New AG Opinion on Medical Practice Ownership

The Tennessee Attorney General’s Office has just released on opinion on the issue of the ability of non-physician health care professionals to own and operate a medical practice and to employee physicians.  Here are the two specific issues addressed:

"1. Considering the provisions of Tenn. Code Ann. §§ 63-6-204(b), 68-11-205(a), or any other law of this state, is it lawful for a certified nurse practitioner, registered nurse, advanced practice nurse, licensed practical nurse or physician assistant to own and operate a professional practice wherein medical services are provided?
2. Considering the provisions of Tenn. Code Ann. § 63-6-204(c) or any other law of this state, is it lawful for a physician to be an employee of, or an independent contractor to, a certified nurse practitioner, registered nurse, advanced practice nurse, licensed practical nurse or physician assistant for the sole purpose of providing the supervision, responsibility and control required by Tenn. Code Ann. § 63-6-204(b) for medical services being provided by those licensed allied health care providers at their practice sites? For purposes of this question, we assume that the physician, if he or she actively practices clinical medicine at all, does so primarily (if not exclusively) at some office or location other than at the referenced practice sites."

And here is the summary of the answers to those questions:

"1. It is not lawful for a certified nurse practitioner, registered nurse, advanced practice nurse, licensed practical nurse or physician assistant to own and operate a professional corporation or professional limited liability company (“PLLC”) for the provision of medical services.1 However, it is lawful for a physician assistant to form and own shares in a Medical Professional Corporation, but only in combination with licensed physician(s) or licensed osteopathic physician(s), except radiologists, pathologists, and anesthesiologists, under Tenn. Code Ann. § 48-101-610(d)(4), and/or in combination with physician entities as described in Tenn. Comp. R. & Regs. 0880-2-.20(1)(b). Further, it is lawful for a physician assistant to be a member of, or holder of financial rights in, a Medical Professional Limited Liability Company, but only in combination with licensed physician(s) or licensed osteopathic physician(s), except radiologists, pathologists and anesthesiologists, under Tenn. Code Ann. § 48-249-1109(e)(1)(D), and/or in combination with  physician entities as described in Tenn. Comp. R. & Regs. 0880-2-.20(2)(b). Otherwise, insofar as our research has revealed no specific statutory prohibition against it, we anticipate that there could be certain circumstances in which a nurse practitioner, advanced practice nurse or physician assistant legitimately might own and operate a practice wherein medical services are provided, so long as such services are provided under the “supervision, control and responsibility” of a licensed physician, as is required by Tenn. Code Ann. § 63-6-204(b).

2. It is not lawful for a physician to be an employee of a certified nurse practitioner, registered nurse, advanced practice nurse, licensed practical nurse or physician assistant for the sole purpose of providing the supervision, responsibility and control required by Tenn. Code Ann. § 63-
6-204(b) for medical services provided by such a licensed allied health care provider. However, a physician in active clinical practice lawfully may enter into an independent contractor arrangement
with a certified nurse practitioner, advanced practice nurse or physician assistant for the sole purpose of providing the supervision, responsibility and control required by Tenn. Code Ann. § 63-6-204(b), and other applicable statutes or rules, for the provision of medical services by such licensed allied health care provider at a remote practice site. Nevertheless, a licensed physician may not contract independently with a licensed practical nurse or registered nurse (who is not, in addition, a certified nurse practitioner or advanced practice nurse) for such purpose."

Read the entire opinion here.