Collaborative Agreements: Key Considerations for Physicians
Has a PA or APRN approached you about entering a collaborative agreement? Know the risks and responsibilities before you commit. We help you navigate the key factors to make the right decision.
Collaborative agreements are legal contracts between a physician and another provider in which the physician agrees to collaborate. For physicians, collaborative arrangements can offer additional income, expand patients’ access to care, and provide an opportunity to support colleagues.
Typically, providers such as physician assistants/physician associates (PAs) and advanced practice nurses (APRN) must enter collaborative agreements except in cases when the APRN has full practice authority — the legal authority to practice with relative independence. A physician’s scope of practice is always broader, even compared to an advanced practice nurse or PA with full practice authority. As a result, non-physician providers often need to find a collaborating physician.
Elements of Collaborative Agreements
A collaborative agreement is a contract that binds both the physician and the other provider to specific terms. It imposes responsibilities that affect the parties’ licenses, finances, and practice. As with all contracts, it includes a few main types of statements, which set forth the requirements:
Representations – statements of fact, such as confirming that you’re licensed in the state where the practice operates.
Covenants – promises to complete specific actions in the future, such as performing regular chart reviews.
Warranties – assurances or guarantees about the quality or nature of services or actions, such as guaranteeing that the services provided will meet a certain standard of care.
The representations, covenants, and warranties of a collaborative agreement seek to outline a non-physician provider’s scope of practice, as defined in state licensing laws, and allow them to practice within legal boundaries. The content of a collaborative agreement, therefore, is often dictated by state-specific regulations. That is, the state’s law will determine what does (and does not) need to be included in the agreement.
A collaborative agreement may need to specify the services the provider will perform, the medications they may prescribe, the standardized procedures and the emergency procedures to be followed, and, importantly, the level of regular contact between the parties. These elements can be extremely detailed and nuanced, as we discuss further below, and it’s crucial that the collaborative agreement contains all the necessary information to ensure compliance.
If you fail to meet the obligations of a collaborative agreement or misrepresent something, you could breach the contract, leading to legal and financial risks. Always review collaborative agreements (and, indeed, all contracts) carefully to know what you’re agreeing to and the expectations of you going forward.
Additionally, take note of other key provisions, like how and when the parties can terminate the contract and how you will handle disputes. Compensation is another critical area to review, as some states require collaborating physicians to be paid for their work, while others do not.
Consulting with an experienced healthcare attorney can help you navigate the fine print, understand the impact of signing, and determine if you need to change any terms of the contract before moving forward.
Physician Involvement: What’s Required?
States vary as to the level of required involvement for collaborating physicians. Some states give general guidelines, stating that the collaborating physician must be available for consultation and communication. Other states have more specific requirements, such as regular chart reviews by the physician or meetings between the physician and the non-physician provider at stated intervals. Many states also require that advanced practice nurses and PAs working in collaboration adopt standardized operating procedures that the physician reviews before implementation.
Work with your collaborating provider and attorney to understand your state’s rules and determine how the relationship will function. Be sure to include these details in the contract.
Does the Agreement Comply with State Law and Ethics Rules?
The requirements for an appropriate collaborative relationship can vary by state, practice setting, and the type of provider involved. Though collaborative agreements can give PAs and advanced practice nurses more freedom than they might have otherwise, collaborative relationships are still subject to scope of practice boundaries.
States typically require that the delegated tasks or duties be consistent with the delegated provider’s education, training, and experience. For example, a contract with a physician does not allow an advanced practice nurse or PA to perform procedures they’ve never done before.
Moreover, states often require that the delegated task be within the physician’s scope and experience. For instance, if you’re a pediatrician who has never had Botox training or experience, you should check with your state law and medical board before supervising a medspa.
See our related articles, “The Pros and Cons of Medspa Arrangements for Physicians” and “Botox Malpractice: How to Protect Yourself From Liability.”
Practicing outside your scope can be considered unprofessional conduct and prompt an investigation. Don’t do anything you’re uncomfortable or unfamiliar with — it will serve the patients (and your license) well.
Liability: What to Watch For
Becoming a collaborative physician may sound low risk. After all, the advanced practice nurse or PA will deliver the patient care. Depending on your requirements, you might never see a patient directly. However, entering into a collaborative agreement exposes you to some risk, particularly if a patient suffers harm under the PA’s or advanced practice nurse’s care.
Pay special attention to whether the collaborative agreement or any corresponding contract addresses liability or includes indemnification clauses. In addition, examine how much control the contract requires that you hold over the collaborating provider. The more control you have in the relationship, the greater the chance a court or medical board could hold you accountable (including in a malpractice case).
You can also open yourself to liability if you sign too many collaborative agreements. If you’re acting as a collaborating physician for several providers, it can be difficult to show you’re putting in enough effort to meet your requirements and provide adequate collaboration. It’s also a matter of simple probability: as more practices treat more patients, the chances for something to go wrong increase.
See our related video, “What Physicians Should Know Before Entering Collaborative Agreements.”
Is a Collaborative Agreement Right for You?
These are just some factors to consider if someone approaches you to serve as a collaborating physician. Every contract and collaborative relationship will be different — different providers, procedures, and applicable laws.
A healthcare attorney can help you weigh these considerations, determine your requirements, and help you decide as to whether or not a collaborative agreement fits with your priorities. If you operate in one of the states where we practice, consider setting up a phone consultation with an experienced healthcare attorney to discuss your goals.
This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.