The Expanding Utilization of Allied Healthcare Providers - Benefits & Risk

Allied health professionals are essential to healthcare practices of all sizes.  They include but aren’t limited to: Nurse Practitioners, Physician Assistants, Registered Nurses and Certified Registered Nurse Anesthetists. Allieds – also called physician extenders and mid-level practitioners – reach rural, underserved areas in the U.S., lower the cost of care for patients and providers, and support physicians in a variety of ways.  It’s no surprise we are seeing more physician extenders pursue higher education to operate independently and reap these benefits. However, this trend presents a more significant medical professional liability exposure for allieds because they’ve amassed greater responsibility of care to their patients. 

Healthcare organizations and practices should consider the following as they expand the use of mid-level practitioners.  

1.    Limit Sharing – Allieds often share limits with the entity to keep premiums as low as possible.  In a scenario where a Nurse Practitioner (NP) or Certified Registered Nurse Anesthetist (CRNA) permitted to operate independently without physician supervision is found negligent, the Respondeat Superior doctrine (Latin for “let the master answer”) may not apply.  Instead of two separate limits, one for the entity and one for the supervising physician, only one limit would apply to the total cost of the claim. 

2.   Informed Consent – Usually, a patient’s first clinical interaction at any practice is with an allied. Therefore, physician extenders should be well trained in establishing informed consent, especially if they operate independently.  Additionally, the patient should consent to be treated by an allied during the appointment scheduling process.

3.    Referring & Notifying – All allieds are responsible for notifying the attending physician of changes in the patient’s condition, especially if the situation becomes critical.  Independent mid-level practitioners gain the responsibility of referring a patient to the appropriate physician if the condition surpasses their scope of work.  It’s crucial to set clear boundaries for an independent allied’s scope of practice as we see more and more healthcare professionals taking this path.

4.  Vicarious Liability – In many allied malpractice claim scenarios, the supervising physician incurs liability.  The plaintiff names the physician in the lawsuit under the Respondeat Superior doctrine alleging negligence and lack of supervision.  Again, clearly defining the scope of work can reduce this ever-present risk. 

5.    Independent Contractors – When a physician extender contracts with multiple healthcare entities, it’s important to ensure they carry their own medical professional liability coverage instead of relying on one or more of the entities’.  The scope of entity coverage may be written differently in each policy and gaps will ensue if the allied’s activities are outside the scope of coverage.  

As the benefits of expanding the utilization of allied healthcare providers become increasingly attractive, it’s crucial to evaluate the medical professional liability risks.  BKS-Partners’ Healthcare Practice Group helps providers navigate the risk management and insurance landscape to ensure their allied health professionals and entities secure adequate coverage. 

 Contact a BKS-Partners Healthcare Advisor for more information.

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