In Pennsylvania, Certified Registered Nurse Practitioners (CRNPs) do not have independence of practice. They may provide diagnoses and prescribe treatments only in collaboration with a physician, as per the details of their Collaborative Agreement. If the CRNP has prescriptive authority, then the Collaborative Agreement is prepared through PALS and filed with the Commonwealth.
Collaboration requires the immediate remote or in-person availability of a physician while the CRNP is providing services, a plan between the two providers for handling emergencies and regular coordination between the two providers regarding referrals and standards of medical practice (e.g., consultation and chart review, relevant drug and other medical protocols and cosigning records when necessary).
But nothing about the collaboration requires the CRNP to be employed by, or work directly with, the collaborating physician. So, the question is: once a prescriptive authority Collaborative Agreement is in place and filed with the Commonwealth, can a CRNP own and operate their own medical practice? To answer this question, one must initially look to the Board of Nursing law and regulations, the Board of Medicine (or Osteopathic Medicine, as the case may be) law and regulations and, critically, Title 15 governing corporations and other business entities (i.e., for our purposes, professional corporations and restricted limited liability companies).
These laws and regulations, including their practical implementation, present certain roadblocks to the possibility of CRNPs owning their own practice. For example, the list of restricted professional services that a Pennsylvania restricted professional limited liability company may provide notably does not include the practice of nursing. The Board of Medicine regulations likewise include language that may cast doubt on the ability of a CRNP to own a medical practice in certain circumstances. This is not to mention contracting questions, such as if and how the collaborating physician will get paid for time spent collaborating.
That said, while these laws and regulations do not expressly permit a CRNP to own and operate their own medical practice, they do leave open enough room for a CRNP to do so. Once set up, the CRNP can then address the hurdles presented by commercial and governmental payors, but that is outside the scope of this post.
