Page 13 - APP Collaboration - Assessing the Risk (Part Two)

SVMIC Advanced Practice Provider Collaboration: Assessing the Risk

between the primary office and separate location, and the

means and availability of continuous direct communication with
the supervising physician. Communication may occur through

the use of technology which may include radio, telephone, fax,
modem, or other telecommunication device.

Medical Record Review

Physicians also have medical record review responsibilities for

the patients being treated by APPs. Most states require only
a random sampling of a small percentage of medical records,

but the statutory minimum should be just that – the minimum.
Many states require all records falling within a set of parameters

(such as when a prescription for a controlled substance is
written or upon patient request, etc.) to be reviewed and the

record countersigned by the physician. Generally, the delegating
physician must document and maintain a record of onsite

observation and a review of medical records on a specified
periodic basis to monitor the quality of care being provided to

the patients.

It is also a risk management best practice to carefully monitor

the APP and consider reviewing most records during the
initial employment period. This may be the best window of

opportunity to discuss and instruct on the method of diagnosis,
ordering, referrals, tracking, follow-up care recommended, as

well as documentation. Ensure the printed record serves as
evidence of, and adequately supports, personal oversight and

review. It is imperative that the physician is aware of any quality
assurance, onsite visit and medical record review requirements

in all states in which there is a collaborative agreement.

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