Key Takeaways:
- Collaborative agreements are legally required unless an NP has full-practice authority
In Illinois, most NPs must have a collaborating physician agreement to practice. It directly impacts what NPs can do clinically and prescribe. - Careful review protects an NPs practice and autonomyBefore signing, verify credentials and ensure the agreement clearly defines scope, responsibilities, prescribing authority, and termination terms.
- Not all agreements are compliant or fairMissing terms, expired physician credentials, or one-sided clauses can put an NPs license, finances, and practice at risk, even if the agreement seems straightforward.
You’ve worked hard to become a nurse practitioner (NP), and now it’s time to sign a collaborative physician agreement. You review the agreement, it seems straightforward, and the physician is someone you trust. So, it should be safe to sign right?
Not always. Unfortunately, many NPs unknowingly sign non-compliant agreements, putting themselves at risk for malpractice liability, license suspension, or even having to shut down their practice.
Compliance risks areas for NPs include:
- Whether or not the physician’s license has expired
- If areas of the agreement scapegoats you (favoring the physician)
- Missing processes and descriptions
In this article, you’ll learn about the purpose of a collaborating physician agreement, what it should consist of to ensure NP compliance, and how a licensed healthcare lawyer can make the review process easy, eliminating risks of improper review.
What Is a Collaborating Physician Agreement?
A collaborating physician agreement is a written contract between a physician assistant (PA), NP, or other healthcare professional and a licensed physician.
The agreement outlines specific clinical functions, scope of the collaboration, responsibilities the healthcare professional is permitted to carry out, along with the degree of oversight required from the collaborating physician. A collaborating physician agreement can be with a medical doctor, doctor of osteopathic medicine, podiatric physician, or dentist.
Do Nurse Practitioners Need a Collaborative Physician Agreement in Illinois?
Unless an NP has full practice authority (more on that below), NPs can’t work completely on their own. To make that official, NPs need to sign a collaborating physician agreement.
This agreement is both a legal requirement and a contract. It outlines what the NP is allowed to do, how closely the doctor needs to supervise them, and what responsibilities each person has.
Additionally, it’s required anytime an NP is treating patients, and it directly affects their daily work such as what care they can provide, what medications they can prescribe, and how much legal risk they take on.
What is an APRN and How does the IDPR Regulate its Licensing?
For NPs, a collaborating physician agreement represents a license type within the larger category of advanced practice registered nurses (APRN) licensed in Illinois.
An APRN refers to someone who has met the qualifications for a certified nurse midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist. Each has been licensed by the Illinois Department of Financial and Professional Regulation (IDFPR).
The IDFPR is a state agency that regulates the delivery of professional and financial services in Illinois, including nursing services. Its oversight function of healthcare professions is housed with its Division of Professional Regulation.
When Is a Collaborating Agreement Not Required for Nurse Practitioners in Illinois?
The licensing framework of nurses in Illinois includes subsets of authority. For an NP with full-practice authority, an Illinois collaborative agreement for nurse practitioners is not required to provide advanced practice registered nursing services. Written collaborative agreements are also not required for nurses engaged in clinical practice in a hospital, hospital affiliate, or ambulatory surgical treatment center.
In Illinois, NPs who have obtained the requisite education and training hours may have full-practice authority (“FPA”). Full-practice authority refers to the authority of a licensed advanced practice registered nurse who can offer advanced nursing services without physician oversight or a written collaborative agreement. These NPs are fully accountable to their patients for the quality of care provided. They are also individually responsible for recognizing when the care demands of their patients exceed the training and experience, including the need to seek out collaborative expertise with other health care professionals.
An NP with full-practice authority can prescribe medication to patients, including Schedule II through V controlled substances.
Otherwise, to prescribe controlled substances under a written collaborative agreement, NPs need to obtain a specific license from the IDFPR as a mid-level practitioner.
How NPs Become Eligible for Full-Practice Authority in Illinois
First, NPs must obtain the education and physician-supervised training hours to be considered eligible for full-practice authority.
To qualify for full-practice authority in Illinois NPs must:
- Complete at least 250 hours of continuing education or training in the area of certification.
- Finish at least 4,000 hours of clinical experience after first attaining national certification.
- Submit an application to the IDFPR.
Keep in mind that each accrediting institution’s transition-to-practice programs that offer these hours are different. Also, verify that the training and clinical experience obtained at a particular transition-to-practice program is satisfactory to the IDFPR.
What a Collaborative Physician Agreement in Illinois Should Include Before Signing
A nurse practitioner collaborative physician agreement should be taken as seriously as HIPAA compliance. If a physician has offered you a written nurse practitioner collaborative agreement, there are specific terms that should be included in order to prevent legal exposure, patient harm, and/or audits of your practice by the IDFPR. Additionally, any missing or required elements can result in a lack of clarity between you and your collaborating physician about your services.
