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Feb 4 2016

Board Meeting Summary: November 2015

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Allied Health
    CPP rule change
    The Board approved changes to the CPP rules, 21 NCAC 32T. The Clinical Pharmacist Practitioner (“CPP”) Joint Subcommittee met in September to discuss amendments to these rules. The joint subcommittee discussed and approved two categories of amendments. The first changes pertain to creating a primary supervising physician model for CPPs similar to what is in place for nurse practitioners and physician assistants. The second set of changes move administration of processing applications and renewals from the Medical Board to the NC Board of Pharmacy.

    2015 PA random compliance review results
    Board investigator Don Pittman provided an annual report on the board’s compliance review of physician assistant. Among physician assistants reviewed in 2015, 66 percent were found in full compliance with applicable laws and rules, 31 percent had minor discrepancies that were corrected by the PA, and 3 percent had discrepancies that were brought to the Board’s attention. During the discussion, the committee Chair inquired about the possibility of performing the compliance reviews by mail. To date, there is no plan to do compliance reviews by mail.

    Appointment of PHP Compliance Committee
    The Executive Committee is responsible for nominating a former Board member to the NC Physicians Health Program Compliance Committee for service from January 1, 2016, until December 31, 2018. The Board voted to appoint former Medical Board member Dr. Karen Gerancher to the NC PHP Compliance Committee.

    Voluntary Licensee Information request added to online renewal
    In 2016, NCMB will launch a public awareness campaign to highlight information found via the Board’s online licensee search. The Committee discussed the best way to increase the quality and quantity of the information provided on the licensee information pages, particularly by increasing the information reported in the voluntary information fields. The Committee discussed concerns about adding additional questions to the license renewal application. The Committee stated that it must be communicated clearly that providing this information is voluntary. It is important to be transparent to the licensees and the public regarding this voluntary information.
    The Board voted to:
      1. Add a page to the license renewal application with questions for the voluntary fields.
      2. Put at the top of the form information that makes it clear to licensees that completion of this portion of the renewal application is voluntary.
      3. Explore adding additional information to the licensee page to alert licensees and the public that the information is audited but that it is a limited audit.
      4. Proactively communicate with licensees and the public the intent behind the voluntary information found on the website.

    USMLE/COMLEX 3 attempt limit retained
    The Board voted to retain its requirement that applicants for licensure demonstrate they have passed each step of the USMLE within three attempts per step (“the 3 attempt limit”).
    The Board decided to retain the rule based on the following:
      1. A plurality of other state medical boards use the 3 attempt rule.
      2. The multistate compact has chosen to use the 3 attempt rule.
      3. A previous Board considered this matter with deliberation and care and instituted the 3 attempt rule.
      4. The current rule was instituted to alleviate multiple problems with a time-based rule.
      5. Increasing the number of USMLE passing attempts does not assure that this would improve the flow of well-qualified physicians to North Carolina.
      6. While it is acknowledged the current 3 attempt rule is not based on hard outcome data, attempts to obtain this information have not proven conclusive. Additionally, other entities that do have resources to analyze the information available have not been able to come to a firm conclusion on what is the best practice.
      7. With very minimal exception the current rule has worked well since it was implemented, and there is no compelling reason to change the current rule.

    Physician supervision of other licensed health care providers
    At the July 2015 Policy Committee meeting, Committee members discussed concerns about: (1) the potential for boundary violations between supervising physicians and their health care supervisees; and (2) the need to clarify the prohibition on supervisees owning a practice and employing their supervising physician. The Committee recommended, and the Board approved, bringing the position statement back to the Committee in September 2015 with proposed language to address both concerns.

    The Committee discussed the proposed language previously submitted to the Committee. The Committee also asked the guests in the audience for their input and Ms. Cathy Fields of the NC Academy of Physician Assistants indicated that they had no further concerns.

    The Board voted to approve the position statement as amended.

    Involuntary departure from hospital-owned practice
    The Board received an inquiry from a licensee regarding a recent termination from a hospital-owned physician network. The licensee felt that the termination was handled in a way that prevented her from following guidelines for patient notification and for safe continuity of care.

    The Committee noted that this particular scenario is likely to occur again in future. The Committee discussed the best way to hold hospital-owned practices accountable for continuity of care. The Board’s Chief Medical Officer mentioned that the American Medical Association has an ethics opinion related to this particular topic and pointed out the proliferation of hospital-owned practices. The Committee also discussed how this issue is intertwined with the corporate practice of medicine.

    The Board voted to take the following steps to address the issue:
      1. Organize roundtable to discuss this particular issue with various stakeholders.
      2. Develop corporate practice of medicine position statement with a section addressing hospital-owned practices.
      3. Refer licensee complaint to the appropriate department.

Upcoming Board Meetings Dates
March 16 - 18, 2016
May 18 - 20, 2016
July 20 - 22, 2016
September 21 - 23, 2016

This is a condensed version of the meeting summary. The full version is available online here.

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