SOPs for Your MSO-Managed Medical Practice: A Key Tool for Compliance

We explain the importance of developing and implementing standard operating procedures (SOPs) for the clinical side of your MSO-managed healthcare practice.

A healthcare professional inserting an IV.

You’ve set up your management services organization (MSO), partnered with a physician-owned practice, executed an MSA, and hired employees. You finally feel like you’re ready to open your doors. Is that everything you need to consider?

Practices, whether physician-managed or MSO-managed, need to be careful about the clinical procedures their employees and contractors perform, ensuring they receive the required level of oversight to comply with state laws and professional regulations.

Understanding the Scope of Clinical Procedures

States often define the practice of medicine broadly. As a result, more procedures may be classified as part of the “practice of medicine” than you think. For instance, aesthetic procedures, like those using Botox or platelets-rich plasma, can constitute the practice of medicine in many places. Treatments that involve IVs are often considered medical, too, whether they involve vitamins and supplements, controlled substances, or anything in between. So, if you’ve hired non-physicians to provide these services, you must understand those professionals’ scopes of practice and how and when they can perform specific tasks.

The scope of practice for nursing, for instance, is often defined in relation to the nurse’s level of experience and supervision. Most nursing practice acts do not give nurses the power to complete medical tasks without instruction and supervision. Even advanced practice nurses may have limits on what they’re allowed to do independently, particularly in states that have not granted nurse practitioners full practice authority.

Physician Supervision

If you’re setting up an MSO-managed practice, the physician might not need to be onsite to oversee every procedure. One state might require the physician to be available for some quantifiable amount of time (e.g., via phone during business hours). Another state might instead require the physician to complete a specific number of monthly chart reviews and concurrences. 

So, if a physician isn’t present during all business hours and a nurse can perform only a limited scope of services, who’s in charge of the day-to-day?

This is where standard operating procedures come in. 

The Critical Role of Standard Operating Procedures

Standard operating procedures (SOPs) function similarly to standing orders in the hospital. SOPs explain:

  • the clinical procedure for each task carried out at the practice
  • the steps the healthcare provider will take to perform the task
  • post-procedure follow-up steps
  • contraindications that would prevent the patient from receiving treatment. 

Standard operating procedures are meant to be used when a patient “qualifies” for the treatment and doesn’t have contraindications. Thus, the patient must receive an initial evaluation to determine whether the SOPs can be used. Note that some states may require a physician to be involved in the initial exam.

When implemented, SOPs can help non-physicians perform medical functions and tasks that would otherwise fall outside of their authority. They also ensure that the overseeing physician and clinical providers are on the same page about how treatments should be provided, helping to ensure that the procedures performed are done safely and uniformly on qualified patients. In an MSO-managed environment, SOPs help the clinical side of the business run smoothly and effectively in conjunction with the management team.

Addressing the Risks: Why SOPs Matter

If you manage a practice where nurses perform procedures they have the experience and training to do, and your patient population is relatively healthy, you might think SOPs aren’t a big deal. 

But there’s always the potential for something to go wrong, even with the most competent staff. Say a patient has an adverse reaction and needs emergency care, or a patient has a bad experience and files a complaint with the board. Investigators will likely examine whether your clinical providers had SOPs in place and followed the SOPs when treating patients.

To make things even more complicated, this area of healthcare compliance is highly state-specific and can change frequently. What’s allowed in Illinois with respect to provider authority, documentation, and physician oversight differs from that of California or Texas. It can be hard to keep up with which rules apply to your practice, especially if you employ professionals with varied licenses (e.g., MD, NP, PA, and RN).

Moreover, state regulators and professional boards often pay special attention to MSO-managed practices to ensure they’re not engaged in the unlicensed practice of medicine. The absence of SOPs can quickly put the practice in hot water, jeopardizing your providers’ licenses and your ability to manage a practice. 

Get Legal Support

Whether you’re a management company starting up an MSO-managed practice or a medical director looking to limit your liability, SOPs are another tool to help start the business on a more compliant footing. While the nature of SOPs is clinical, having an attorney draft or review your SOPs can ensure the necessary elements are consistent and compliant with state law.

Jackson LLP handles many aspects of MSO arrangements for independent private practices that operate in any of the states where we are licensed. To learn how we can help you succeed in managing your practice, schedule a free consultation with one of our attorneys.

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. This blog should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

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