Before accepting a nurse practitioner collaborative physician agreement, first verify your collaborating physician’s credentials. If they’re delegating prescribing authority, they must have a valid Illinois controlled substances license and active federal registration to delegate authority to prescribe controlled substances.
Next, ensure that the agreement itself contains the following elements to ensure compliance:
- A description of the relationship between the NP and collaborating physician
- A description of the categories of care, treatment, and procedures the NP will provide
- A definition of the scope of the NP’s practice
- A description of the clinical activities that are authorized
- A description of any restrictions on the authorized clinical activities
- A detailed description of your prescribing authority
- A description of any hospital privileges
- The specific location at which you are obligated to practice
- The required methods of communication with the collaborating physician
- The physician’s expected location when providing supervision
- Whether supervision can take place by phone or virtual means
- The specific NP obligations for confirming if the collaborating physician is in-person or on-site before providing a particular service
- The expected frequency of chart reviews with the collaborating physician
- The expected frequency of supervision contact
- The process for initial patient consultation
- The process for referring patients to other practices
- The obligations for malpractice insurance coverage
- Liability-shifting terms, like indemnification
- The process for terminating the agreement
- The process for giving notice to the collaborating physician that the agreement will be terminated
- The transition plan for affected patients following termination of the collaborating physician relationship.
Keep in mind that the written collaborative agreement for nurse practitioners cannot:
- Restrict the categories of patients within the scope of the NP’s training and experience
- Limit third-party payors or government health programs
- Limit the NP’s geographic area or practice location
Finally, a prescribing authority in the agreement should include the selection of drugs, the ordering process, the administration process, the storage expectations, the use or non-use of samples, and dispensing restrictions. Consider any supplements and non-controlled substances subject to this prescribing authority. You should also provide the IDFPR with a copy of your written nurse practitioner collaborative agreement.
What to Watch For: Terms That Favor the Collaborating Physician
The primary focus of an NP and collaborating physician should always center on the best interests of the patient. However, certain agreement arrangements can put NPs at risk if not carefully reviewed. For example, a collaborating physician may present an agreement that includes provisions that only protect them and push the risk onto the NP.
High-risk provisions may include (but are not limited to):
- The ability for the collaborating physician to terminate the clause unilaterally with little notice
- Stricter limitations on the scope of services the NP can provide, even if those services are permitted under the Illinois Nurse Practice Act without a collaborative agreement
- Fee arrangements that are above what the market would bear
- Indemnity clauses that shift liability to the NP
- Restrictive covenants, including non-solicitations and non-competition clauses
These are just a sampling of some unfavorable provisions you might see in a collaborating physician agreement.
In short, without a collaborative agreement, unless you have full practice authority, you can’t treat patients in private practice. However, the IDFPR allows you to practice for up to 90 days after an agreement ends so long as you secure temporary collaboration (such as through a hospital) and refer cases beyond your scope.
Poorly structured agreements can also limit the patients you’re able to treat. And if you’re paying your collaborating physician more than you pay yourself at your practice, you risk creating financial dependence that can compromise your clinical judgment.
How Jackson LLP Helps NPs with Collaborating Physician Agreements
Collaborating physician agreements are a technical document that, if not reviewed properly, can put NPs at risk or even sanctioned. Jackson LLP provides the support advanced practice providers need before signing a collaborating physician agreement.
- We review your existing or proposed agreement in detail and provide an explanation of each material term in plain language.
- We identify the provisions that expose you to legal risk or fall short of what Illinois law requires.
- We negotiate or redraft provisions to protect your individual interests and those of your practice.
- If you are starting a new practice and do not yet have a collaborating physician relationship in place, we can answer your questions about how you can structure that relationship.
Get started today by booking a free consultation with Jackson LLP. We will provide you with an explanation of what your agreement may be missing.
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Collaborative Agreement for Nurse Practitioners FAQs
Do all nurse practitioners in Illinois need a collaborating physician agreement?
No. NPs with full-practice authority or those working in certain settings, like hospitals, may not need one. However, most NPs in outpatient or independent settings are required to have a written agreement.
What happens if NPs don’t have a collaborative agreement in place?
NPs generally cannot treat patients without a collaborative physician agreement. Illinois allows a short grace period (up to 90 days) after termination of an agreement, but only with temporary collaboration and proper patient referrals.
What should a compliant collaborative agreement include?
It should clearly define an NPs scope of practice, authorized clinical activities, prescribing authority, supervision requirements, communication methods, and processes for referrals, chart reviews, and termination.
What are common red flags to watch for before signing?
Look out for expired physician credentials, one-sided liability clauses, below-market or excessive fees, restrictive non-compete terms, and provisions that give the physician too much control over termination or scope.
