HB 699, a Review and Summary
Q. As a result of the passing of HB 699 in 2006 will I, as a Family Practice Nurse Practitioner, be able to see and treat patients with skin conditions?
A. Absolutely, because you do see patients with dermatology conditions and nothing in HB 699 prohibits you from continuing to do exactly as you are doing now so long as you practice within the protocol between you and your collaborating/supervising physician. The only new requirement in HB 699 that may affect the way that NPs treat skin conditions relates to satellite offices or practices that primarily provide dermatology or skin care services. Such satelite offices must be supervised by a board certified/eligible dermatologist or plastic surgeon.
Q. When is it required for an NP to have a protocol with a Dermatologist or Plastic Surgeon?
A. NPs who own or practice in a Medical Skin Spa and who promote their practice as a dermatology practice will have to have a protocol with a Florida Board Certified/Eligible Dermatologist or Plastic Surgeon. Also if you advertise in any way, such as when your phone is answered, that the practice specializes in Dermatology then you must have a protocol with a Dermatologist or if you advertise in a local paper or phone directory that you offer specialized services in Dermatology or Skin Care then you must have a protocol with a Dermatologist or plastic surgeon.
Q. Why is the specialty of dermatology singled out to have fewer practice sites allowed especially starting in 2011 and why do nurses with expertise in dermatology have to have a protocol with a dermatologist when other clinical specialties do not require a protocol with a physician in the same specialty?
A. The original HB 699 was a proposal of the Florida Association of Dermatologists because of the significant increase in the number of clinics, Skin Spas, and Medical Spas that advertise expertise in dermatology and skin care and treatments. As we fought the original bill we came to realize that there is genuine concern among many Dermatologists and Medical Associations that such clinics or Spas are seen by the public as offering specialized care and services. This phenomenon does not seem to be happening in any other specialized area of practice such as cardiology, orthopedics, endocrinology, etc. As we worked through the bill and the issues with proponents and opponents of the original bill we were able to address the concerns we had about the original bill. In most specialties we were able to demonstrate that NPs also have National Certification in specialty areas but Dermatology is one specialty where there is no National Certification that is offered by a national accrediting body such as ANCC and AANP. Again, remember that acute care, family practice NPs and other specialty NPs take separate boards to become certified just as physicians do.
Q. I work for a cardiology group that includes eight physicians and the group now has seven satellite offices in our surrounding area. Will the group still be able to have these practice sites mostly staffed by NPs and/or PAs?
A. Each physician in the group who is a Cardiologist may have two practice sites in addition to the site he/she lists in their profile as being their primary practice site. Therefore this group can maintain up to sixteen satellite offices assuming each physician is a cardiologist who will have two additional sites.
Q. Does HB 699 give the Board of Medicine authority to promulgate rules that will have a chilling impact on Nurse Practitioners and our ability to practice as we do now?
A. NO, HB 699 clearly states that the bill is self implementing and provides no authority for a regulatory board to promulgate/develop rules to implement the bill.
Q. Does HB 699 require that my supervising physician be “on site” for a percentage of time?
A. No, this was one of the provisions that concerned us very much because the original bill would have allowed the Board of Medicine to unilaterally develop rules that might require “on site” supervision. The original bill actually directed the Board of Medicine to unilaterally develop rules setting standards and criteria for supervision. We believe that this bill actually codified the current rules of the Board of Medicine and Board of Nursing that set the “Standards for Protocols.” These standards are posted here in the ARNP Corner of the FNA Website. Those of you who renew after July 1 2006 will have to submit your signed and dated protocols with your license renewal application. For the first time ever the Board of Nursing will review the protocols to insure that they meet the standards in the current rule. If they do not then you will be notified to amend your protocol and meet the standards or appear before the Board of Nursing. This is why we urge you to review the Standards for Protocols and make sure that the ones you submit with your license renewal meet those standards. The submission of your protocols with your biennial renewal is the only time you will need to send in your protocols except for any time the protocols are amended.Protocols should not be sent to the Board of Medicine, only the Board of Nursing. The physicians will continue to have to file with the Board of Medicine the statement that they supervise ARNPs with the number supervised. HB 699 does require that in any medical practice there must be a sign or notice posted stating when the Physician is in the office but there is no set requirement for physician presence.
Q. Is there a limit on the number of NPs a physician can supervise?
A. No, the only limit is on the number of practice sites a physician can supervise and those limits are as follows:
Family Practice Physicians including OB/GYN physicians may each have four practice sites in addition to his/her primary site listed in the profiling information. The physician can have any number of NPs in each practice location but the times and hours the physician is usually present must be posted.
Specialty physicians such as cardiologists, orthopedists, endocrinologists may each have two practice sites in addition to the site listed in the physician’s profile as their primary practice site. Again any number of NPs may practice at each site.
Dermatologists may have two additional sites until July of 2011 and then the Dermatologists may have only one additional site. For Dermatologists the satellite offices must be within 25 miles of the primary practice site or within 75 miles if it is in a rural area.
Q. Is there anything in HB 699 that will impact my ability to prescribe or see new patients, even those referred for specialty care?
A. Actually HB 699 clarifies that NPs can see patients referred for specialty care so long as the patient is informed of the credentials of the practitioner they will see and agree to it. The bill also requires that the supervising/collaborating physician in a specialty practice must review the consultation report that must be sent to the referring practitioner within 10 working days after the visit. We hope this will result with the NPs being sent consultation reports rather than those reports being sent to the NPs protocol physician. There is nothing in HB 699 that changes in any way your current scope of practice.
We hope that these questions and answers will clarify for you what HB 699 does and how it impacts your practice. We know that it is very likely some “glitches” will probably arise that will need to be addressed in the next session or two. Thankfully legislation is not carved in stone. It is our hope that the fundamental issues and concerns surrounding how physicians supervise NPs will not come up again for many years. We believe that with the Board of Nursing review of protocols to insure that they comply with the current standards a transparency of the relationship between NPs and the physicians they collaborate with will be created for nurses, NP’s physicians, policymakers, insurers, and consumers. Your protocols will be included in the information available for public review in your MQA Profile.
Hopefully this answers some of your questions and concerns about HB 699 and its impact on your practice. Please feel free to contact us for further clarification or for a copy of the Standards for Protocols that are current rules of the Board of Nursing.