As telehealth and mobile healthcare services continue to expand, more practices and health tech businesses are becoming multistate operations. While this presents substantial opportunities for growth and removes healthcare access barriers, it also introduces complexities related to licensure, scope of practice variations and increased liability risks.
The good news is that many states are also recognizing this trend by making it easier for advanced practice providers (APPs) to practice in multiple states. “States recognize that collaborative agreements are often unnecessary, costly and restrict nurse practitioners who are trained to practice independently,” says Gigi Acevedo-Parker, a nurse practitioner and licensed attorney who is the national clinical risk management leader in the risk services division of HUB International.
Acevedo-Parker, who is licensed in multiple states, explains the challenges and risks associated with multistate practices that employ APPs.
Shifting toward more independent practice
A significant trend shaping multistate practice opportunities is a shift toward more independent practice for nurse practitioners. Currently, 28 states allow nurse practitioners (NPs) to practice independently, with more states reconsidering restrictive collaborative agreements.
Click here to see a map of full practice, reduced practice and restricted practice states.
Physician associates (PAs) are required in all states to practice in collaboration with a physician, but the level of supervision varies from state to state. States have also modified their approach to PA regulation in response to healthcare needs and evidence of the high-quality care of PAs.
Click here to see a map of state-by-state PA practice categories.
“The need in the healthcare industry is great, so expect to see the practice authority trend continue to expand,” says Acevedo-Parker.
Understanding the interstate licensing compact
Many practices take advantage of the interstate licensing compact, which allows NPs to hold licenses in multiple states that participate in the compact simultaneously. However, Acevedo-Parker cautions that having a compact license doesn’t automatically simplify regulatory compliance.
The compact licenses are convenient, but practitioners still need to understand the specific practice nuances in each state to stay compliant, says Acevedo-Parker. “Compact licensure grants the right to practice, but compliance with individual state regulations remains the practitioner’s responsibility.”
How to avoid common risks of multistate practice
The expanding shift toward multistate practice increases both opportunities and liability risks. Staying compliant in all states where APPs practice is a tedious but necessary requirement for managing multistate licensure.
The following are costly mistakes some practices make in multistate businesses:
- Assuming uniformity: Practice rules in one state can vary significantly from those in another. Research closely before expanding your business to a new state.
- Lack of regular compliance audits: Conduct audits to ensure continued compliance at least once a year because states frequently change their rules.
- Misunderstanding telehealth restrictions: Each state has different compliance requirements for telehealth. Not only must providers be licensed in the patient’s state, but they must also be familiar with each state’s specific requirements for virtual care.
This all may seem obvious, but it can get complicated. For example, if a patient travels out of state for work, any appointments during that period may be out of compliance. Prescribing medication across state lines can be problematic if the patient travels or relocates. “Patients frequently cross state borders, complicating compliance and potentially creating legal challenges,” says Acevedo-Parker.
Mitigating common risks
Besides proactively staying compliant in multiple states, knowing the top healthcare liability risks helps mitigate them.
“Misdiagnosis and delayed diagnosis continue to be the most significant claims against NPs,” says Acevedo-Parker.
In both cases, best practices in clinical care can help reduce risks. Thorough documentation is critical in case a claim does arise.
Related read: PA’s documentation checklist to mitigate risks
Strategies for ensuring multistate compliance
Practices should proactively manage the complexities of multistate practice. What you don’t want to do is depend on busy providers to remain compliant without support and oversight. “Companies should never rely solely on practitioners to self-report compliance,” says Acevedo-Parker.
Instead, Acevedo-Parker recommends the following:
- Maintain clear policies: Regularly update internal protocols and educate providers about state-specific practice guidelines.
- Engage experts: Legal counsel and your insurance carrier can help you stay up to date on state regulations.
- Consider using compliance monitoring tools: Technology solutions can streamline license monitoring, renewal processes and state-specific compliance checks.
- Ensure comprehensive coverage: Coverage must account for varying state-mandated minimum limits and specific telehealth risks. Let your insurance carrier know if you expand to a new state.
“A reliable insurance carrier understands multistate challenges and can guide practices seamlessly, while significantly reducing stress and financial exposure,” says Acevedo-Parker.
Navigating multistate practice complexities can be challenging, but proactive strategies and liability protection enable healthcare businesses to expand and support more patients.
Gigi Acevedo-Parker, EJD, MSN, NP, APN, RN, PMHNCNS-BC, HCRM, CPS, is HUB’s National Clinical Risk Management Leader, Risk Services Healthcare Vertical Lead, Risk Services Division and an advanced practice nurse with a clinical specialty in psychiatry/behavioral health.
Learn more about CM&F Group’s professional liability insurance.
