Page 5 - Part 2 Collaborating with Advanced Practice Providers - An Overview of State Rules

SVMIC Collaborating with Advanced Practice Providers

PART TWO

Protocols and Collaborative Agreements

Physicians must also enter into a treatment protocol or collaborative

practice agreement (CPA) with APPs (except for a nurse practitioner in

Kentucky who does not prescribe and a nurse practitioner in Virginia
who has practiced for five years full time clinical experience in a patient

care team), both of these exceptions are discussed in greater length

below. States require physicians and APPs to define protocols which are

generally specific to the population seen and outline the standard of

care. Protocols must also include a method of consultation and referral,
prescriptive privileges and medication formulary, plans for coverage of

the healthcare needs of a patient in the emergency absence of the APP,

and any required chart review or co-signature by the physician.

Agreements and protocols must be signed by both the physician and

APP.

Additionally, protocols may also cover the APP’s authority to delegate

duties to other licensed or unlicensed personnel, title transparency and

identification of the providers, how to handle patient requests to see a

physician, a quality assurance plan if required and other mutually

agreed upon practice guidelines. The success of integrating the APP

into the team-based approach to patient care depends on careful
consideration of the APP’s role, selecting the best fit for the practice and

existing team and commitment to invest in the mentoring and guidance

required.

Simply adopting a text or other medical publication is generally not
sufficient to meet the state medical board standard. Keep in mind, the

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