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Navigating a New Era of Health Care

A Guide for Physicians and Physician Assistants

March 10, 2014

As physicians search for new revenue streams in response to declining reimbursement and additional administrative complexity, a new law passed in 2013 should provide added flexibility and time to expand practices through the use of physician assistants. The health care markets continue to realign as the Affordable Care Act is implemented and if all goes as planned, there will be more patients.

More patients require more caretakers.  As leaders of the traditional health care teams, physicians are uniquely positioned to meet this need, and amendments made to the SC Physician Assistant Practice Act in last year’s legislative session could provide additional tools to transform practices in order to handle the new influx of patients.  Here are the top four things physicians need to understand about the new law.


(1) Physicians can supervise more physician assistants.  Physicians are now able to supervise three full-time equivalent PA’s.  The previous limit was two. This increase can be implemented in two ways: employ one more full-time PA or by using  “full-time equivalents.” Under the new law, a physician can employ six half-time PA’s and still be within the bounds of the law.  However, the law does limit supervision to three PA’s at any given time, So, if a physician employs six, only three could be working simultaneously.

(2) Physicians no longer need to be on-site.  Previous law required physicians to be on-site with a PA at least 20 percent of the time. Now, physicians are never required to be on-site.  This new freedom is balanced by requiring physicians, in addition to the standard review and signing of charts, to “verify the adequacy of clinical practice” of ten percent of the off-site PA’s charts monthly.  Exactly how physicians are supposed to “verify the adequacy of clinical practice” was not defined in the statute.  Also, off-site PA’s can be farther away. Previously it was a limited to 45 minutes of travel time.  Now, that’s extended to 60 miles from the physician’s on-site location.

(3) Physician role in PA licensing has been streamlined.  Previous law required the supervising physician to attend an interview with the Board of Medical Examiners during the PA licensing process.  The new law has eliminated this requirement, meaning physicians can hire more PA’s without taking days off for travel.  However, the requirement remains for developing scope of practice guidelines. Those set forth what a PA will be allowed to do and must be approved by the BME.

(4) PA’s now can prescribe Schedule II drugs in limited situations.  It is important for physicians to understand what their PA can and cannot do with Schedule II.  There are separate rules for oral and IV drugs.  For oral Schedule II medications, a PA will be able to write initial prescriptions for no more than a 72 hour supply. Prescriptions beyond a 72-hour supply must involve consultation with a physician, who must also personally examine and evaluate the patient.  For parenteral (IV) Schedule II medications, a PA can order a one-time administration of the drug within a 24-hour period only in hospital settings and only if the physician has already performed an initial patient exam and evaluation.  In certain cases where the physician is unavailable due to clinical demands, the PA may order administration of the IV drug.  But, this only applies in the emergency department and the physician is required to conduct a patient evaluation as soon as practicable.

These new changes will allow physicians to transform their practices.  But, because the law places a priority on safe and high quality patient care, it is imperative that physicians know the limits of their ability to extended supervision responsibilities.

Scott Hultstrand works with physicians, hospitals, and other health care providers to ensure compliance with the increasingly complex state and federal regulations. Prior to joining Nexsen Pruet, he was general counsel and vice president of external affairs for the South Carolina Medical Association.