what their regulations are). I am self-employed, own my practice, and share office and expenses with my collaborating physician in the Houston area. As I interpret regulations,you must have some sort of oversight by delegating physician. This is accomplished by direct supervision as in office or if not in office, chart reviews with a log of reviewed charts and consultations. It makes it a little difficult to be independent.

The physician's need you to educate them and, in my opinion, they could face liability if they wrongfully restrict your right to practice.

REPLY FROM: HYATTEVE

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I am from the Houston area also, and started my own practice.
Don't kid yourself....hospitals can and do implement NP practice constraints that are not in line with state board NP practice regs and their charter by-laws allow them to do so without penalty.
I am now in Portland, Oregon where NP's may practice independently, because I got tired of the frustrations.
I consider my experience in the south certainly useful from a business management standpoint, but until practice parameters are equal across state lines, I can make more money as a grunt, than a practice-owner.

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Eve Hyatt, ANP

I have just read your post and the reply post. The doctor must be on site every 10 days to review charts. And you must be able contact the doctor as needed by phone or other means.

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Diane Keahey, MS, APRN-BC, FNP

Yes, it is legal. In TX one does not have to be a doctor to register a professional corporation. As long as you have the collaborative doc who complies with 20/10% rule, you (and he/she) should be find. From my experience in Houston, getting a reliable doc is expensive, at least 10% of your collected. Not worth the trouble.

Yes, you could sue the hospital but you will probably lose. I agree with the last person who moved to Oregon: TX is one of the worst places for NPs to practice (Maryland is worse). I worked in CA, CO, AZ and other states. 11 States + DC have no collaboration. My advice? Get out of TX and become .... FREE.

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The Power of Touch

It totally depends on state laws. In Oregon, we need no physician relationship unless we want to provide certain services within our practice. We have an NP practice (Three NPS), and we only contract specific needs with MDs as necessary. You need to look at your individual state regs.

Sorry to be late to this question, but you may want to check with the Texas NP group, http://www.texasnp.org/

 

 

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Barbara C. Phillips, NP
www.NPInterviews.com
www.NPBusiness.ORG

My suggestions - only suggestions and not to be construed as legal advice - no attorney-client relationship of any sort is created here:

1) Make application - again maybe? - in writing to this master "Board". Send it with return receipt and save copy

2) Request - in writing with return receipt and save copy - that these folks put their denial of your application to you in writing.

3) Suggest to them - in writing with a return receipt and save copy - that they are engaging in an illegal restraint of trade and request that they reconsider their denial and notify you, in writing, within 10 business days of their decision. Ask, in wiriting and politely, for  1) the identity of the attorney who has rendered this legal opinion to them or 2) the name of the physician who came up with this excuse and which law school he graduated from, and the date of graduation from said law school (certainly these good folks aren't practicing law without a license).  Also send this letter with a return receipt and copy it (note in the letter that you have copied it) to the Texas Office of the Attorney General and the Texas State Board of Insurance ( addresses in blue pages of phone book or call info for Texas state government)

4)  Educate your patients, as consumers of health care in the state of Texas, to the fact that they are being denied the benefits of your care and you believe that to be due solely to the circumstances as you have described them  -  so that they may also write to their carrier and request that you be added to the insurance lists - let them know they may copy their letters to the State Insurance Board and Attorney General under consumer complaints and that they are free to so note to their carriers.

5)  Ask these doctors, in writing, to define for you  "own your own practice". Do they mean that all patients you see must be a physician's patients?  Do they mean a doctor must be on the premises lease ?  Do they mean a physician must own the real property and equipment ?  So can a physician's wife also own the "practice" ? So, is it that a non-MD wife can own a practice but not a NP ?  Ask them if you incorporate will they then put you on the panels ?  Ask them to, please, point out to you which part of the NPA their lawyer is of the opinion mandates that all practice sites be "owned" by an M.D.  Are they requiring that 100% be physician owned - or are they allowing for community property ownership ? 

5)  Do the same process  - applying and getting everything in writing - with each insurnce carriers individually - in addition to making the common application to this local "Board" of docs who appear to be practicing law without a license.

6)  Apply for and obtain inclusion in Texas medicaid + federal medicare programs. These should not go through your local good old boys club. But if they have a say about these also - file a complaint - in writing, RRR, nad save copy - with the US Federal Government Dept. of Health + Human Services and the State of Texas Dept, of Helath + Human Services.  

 7) When you have all of this in writing, contact me and we'll see if I can refer you to an attorney who may be willing to deal with this as a class action legal issue - or we might request an opinion from the Texas Attorney General, depending on the elections out come.  You might also do some work to find out which legislators are sympathetic to NP practice - state APN association may be able to help with this.

8)  As for the on-site supervision - there is a provision in the NPA which no physician has yet used - allows for them to claim a hardship is created by having to supervise on site - so even that is not absolutely necessary. However, what MD wants to rock the boat when his buddies are racking in big bucks for "supervising"  want-a-be doctors.

9)  Consider that the NPA allows us to provide services to poor patients with less supervision that we are required to have in order to provide the same care to rich patients in private practice offices.  Obviously, the BNE + BME is of the opinion that rich folks here deserve better care than our indigent, medically underserved or this "collaborative practice" joke must be simply about money.    

10)  Consider relocating to one of the 11 states that has either  1) a less financially obsessed medical association lobby or 2) a more educated electorate than Texas (my home state which I love but too old to wait around for it to change).

Best of wishes.

   

Hi,

    Here is an tip to improve your hospital:

        If you educate your patients,then it  benefits of your care and you believe that to be due solely to the circumstances as you have obey them and  request that they added to the insurance lists - by this they may copy their letters to the State Insurance Board and Attorney General under consumer complaints and that they are free to, so identify to their carriers.

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jelinda16

Addiction Recovery Alabama 

Addiction Recovery Alabama

 

I also live in Texas - in Austin. I would love to have my own practice but I can't find a doctor to collaborate with. They think it too much of a liability. Even when I explain I'm working under my own license - they don't believe it. There is legislation right now to end collaboration and supervision in TX - pray that it passes. But Texas is always one of the last ones to go - so I'm not holding my breath. A good resourse for you would be CNAP as well as the TNP Association. CNAP lobbies for us and they are awesome. They are in Austin. Here is their contact information.

E-Mail	CNAP Public Policy Director Lynda Woobert
Telephone	Lynda Woolbert, CNAP Public Policy Director 979-345-5974 office 512-750-3747 mobile 979-345-3496 fax
Mail	Lynda Woolbert CNAP Public Policy Director 2229 River Valley Drive West Columbia, TX 77486-9640 OR CNAP P.O. Box 5047 Austin, Texas 78763