Historically, privileges to admit patients to Idaho hospitals and healthcare facilities were reserved only to physicians, thus creating a limitation for physician assistants and nurse practitioners who were not permitted to admit their patients when necessary for their care. This limitation has become outdated and burdensome due to the expanding roles of physician assistants and nurse practitioners in health care in Idaho. The licensure of these midlevel practitioners allows them to perform services traditionally performed by physicians, and in some rural areas of the state they are the main source of access to health care for Idaho residents, yet the limitation has negatively impacted their ability to provide comprehensive care to their patients.
In July 2017, the Idaho legislature responded to these issues by enacting a law which allows these mid level practitioners to admit patients. Idaho Code § 39-1396 stipulates that a hospital or healthcare facility may give admitting privileges to doctors, advanced practice nurses, or physician assistants under the following conditions: 1) those privileges are recommended by the facility’s medical staff; 2) those privileges have met with approval by the facility’s governing body; and 3) those privileges fall under the admitting practitioner’s scope of practice.
The new law, however, is not a broad grant of unchecked power to physicians and mid level practitioners. The law requires the hospital or facility to specify in its bylaws the process by which its governing body and medical staff oversee those practitioners granted admitting privileges. The law further clarifies that such oversight must include, but is not limited to, credentialing and competency review. In addition, Idaho law still requires that a member of the medical staff have responsibility for the overall care of a patient while in the hospital and hospital licensing regulations require that hospital bylaws specify that every patient be under the care of a physician licensed by the Idaho State Board of Medicine.
Mid level practitioners and health care facilities should take into special consideration subpart 1(a) of the new law, which requires that the medical staff of the facility recommend admitting privileges. The law gives much power to the medical staff to control or curtail the expansion of clinicians with admitting privileges. The question arises, will the medical staff withhold recommendation of these midlevel practitioners (perhaps in an effort to defend its territory)? Time will tell whether this problem will surface in Idaho hospitals.
In response to the new law, Idaho hospitals and healthcare facilities should review and update their bylaws to identify which types of clinicians are eligible for admitting privileges and specify processes for physician oversight in compliance with state law and other applicable regulations.