CRNP Collaborative Agreement Informational Meeting
Written by Legislative Consultant, Bruce Hironimus

January 26, 2018

The Pennsylvania House of Representatives, Professional Licensure Committee held an informational meeting on collaborative agreements between certified nurse practitioners (CRNP) and physicians. Anthony DiMarco, DO, immediate past president of POMA, was one of two physicians on the panel. Seventeen legislators of the 25 committee members were in attendance.

Chairman Mark Mustio (R-44) made a clear point that this is not a hearing on any specific legislation, rather a time to educate the committee on the definition of a collaborative agreement, its purpose and functions, and what required guidelines and authority it grants CRNPs relative to patient care.

After a brief history on collaborative agreements, the committee’s questions focused on how the form is comHow Are You DOing? pleted, with a focus on the required amount of physician supervision and chart review. Each CRNP requires at least one main physician and an alternate on any collaborative agreement. Dr. DiMarco clearly pointed out, with support from all the other panelists, that each agreement is set on a case by case basis. Each agreement is different based on the CRNP involved. No legal requirement or state law exists on the number of charts the collaborating physician is required to review. Additionally, there is no required timetable in which to complete the review. The majority of collaborative agreements use the language “as needed.”

The committee angled questioning toward the existence of a governing body or central repository for all the collaborative agreements signed by CRNPs in the state. No such entity is in place, nor is there set language for the agreements.

Ms. Bock, Ms. Caruso, and Ms. Fattibene answered several questions about how often the physician on the agreement actually interacts with the patient or whether the physician is even on premises during the patient encounter, specifically in regards to the retail and independent clinics. There is no legal requirement for the physician to be on site.

Dr. DiMarco mentioned that with the advances in technology and telemedicine, it is now easier to review charts and information than when collaborative agreements began.

The committee attempted to ask questions on malpractice insurance, liability, case examples, patient care, cost and billing but Chairman Mustio refocused the questioning. These lines of question are designed for a hearing not an informational session. The committee has no plans for consideration of the associated legislation at this time.

A transcript of the session will be made available in the future by the Professional Licensure Committee. When available it can be found here.